What is it about ?
Balanitis is an infection of the lining that covers the glans penis. Usually, the inside of the foreskin is also inflamed, this is called balanoposthitis. These inflammations can have many causes:
- infections (mushrooms, bacteria, sexually transmitted infections (STIs));
- skin conditions (eczema, psoriasis…);
- allergies, for example to skin care products, rubber (think condoms), certain antibiotics such as tetracyclines;
- other diseases (diabetes, certain systemic conditions, tumors).
Paraphimosis is the situation in which the foreskin, which is too narrow, is blocked behind the glans, which is then strangled. The foreskin then begins to swell and therefore cannot return to its normal position. The cause is usually mechanical and occurs, among other things, following normal intercourse, probing or piercing.
What is its frequency?
Balanites and balanoposthites are quite rare. They occur in 1.7 men per 1,000 under 24 and in 3.4 men per 1,000 over 65 years. Paraphimosis is much more common. For example, 1 in 10 boys aged 1 to 3 years have a foreskin that cannot be pulled back or only partially. In adult men, it ranges from one in 100 men to one in 20 men.
How to recognize it?
In balanitis and balanoposthitis, the glans head and foreskin are red, hot, a little swollen, and painful. Sometimes there is a purulent or white layer. There may also be painful cracks. Often there is a burning sensation when urinating.
In case of paraphimosis, the symptoms are due to the constriction of the glans. In addition to the pain, there is mainly swelling, both of the glans penis and the ring of the foreskin. This situation cannot go on for too long. Insufficient blood supply to the glans can lead to tissue death. This results in a black color of the glans or foreskin.
How is the diagnosis made?
A clinical examination is sufficient to make the diagnosis. If the inflammation returns easily, the doctor will send a sample of pus or fungus to the lab for further examination. He will also check to see if you have diabetes. If he deems it necessary, he will refer you to a skin specialist (dermatologist) or urinary tract (urologist) for further examination.
What can you do ?
In order to avoid these conditions, it is better to avoid certain possible causes:
- do not use soap or care products for the intimate hygiene of the glans;
- check if this happens to you after using the condom, as you may be allergic to the rubber in condoms;
- if you want to avoid paraphimosis, it is better not to have a glans piercing.
In case of paraphimosis, gently bring the foreskin forward. This is sometimes achieved by pressing on the glans for a few minutes.
In children, it is quite normal that the foreskin cannot be removed. Until puberty, the foreskin may be narrow and stick to the glans. During development, spontaneous erections will cause the tip of the foreskin to widen, which can more easily be removed. Before puberty, treatment is rarely indicated, except when symptoms are present.
What can the doctor do?
The doctor will always treat the cause. In case of balanitis or balanoposthitis, it is usually sufficient to apply a cream with antibiotics or a product against fungi (antimycotic cream). Your doctor may also prescribe a potassium permanganate bath (100 mg per liter of water) for 10 minutes. Be careful as this solution can cause stubborn stains. Cortisone creams are effective in allergy or eczema. Underlying illnesses, such as diabetes and STIs, also need to be taken care of.
If you have paraphimosis, the foreskin should be pushed back onto the glans as quickly as possible. Otherwise, tissue may die (necrosis). To do this, the doctor anesthetizes the penis with a gel and, while holding the penis, presses on the tip of the glans until the foreskin is released. If this is not successful, the doctor will make an incision in the foreskin. Later, a circumcision can possibly be performed.
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