inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
of the
glans penis
In male human anatomy, the glans penis, 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 their primary anatomical source of sexual p ...
. When the
foreskin
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 g ...
is also affected, the proper term is balanoposthitis. Balanitis on boys still in
diaper
A diaper /ˈdaɪpə(r)/ (American and Canadian English) or a nappy ( Australian English, British English, and Hiberno-English) is a type of underwear that allows the wearer to urinate or defecate
Defecation (or defaecation) follows dig ...
s must be distinguished from redness caused by
ammoniacal
Ammonia is an inorganic compound of nitrogen and hydrogen with the formula . A stable binary hydride, and the simplest pnictogen hydride, ammonia is a colourless gas with a distinct pungent smell. Biologically, it is a common nitrogenous was ...
dermatitis
Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can v ...
. The word ''balanitis'' is from the Greek βάλανος'' '', literally meaning '
acorn
The acorn, or oaknut, is the nut of the oaks and their close relatives (genera ''Quercus'' and '' Lithocarpus'', in the family Fagaceae). It usually contains one seed (occasionally
two seeds), enclosed in a tough, leathery shell, and borne ...
', used because of the similarity in shape to the
glans penis
In male human anatomy, the glans penis, 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 their primary anatomical source of sexual p ...
.
Signs and symptoms
* Small red erosions on the glans (first sign)
* Redness of the foreskin
* Redness of the penis
* Other rashes on the head of the penis
* Foul smelling discharge
* Painful foreskin and penis
urethral meatus
The urinary meatus, (, ) also known as the external urethral orifice, is the opening of the urethra. It is the point where urine exits the urethra in both sexes and where semen exits the urethra in males. The meatus has varying degrees of sensiti ...
*
Phimosis
Phimosis (from Greek language, Greek φίμωσις ''phimōsis'' 'muzzling'.) is a condition in which the foreskin of the Human penis, penis cannot stretch to allow it to be pulled back past the Glans penis, glans. A balloon-like swelling under ...
*
Paraphimosis
Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be ''reduced'' (pulled back to its normal flaccid position covering the glans). If this condition persists for several ...
Cause
Inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
has many possible causes, including irritation by environmental substances,
physical trauma
An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, ...
, and
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
such as bacterial, viral, or fungal. Some of these infections are
sexually transmitted disease
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...
s.
It is less common among people who are
circumcised
Circumcision is a surgical procedure, 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 ...
, as in many cases, a dysfunction of the
foreskin
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 g ...
is a causal or contributing factor. Both not enough cleaning and too much cleaning can cause problems.
Diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
can make balanitis more likely, especially if the blood sugar is poorly controlled.
It is important to exclude other causes of similar symptoms such as
penile cancer
Penile cancer is 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.
Risk factors include phimosis (inability to retrac ...
.
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
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
.
Types
* Zoon's balanitis, also known as ''Balanitis Circumscripta Plasmacellularis'' or ''plasma cell balanitis'' (PCB), is an idiopathic, rare, benign penile dermatosisKeogh G. for which circumcision is often the preferred treatment. Zoon's balanitis has been successfully treated with the
carbon dioxide laser
The carbon-dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed. It was invented by Kumar Patel of Bell Labs in 1964 and is still one of the most useful types of laser. Carbon-dioxide lasers are the highest-power continuou ...
; and more recently, Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser. Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.
* Circinate balanitis, also known as
balanitis circinata
Balanitis circinata (also known as circinate balanitis) is a skin condition of reactive arthritis comprising a serpiginous ring-shaped dermatitis of the glans penis. Circinate balanitis is one of the most common cutaneous manifestation of reactive ...
, is a
serpiginous
Serpiginous, first known to be used in the 15th century, is a term from Latin serpere to creep, usually referring to a creeping, snakelike or slowly progressive skin disease.
It is used to describe the rash in cutaneous larvae migrans, erythema an ...
annular dermatitis associated with
reactive arthritis
Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can ...
.
*
Pseudoepitheliomatous keratotic and micaceous balanitis
Pseudoepitheliomatous keratotic and micaceous balanitis 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.
See also
* Balanitis
* Balanitis plasmacellu ...
Treatment
Initial treatment in adults often involves simply pulling back the
foreskin
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 g ...
and cleaning the penis.
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
Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...
clinics and 3% of children" in the United States; globally, balanitis "may occur in up to 3% of uncircumcised males".
Other animals
In
dog
The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. Do ...
s, balanoposthitis is caused by a disruption in the
integumentary system
The integumentary system is the set of organs forming the outermost layer of an animal's body. It comprises the skin and its appendages, which act as a physical barrier between the external environment and the internal environment that it serves ...
, such as a
wound
A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...
or intrusion of a
foreign body
A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object.
Most references to foreign bodies involve propulsion through natural orifices into hollow organs.
Foreign bo ...
. A dog with this condition behaves normally, with the exception of excessive licking at the prepuce, and a yellow green,
pus
Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection ...
-like
discharge
Discharge may refer to
Expel or let go
* Discharge, the act of firing a gun
* Discharge, or termination of employment, the end of an employee's duration with an employer
* Military discharge, the release of a member of the armed forces from serv ...
is usually present.
In
sheep
Sheep or domestic sheep (''Ovis aries'') are domesticated, ruminant mammals typically kept as livestock. Although the term ''sheep'' can apply to other species in the genus ''Ovis'', in everyday usage it almost always refers to domesticated s ...
(rams/wethers), ulcerative enzootic balanoposthitis is caused by the ''
Corynebacterium renale
''Corynebacterium renale'' is a pathogenic bacterium that causes cystitis and pyelonephritis in cattle.
''C. renale'' is a facultatively anaerobic Gram-positive organism, characterized by nonencapsulated, nonsporulated, immobile, straight or c ...
'' group (''C. renale, C. pilosum & C. cystidis'').
For the condition in
bull
A bull is an intact (i.e., not castrated) adult male of the species ''Bos taurus'' (cattle). More muscular and aggressive than the females of the same species (i.e., cows), bulls have long been an important symbol in many religions,
includin ...
s, caused by a
virus
A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea.
Since Dmitri Ivanovsky's 1 ...
see
Bovine herpesvirus 1
''Bovine alphaherpesvirus 1'' (BoHV-1) is a virus of the family ''Herpesviridae'' and the subfamily ''Alphaherpesvirinae'', known to cause several diseases worldwide in cattle, including rhinotracheitis, vaginitis, balanoposthitis, abortion, co ...
.
Balanoposthitis is believed to have contributed to the decline to near-extinction of
Gilbert's potoroo
Gilbert's potoroo or ngilkat (''Potorous gilbertii'') is Australia's most endangered marsupial, the rarest marsupial in the world, and one of the world's rarest critically endangered mammals, found in south-western Western Australia. It is a ...
.
References
Further reading
*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.