Balanitis

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Steven C. Campbell, M.D., Ph.D.

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Overview

Balanitis is inflammation of the glans penis (from Greek: βάλανος balanos "acorn"). When the foreskin (or prepuce) is also affected, it is termed balanoposthitis.

Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema.

Etiology and epidemiology

Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus — each of which require a particular treatment (Edwards, 1996).

Prevalence

Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk "in any individual, uncircumcised boy appears to be no greater than 4%." (Escala, 1989). Øster reported no balanitis in 9545 observations of uncircumcised Danish boys (Oster, 1968). Balanitis in boys still in nappies must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis (Simpson, 1998).

While any man can develop balanitis, the condition is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.

Circumcision

Some studies indicate balanitis to be more common in uncircumcised boys (Fergusson, 1988; Herzog, 1986; Fakjian, 1990; Leber, 2005; Waskett, 2005), but Van Howe found balanitis only in circumcised boys (Van Howe, 1997). Van Howe's study has been criticised for the fact that few boys were uncircumcised (Waskett, 2005).

Genital washing

Many studies of balanitis do not examine the subjects' genital washing habits. However, O'Farrell et al. report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers (O'Farrell, 2005). Birley et al., however, found that excessive genital washing with soap may be a strong contributing factor to balanitis (Birley, 1993).

Diagnosis

Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathologic examination of a biopsy (Edwards, 1996).

Complications

Balanitis may cause oedema (Chow), resulting in phimosis, or inability to retract the foreskin from the glans penis. Adherence of the foreskin to the inflamed and edematous glans penis is the cause (Leber, 2005; Chow; Edwards, 1996).

Zoon's balanitis

Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis (Keogh, 2005) for which circumcision is often the preferred treatment (Pellice, 1999; Buechner, 2002; Keogh, 2005). Zoon's balanitis has been successfully treated with the carbon dioxide laser (Baldwin, 1989) and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser (Albertini, 2002). Another study, by Retamar and colleagues, found that 40 percent of those treated with CO₂ laser relapsed (Retamar, 2003).

Circinate balanitis

Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with Reiter's syndrome.

External links

• Balanitis - InteliHealth
• Zoon's Balanitis - InteliHealth
• Edwards S. (for the Clinical Effectiveness Group) National guideline on the management of balanitis. Association for Genitourinary Medicine (UK) and the Medical Society for the Study of Venereal Diseases (UK), 2001.

Images of balanitis

• STD services
• Dermatological atlas

See also

• Penis
• Glans penis
• Foreskin
• Inflammation
• Circumcision
• Balanitis xerotica obliterans

References

1. Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med 1996;72(3):155-9
2. Leber M. Balanitis. (online). eMedicine.com. Cited 20 Aug 2005
3. Chow KW. Balanitis and other genital conditions. In: Social Hygiene Handbook. Hong Kong.
4. Escala JM, Rickwood AMK. Balanitis. Brit J Urol 1989;63:196-7
5. Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish Schoolboys. Arch Dis Child 1968;43:200-3
6. Simpson ET, Barraclough P. The management of the paediatric foreskin. Aust Fam Physician 1998;27(5):381-3
7. Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988;81(4):537-41
8. Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child 1986; 140: 254-256
9. Fakjian N, Hunter S, Cole GW, Miller J. An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 1990 Aug;126(8):1046-7.
10. Waskett JH. Balanitis and the uncircumcised male. Pediatrics. P3R Response (12 Jun 2005)
11. Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Brit J Urol 1997;80:776-782
12. Birley HDL, Luzzi GA, Bell R. Clinical features and management of recurrent balanitis: association with atopy and genital washing. Genitourin Med 1993;69(5):400-3
13. Pellice i Vilalta C, Casalots i Casado J, Cosme i Jimenez MA. Zoon's balanoposthitis. A preliminary note. Arch Esp Urol 1999 Jan-Feb;52(1):69-72
14. Buechner SA. Common skin disorders of the penis. BJU Int 2002 Sep;90(5):498-506.
15. Keogh G. Balanitis circumscripta plasmacellularis. (online). eMedicine.com. Cited 20 Aug 2005
16. Baldwin HE, Geronemus RG. The treatment of Zoon's balanitis with the carbon dioxide laser. J Dermatol Surg Oncol 1989 May;15(5):491-4
17. Albertini JG, Holck DE, Farley MF. Zoon's balanitis treated with Erbium:YAG laser ablation. Lasers Surg Med 2002; 30(2):123-6
18. Retamar RA, Kien MC, Chouela EN. Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser. Int J Dermatol 2003 Apr;42(4):305-7
19. O'Farrell N, Quigley M, Fox P. Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study. Int J STD AIDS 2005 Aug;16(8):556-9.