Balanoposthitis and Balanitis for adults and Children

Balanoposthitis is an inflammatory condition that affects both the glans penis (balanitis) and prepuce (foreskin). The condition is most common in uncircumcised males and is characterized by symptoms such as penile pain, pruritus (itching), discharge, erythema (redness), rash, or inconsolable crying in children.

There are several possible causes of balanoposthitis, including poor hygiene, infections (such as candidal, bacterial, or viral infections), inflammatory skin diseases, irritants, trauma, and cancer. Poor hygiene is the most common cause of nonspecific balanoposthitis. Infections such as candidal infections are common in children. They can be associated with diaper rash, while other infectious causes include aerobic bacteria such as Staphylococcus aureus and Group A Streptococcus, anaerobic bacteria, and viruses such as human papillomavirus.

The prevalence of balanoposthitis is between 12% to 20% in males of all ages. Paediatric patients commonly present around ages 2 to 5 years, likely due to physiologic phimosis and hygiene habits. In adults, uncircumcised males with diabetes mellitus are at the highest risk, with a prevalence of around 35%. Circumcision has been shown to decrease the prevalence of inflammatory conditions of the glans penis by 68%.

According to the American Urological Association, balanitis affects up to 11% of men and can occur at any age, but it is more common in older men and those who are uncircumcised.

Pathophysiologic processes can vary widely depending on the aetiology of balanoposthitis. Most cases commence with moisture such as urine, sweat, or smegma (physiologic secretion from genital sebaceous glands) becoming trapped within the preputial space, creating a nidus for bacteria and fungi. Balanoposthitis can also be commonly provoked by irritants and allergens, causing non-specific inflammation leading to erythema and pruritis.

A thorough history and physical exam are sufficient in most cases of balanoposthitis for diagnosis and establishing a course of treatment. Your doctor may also recommend testing for sexually transmitted infections (STIs) if there is a suspicion of infection.

if you experience persistent or severe symptoms of balanitis or balanoposthitis, or as untreated cases can lead to complications such as scarring or phimosis. The diagnosis of BXO is typically made based on the appearance of the affected skin. Still, a circumcision and biopsy may be necessary to confirm the diagnosis and treatment of the phimosis.

Treatment may include hygiene improvements, topical or systemic antimicrobial agents, anti-inflammatory agents, topical steroids and circumcision in severe cases. Establishing the underlying cause of balanoposthitis is vital to guide appropriate treatment. Additionally, practising good hygiene habits and using protection during sexual activity can help prevent the development of balanitis.

Circumcision is recommended in phimosis and scaring due to BXO

Treatment options for BXO include topical and intralesional steroids, circumcision with frenuloplasty, and various surgical techniques for more severe cases.

Regular follow-up care is important to monitor changes in the affected areas that may indicate malignancy.

Sources:

1. American Urological Association. Balanitis. https://www.auanet.org/education/auauniversity/medical-student-education/conditions-education/balanitis

2. Mayo Clinic. Balanitis. https://www.mayoclinic.org/diseases-conditions/balanitis/symptoms-causes/syc-20354817

3. NHS. Balanitis. https://www.nhs.uk/conditions/balanitis/

4. Harvard Health Publishing. Balanitis. https://www.health.harvard.edu/a_to_z/balanitis-a-to-z