Balanitis

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Balanitis
Inflammation of the glans penis and the preputial mucosa.jpg
Inflammation of the glans penis and the preputial mucosa of a circumcised penis
Specialty Urology

Balanitis is inflammation of the glans penis. [1] Balanoposthitis is the proper term when the foreskin is also affected. [1] Balanitis on persons in diapers must be distinguished from redness caused by ammoniacal dermatitis. [2]

Contents

Etymology

The word balanitis is from the Greek βάλανος balanos, literally meaning 'acorn' because of the similarity in shape to the glans penis. [3] -Itis is a suffix from the Greek for 'inflammation'. Posthe is the Greek word meaning 'foreskin'.

Signs and symptoms

Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; the reduced elasticity may lead to pathologic phimosis. [4] Further complications may include: [5]

Causes

Balanitis caused by smegma Balanitis caused by smegma.jpg
Balanitis caused by smegma

Inflammation has many possible causes, including irritation by environmental substances, certain medications, physical trauma, and infection such as bacterial, viral, or fungal. [6] [7] Some of these infections are sexually transmitted, however a yeast infection, Candida balanitis, is generally not categorized as such.

It is less common among people who are circumcised; in many cases, a dysfunction of the foreskin is a causal or contributing factor. [1] Both not enough cleaning and too much cleaning can cause problems. [1]

Diagnosis

Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathological examination of a biopsy. [6]

Types

Treatment

Initial treatment in adults often involves simply pulling back the foreskin and cleaning the penis. [1] However, some topical antibiotic and fungal ointments may be used for treatment for mild cases. Depending upon severity, hydrocortisone and other steroidal creams may be used upon consultation.

Epidemiology

Balanitis "is a common condition affecting 11% of adult men seen in urology clinics and 3% of children" in the United States; globally, balanitis "may occur in up to 3% of uncircumcised males". [14]

Other animals

Prepuce of a dog affected by balanoposthitis Balanoposthitis canine prepuce discharge.jpg
Prepuce of a dog affected by balanoposthitis

In dogs, balanoposthitis is caused by a disruption in the integumentary system, such as a wound or intrusion of a foreign body. A dog with this condition behaves normally, with the exception of excessive licking at the prepuce, and a yellow green, pus-like discharge is usually present.

In sheep (rams/wethers), ulcerative enzootic balanoposthitis is caused by the Corynebacterium renale group (C. renale, C. pilosum & C. cystidis).

For the condition in bulls, caused by a virus see Bovine herpesvirus 1.

Balanoposthitis is believed to have contributed to the decline to near-extinction of the marsupial Gilbert's potoroo. [15]

Related Research Articles

<span class="mw-page-title-main">Glans penis</span> End of the penis

In male human anatomy, the glans penis or penile glans, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and primary anatomical source of sexual pleasure. The glans penis is present in the male reproductive organs of humans and most other mammals where it may appear smooth, spiny, elongated or divided. It is externally lined with mucosal tissue, which creates a smooth texture and glossy appearance. In humans, the glans is located over the distal ends of the corpora cavernosa and is a continuation of the corpus spongiosum of the penis. At the summit appears the urinary meatus and at the base forms the corona glandis. An elastic band of tissue, known as the frenulum, runs on its ventral surface. In men who are not circumcised, it is completely or partially covered by a fold of skin called the foreskin. In adults, the foreskin can generally be retracted over and past the glans manually or sometimes automatically during an erection.

<span class="mw-page-title-main">Foreskin restoration</span> Process to expand skin on the penis

Foreskin restoration is the process of expanding the skin on the penis to reconstruct an organ similar to the foreskin, which has been removed by circumcision or injury. Foreskin restoration is primarily accomplished by stretching the residual skin of the penis, but surgical methods also exist. Restoration creates a facsimile of the foreskin, but specialized tissues removed during circumcision cannot be reclaimed. Actual regeneration of the foreskin is experimental at this time. Some forms of restoration involve only partial regeneration in instances of a high-cut wherein the circumcisee feels that the circumciser removed too much skin and that there is not enough skin for erections to be comfortable.

Smegma is a combination of shed skin cells, skin oils, and moisture. It occurs in both male and female mammalian genitalia. In females, it collects around the clitoris and in the folds of the labia minora; in males, smegma collects under the foreskin.

<span class="mw-page-title-main">Paraphimosis</span> Medical condition

Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced. If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.

<span class="mw-page-title-main">Phimosis</span> Medical condition

Phimosis is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

Penile cancer, or penile carcinoma, is a cancer that develops in the skin or tissues of the penis. Symptoms may include abnormal growth, an ulcer or sore on the skin of the penis, and bleeding or foul smelling discharge.

<span class="mw-page-title-main">Frenulum breve</span> Medical condition

Frenulum breve, or short frenulum, is a condition in which the frenulum of the penis, which is an elastic band of tissue under the glans penis that connects to the foreskin and helps contract it over the glans, is too short and thus restricts the movement of the foreskin. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the foreskin so that it lies smoothly back on the shaft of the erect penis.

<span class="mw-page-title-main">Lichen sclerosus</span> Itchy skin rash usually affecting the genitals

Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals and is also known as balanitis xerotica obliterans (BXO) when it affects the penis. Lichen sclerosus is not contagious. There is a well-documented increase of skin cancer risk in LS, potentially improvable with treatment. LS in adult age women is normally incurable, but improvable with treatment, and often gets progressively worse if not treated properly. Most males with mild or intermediate disease restricted to foreskin or glans can be cured by either medical or surgical treatment.

Vulvitis is inflammation of the vulva, the external female mammalian genitalia that include the labia majora, labia minora, clitoris, and introitus. It may co-occur as vulvovaginitis with vaginitis, inflammation of the vagina, and may have infectious or non-infectious causes. The warm and moist conditions of the vulva make it easily affected. Vulvitis is prone to occur in any female especially those who have certain sensitivities, infections, allergies, or diseases that make them likely to have vulvitis. Postmenopausal women and prepubescent girls are more prone to be affected by it, as compared to women in their menstruation period. It is so because they have low estrogen levels which makes their vulvar tissue thin and dry. Women having diabetes are also prone to be affected by vulvitis due to the high sugar content in their cells, increasing their vulnerability. Vulvitis is not a disease, it is just an inflammation caused by an infection, allergy or injury. Vulvitis may also be symptom of any sexually transmitted infection or a fungal infection.

<span class="mw-page-title-main">Pearly penile papules</span> Small bumps on the head of the human penis

Pearly penile papules are benign, small bumps or spots on the human penis. They vary in size from 1–4 mm, are pearly or flesh-colored, smooth and dome-topped or filiform, and appear in one or, several rows around the corona, the ridge of the head of the penis and sometimes on the penile shaft. They are painless, non-cancerous and not harmful. The medical condition of having such papules is called hirsutoid papillomatosis or hirsuties papillaris coronae glandis.

<span class="mw-page-title-main">Posthitis</span> Inflammation of the foreskin of the penis

Posthitis is the inflammation of the foreskin (prepuce) of the penis. It is characterised by swelling and redness on the skin and it may be accompanied by a malodorous discharge.

<span class="mw-page-title-main">Penile frenulum</span> Band of tissue under the glans penis connecting the foreskin to the ventral mucosa

The frenulum of the penis, often known simply as the frenulum or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa. In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection. In flaccid state, it tightens to narrow the foreskin opening.

<span class="mw-page-title-main">Circumcision</span> Removal of the human foreskin

Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress. Circumcision is generally electively performed, most commonly done as a form of preventive healthcare, as a religious obligation, or as a cultural practice. It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male sex organ that serves as a passage for excretion of urine and ejaculation of semen. The main parts are the root, body, the epithelium of the penis including the shaft skin, and the foreskin covering the glans. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The urethra passes through the prostate gland, where it is joined by the ejaculatory ducts, and then through the penis. The urethra goes across the corpus spongiosum and ends at the tip of the glans as the opening, the urinary meatus.

<span class="mw-page-title-main">Balanitis plasmacellularis</span> Medical condition

Balanitis plasmacellularis, also known as balanitis circumscripta plasmacellularis, Zoon balanitis, or plasma cell balanitis, is a cutaneous condition characterized by a benign inflammatory skin lesion characterized histologically by a plasma cell infiltrate.

Pseudoepitheliomatous keratotic and micaceous balanitis, (PKMB) is a cutaneous condition characterized by skin lesions on the glans penis that are wart-like with scaling. It can present as a cutaneous horn. PKMB is usually asymptomatic, with occasional irritation, burning sensation, fissuring, or maceration.

<span class="mw-page-title-main">Dorsal slit</span> Incision on penis foreskin expoing the glans

A dorsal slit is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue. An ancient practice, it has been a traditional custom among a number of peoples, particularly Filipinos and Pacific Islanders, probably for thousands of years.

<span class="mw-page-title-main">Foreskin</span> Retractable fold of skin which covers and protects the glans of the penis

In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the glans by an elastic band of tissue, known as the frenulum. The outer skin of the foreskin meets with the inner preputial mucosa at the area of the mucocutaneous junction. The foreskin is mobile, fairly stretchable and sustains the glans in a moist environment. Except for humans, a similar structure known as a penile sheath appears in the male sexual organs of all primates and the vast majority of mammals.

<span class="mw-page-title-main">Buried penis</span> Male congenital condition

Buried penis, also called hidden penis or retractile penis, is a congenital or acquired condition in which the penis is partially or completely hidden below the surface of the skin. A buried penis can lead to urinary difficulties, poor hygiene, infection, and inhibition of normal sexual function.

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to not being circumcised, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

References

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  2. Simpson ET, Barraclough P (1998). "The management of the paediatric foreskin". Aust Fam Physician. 27 (5): 381–3. PMID   9613002.
  3. βάλανος . Liddell, Henry George ; Scott, Robert ; A Greek–English Lexicon at the Perseus Project.
  4. Phimosis at eMedicine
  5. [https://www.clarewellclinics.co.uk/sexual-health-clinic/balanitis/
  6. 1 2 Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med. 72 (3): 155–9. doi:10.1136/sti.72.3.155. PMC   1195642 . PMID   8707315.
  7. Cleveland Clinic: Penile Disorders
  8. 1 2 Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
  9. Pellicé i Vilalta C, Casalots i Casado J, Cosme i Jiménez MA (1999). "[Zoon's balanoposthitis. A preliminary note]". Arch. Esp. Urol. (in Spanish). 52 (1): 69–72. PMID   10101891.
  10. Buechner SA (2002). "Common skin disorders of the penis". BJU Int. 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID   12175386. S2CID   45605100.
  11. Baldwin HE, Geronemus RG (1989). "The treatment of Zoon's balanitis with the carbon dioxide laser". The Journal of Dermatologic Surgery and Oncology. 15 (5): 491–4. doi:10.1111/j.1524-4725.1989.tb03407.x. PMID   2497162.
  12. Albertini JG, Holck DE, Farley MF (2002). "Zoon's balanitis treated with Erbium:YAG laser ablation". Lasers Surg Med. 30 (2): 123–6. doi:10.1002/lsm.10037. PMID   11870791. S2CID   33098632.
  13. Retamar RA, Kien MC, Chouela EN (2003). "Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser". Int. J. Dermatol. 42 (4): 305–7. doi:10.1046/j.1365-4362.2003.01304.x. PMID   12694501. S2CID   21305117.
  14. Balanitis at eMedicine
  15. Vaughan-Higgins, Rebecca; Buller, Nicky; Friend, J. Anthony; Robertson, Ian; Monaghan, Cree L.; Fenwick, Stan; Warren, Kristin (2011). "Balanoposthitis, Dyspareunia, and Treponema in the Critically Endangered Gilbert's Potoroo (Potorous gilbertii)". Journal of Wildlife Diseases. 47 (4): 1019–1025. doi: 10.7589/0090-3558-47.4.1019 . PMID   22102677. S2CID   7279808.

Further reading