Balanitis Xerotica Obliterans (BXO) presents as thin, white, wrinkled patches on the foreskin. If untreated, it can become troublesome and lead to a tight foreskin (phimosis), painful cracking, and repeated splitting in both children and adults.
BXO is also known as lichen sclerosus, Csillag’s disease, or white spot disease.
What Is BXO?
BXO is a chronic skin condition affecting the foreskin of uncircumcised males. It causes scarring, tightening, and fragile skin that splits easily. In later stages, it can narrow the foreskin opening and interfere with passing urine.
Who Is Affected?
BXO can affect males from early childhood to older age. It is uncommon in boys under five. Individuals with diabetes may have a greater risk of developing BXO.
Is BXO Infectious?
No. BXO is not contagious, and partners cannot catch it. It is affecting the genital skin, BXO does not spread between individuals.
Causes of BXO
The exact cause of BXO remains unknown. However, several factors may be involved:
- Possible links with autoimmune conditions
- Urinary dribbling irritating the foreskin
- Rare familial cases
- Occasional association with human papillomavirus (HPV)
- Diabetes
Symptoms of BXO
Many patients describe progressive tightening of the foreskin, often preceded by repeated cracking or tears.
Symptoms can include:
- Itching or burning around the foreskin
- Cracked or split foreskin
- Pain during sexual activities
- Tight foreskin (phimosis)
- Difficulty retracting the foreskin
- Painful intercourse
- Narrowing of the urinary opening
- Slower or obstructed urine flow
The fragile skin may bleed or become infected more easily.
What BXO Looks Like
BXO typically appears as:
- Ivory-coloured, slightly raised patches
- White, thin, fragile areas resembling wrinkled tissue paper
- Yellowish horny plugs within pale patches
- Wavy or figure-of-eight patterns around the foreskin
- Easy bruising or erosions
- Progressive narrowing of the foreskin opening
These changes may restrict retraction and complicate sexual or urinary function. In children, BXO can cause difficulty passing urine and may resemble thrush.
Diagnosis of BXO
Most cases can be diagnosed by clinical appearance.
To confirm, a biopsy (£250) will be taken and examined under a microscope.
This helps rule out other conditions and assess long-term risks of cancer.
Treatment Options for BXO
Can BXO Be Cured?
Although structural changes cannot be reversed completely, BXO can be controlled effectively with appropriate treatment.
First-Line Treatments
- Steroid creams or ointments to reduce inflammation
- Moisturisers to protect fragile skin
- Anti-fungal or antibiotic medication if infection occurs
Treatment in Adults
- Early tightening may respond to steroid ointments
- If symptoms persist, circumcision offers the most reliable long-term improvement
- In severe cases, further surgical management may be required
Treatment in Children
- Circumcision is usually necessary due to scarring and poor response to conservative treatment
Advanced or Complex BXO
- Wee tube steroids injections for associated urethral stricture disease
- Surgical correction for meatal or urethral narrowing
- Buccal mucosal graft for BXO-induced strictures
- Careful long-term follow-up to monitor skin changes leading to skin cancer
When Can BXO Be Serious?
Penile skin cancer is rare but has been linked to long-standing, untreated BXO. Any lumps, persistent ulcers, or non-healing lesions should be reviewed promptly.
If BXO continues after circumcision, further assessment by a GP or Urologist is essential.
Our BXO Treatment Pathway
At the London Circumcision Centre in South Woodford, Leyton Healthcare and Cambridge Clinics, we provide a structured, evidence-based pathway:
- Assessment and discussion of treatment options (steroid cream, circumcision, or further surgery)
- Pre-circumcision consultation
- Circumcision using medical glue with a few stitches
- Aftercare guidance
- Biopsy to confirm diagnosis and exclude malignancy
- Review after six weeks
- Follow-up consultation (£150) with our Urologist.
- Long-term monitoring for confirmed BXO cases
Pricing
- Adult circumcision with frenuloplasty: £760
- Biopsy: £250
- Follow-up consultation: £150 (Gold Packages available)
Why Choose London Circumcision Centre for BXO?
- Expertise in managing tight foreskin, BXO, and phimosis
- Specialist surgeons and urologists with extensive experience
- Diagnostic biopsy service
- Evidence-based treatment pathway
- High-quality aftercare and long-term monitoring
PS: This information is for guidance only and does not replace professional medical advice. Please obtain advice from a specialist by calling +447527314081.