Balanitis

What is balanitis?

The term "balanitis" indicates an inflammation of the terminal part of the penis (glans or balanus), which is particularly red, painful, itchy and swollen. Most of the time, the inflammation also extends to the foreskin (balanoposthitis), while when it is limited to the preputial mucosa only, it is called postitis.

These three clinical conditions are closely related to each other and the triggers that cause them are almost the same.
According to the thought of some authors, balanitis is one of the sexually transmitted diseases; others, however, do not support this theory, since balanitis, unlike what is believed by common thought, are very frequent during childhood. In adulthood, balanitis are often the most immediate consequence of poor intimate hygiene. use of aggressive and poor quality detergents, and the accumulation of secretions near the foreskin (smegma), predisposing elements for bacterial infections.

Etymology

The term "balanite" comes from the Greek: the root balanus means "acorn" (indicates the terminal part of the penis), while the Greek suffix -itis is synonymous with "inflammation". The literal translation (inflammation of the acorn) portends the symptomatic picture of the disease.

Incidence

A randomized study was conducted on 398 patients suffering from dermatological diseases; interesting data emerged from the analyzes:

2.3% of the circumcised subjects had balanitis;
12.5% of uncircumcised men had balanitis;
it seems that the disease has a rather high incidence rate among uncircumcised diabetics: about 35%.

[adapted from Clinical Andrology, By Wolf-Bernhard Schill, Frank H. Comhaire, Timothy B. Hargreav]

In general, balanitis have an incidence index 5 times higher in uncircumcised subjects than in circumcised ones.
In some circumcised adult subjects, balanitis is asymptomatic: certainly a positive factor for the carrier man, but certainly not for the woman. In fact, the man with asymptomatic balanitis could transmit the beating responsible for the disease to the woman (in this case, collapses the theory of some authors according to which balanitis are not included among the venereal diseases).
The possibility of contracting balanitis increases in diabetics.

Symptoms of balanitis

The symptomatic picture of balanitis designates a considerable inflammation of the glans, always accompanied by erythema, itching and / or burning of the area itself. Often, subjects affected by balanitis complain of urination disturbances, bleeding, edema; in some cases, albeit sporadic , balanitis also manifests itself with ulcerative lesions associated with whitish secretions that emit bad odor (indicator of the proliferation of anaerobic bacteria).
Sometimes, balanitis occurs with swelling of the inguinal lymphatic glands, which are particularly annoying or painful to the touch.

Causes

Balanitis are the result of several causal factors, sometimes very heterogeneous from each other. Just think that balanitis can result from:

Bacterial, parasitic, fungal or viral infections (which can also be favored by poor hygiene or by the use of too aggressive detergents)
Immunological deficiencies (e.g. diabetes)
contact dermatitis
Lichen planus (chronic autoimmune disease affecting the skin and mucous membranes)
Allergies to drugs
Gonorrhea (also called blenorrhagia)
Syphilis
Intertrigo

Classification

As we have seen, the causes that predispose balanitis are many: in this regard, there are many forms of balanitis. In any case, generally, the inflammation of the glans also extends to the foreskin, so we speak more correctly of balanoposthitis.
The following are the most common forms of balanitis:

Balanitis psudoepitheliomatosa by Lortat – Jacob and Civatte: it manifests itself with typical keratotic masses and belongs to the category of immunological balanitis.
Obliterating xerotic balanitis (sclero-atrophic lichens): precancerous form of balanitis that presents with whitish spots that generate severe itching and dryness in the glans. It could generate stenosis of the urethral meatus or phimosis.
Plasma cell zoon balanitis (or balanoposthitis): rare (if not unlikely) disease in infants: it is particularly common among adults over 30 years of age. This type of immunological balanitis generally causes the formation of red spots at the level of the glans and foreskin (in this regard, we speak of balanoposthitis, since it is rare that the inflammation remains limited to the glans)
Balanitis circinata (Reiter's syndrome): occurs with hyperkeratotic pustules (apparently equivalent to those of psoriasis) in the glans, caused by bacterial infections.
Allergic balanitis: generated by allergies to latex from condoms, cosmetics, metals, drugs. Typically, the most common manifestation of the allergic form of balanitis is itching.
Moniliasic balanitis: consequence of diabetes.
Immunological balanitis: caused by autoimmune diseases.

Treatment

After having ascertained that it is balanitis, the doctor must search for the triggering factor through a scrupulous fungal / bacteriological diagnosis: the patient must follow the most suitable therapy according to the cause that caused the disease.
The most frequent treatments are:

Administration of specific antibacterial, anti-inflammatory, anti-microbial medicinal products
Topical application of cortisone
Circumcision (not surprisingly, circumcised individuals tend to experience balanitis more rarely than uncircumcised ones).