November 11th, 2014
Balanitis refers to an inflammation of the head of the penis (or glans). Inflammation of the under-surface of the foreskin is technically called ‘posthitis’ but the term is rarely used today and balanitis has come to mean inflammation of either glans penis or foreskin or both.
Many factors contribute to balanitis. These include: extra long foreskin, foreskin which cannot be retracted behind the head of the penis (phimosis), poor hygeine, venereal diseases, trauma, incontinence and diabetes mellitus.
While balanitis can be caused by almost any irritant, chemical or bacterial, the most common source of balanitis is a yeast called candida albicans. Diabetics are particularly prone to candida infections and frequently the first symptom or presentation of diabetes is a case of balanitis.
With most cases of balanitis, the foreskin is red, painful, swollen and often weeping. In cases that do not respond to standard treatment, culture of the skin is indicated to see what bacteria or yeast might be present.
One must always be aware that cancer of the penis may rarely present with redness, swelling and pain. Normally, cancers are not painful and are well demarcated. A variant of pre-cancer called ‘Erythroplasia of Queyrat‘ shows bright red, well demarcated painless lesions on the head of the penis. A biopsy must be taken if cancer is suspected.
Keeping the foreskin dry is important. The warm dark moisture of the undersurface of the foreskin is a wonderful place for bacteria and yeast to grow. You must dry the head of the penis and undersurface of the foreskin area frequently. Try washing area with clear water, then pat dry gently. Then dry the area thoroughly with a hand-held hair dryer using a warm (not HOT) setting. Repeating this maneuver as often as possible during the day. If you cannot withdraw the foreskin easily because of pain, DO NOT WITHDRAW THE FORESKIN BEHIND THE HEAD OF THE PENIS AND LEAVE IT WITHDRAWN.
A prescription for a cream with a small amount of anti-fungals can be helpful. Usually we use Nystatin or Miconozole creams or ointments. In more severe cases we might add a steroid with antibiotic such as Mycolog cream or ointment. It is to be used very, very sparingly over the areas of redness and is to be applied after thorough drying. The drugs cannot be used indefinitely and if no improvement occurs within a few days let us know. In any event, you should not use the drugs constantly for more than a week. Intermittent use, when needed, is OK. In severe cases, oral antifungal medication are necessary such as diflucan or broad spectrum antibiotics for bacterial infections. Again, if the inflammation does not respond, biopsy may be needed to ensure that cancer of the penis is not present.
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