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OK, so according to the numbers, about 50 per cent of you guys can completely ignore this article. For the other 50 per cent or so who still have your foreskins, read on, because we’re talking about balanitis, which is inflammation and/or infection of the foreskin. When balanitis occurs, the symptoms usually develop over about three to seven days and usually consist of pain, itch, red lesions on the head of the penis and foreskin, discharge, and swelling of the foreskin. If the swelling gets bad enough, if can make it difficult or even painful to retract the foreskin (the medical term for this is phimosis). Balanitis can be caused by any number of medical conditions ranging from infections to inflammatory conditions to trauma. The most common causes of recurrent balanitis that I see in my clinic, however, are yeast infections and an chronic inflammatory condition called Balanitis Xerotica Obliterans (BXO for short).

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Yeast infections of the head of the penis and foreskin usually present as small reddened areas on the head of the penis or inside of the foreskin and the entire area often appears eroded or dry. The foreskin can become swollen and painful to retract, and may appear cracked. Often times, men complain of an intense itch or burning sensation (which is usually worse after sexual intercourse). There may or may not be some whitish cheese discharge noted under the foreskin. When a yeast infection is diagnosed, most are easily treated with antifungal creams for one to three weeks (which can sometimes be combined with steroid creams), or a one time dose of an oral antifungal medication.

When yeast infections are recurrent, your physician will want to screen you for underlying medical issues which may make you more prone to infection, such as diabetes or other conditions which may affect your immune system. Another relatively common cause of recurrent yeast infections is a sexual partner with recurrent vaginal yeast infections. Balanitis Xerotica Obliterans (BXO, also known as “ lichen sclerosus”) is a condition which can cause a chronic inflammation of the head of the penis and the foreskin. At earlier stages, this condition can look quite a bit like a yeast infection with some whitish material under the foreskin or stuck on the head of the penis. As the condition develops and worsens, however, the foreskin will often become whitish or scarred looking and will often crack. Also some of the whitish material on the head of the penis can start to look like plaques or even small ulcers. If recognized at early stages, BXO can usually be treated with potent steroid creams used regularly for a couple of weeks then once or twice weekly to keep it from redeveloping.

If BXO gets bad enough though, it can lead to difficulty with retraction of the foreskin (a medical condition called ‘phimosis’). In this case, the treatment of choice is usually circumcision. It is important that BXO be recognized and correctly diagnosed, as there is about a one per cent chance that it may develop into a cancer if left untreated. One of the best things you can do to prevent many types of balanitis is to be diligent about hygiene in the area.

If you are a parent of uncircumcised boys, teach them early that when they bath or shower they should retract the foreskin and carefully wash the area with mild soap and water (as a side note on uncircumcised boys, it is normal that the foreskin won't pull back from the head of the penis at young ages; in most cases the foreskin won’t be fully retractile until school age, around five years old or so). There is also some evidence that exposure to harsh chemicals in heavily scented soaps and shower gels may be a risk factor for development of BXO and other types of balanitis, so it is a good idea for men of all ages to stick to gentle soaps and cleansing products without strong dyes or scents. The bottom line is that if you notice swelling or tightness of the foreskin, get it checked out by your primary health care provider.

If this is happening to you on an regular basis, or if treatments don’t seem to be working, ask about other underlying causes (such as diabetes) that might be going on in the background. Aaron Smith is a Family Physician practicing in Westville. This column is intended to provide general information only. Always consult your primary health care provider for specific information on personal health matters.