what it is, what the causes and treatments are

Balanitis and balanoposthitis are inflammatory diseases of the penis. The first affects the gland, known as the “head” of the penis; the second is defined as inflammation of the joint that affects the gland and foreskin, which is the skin that covers the organ.

Quite commonly, these diseases can occur in men of all ages. Balanoposthitis is more common in boys and adults with phimosis, affecting 12% to 20% of the male group in all age groups. People with diabetes and phimosis, however, are more likely to have these inflammatory processes.

These conditions change intensely and sometimes good local hygiene can alleviate symptoms such as pain, itching, redness and swelling and in some cases can even fix the problem.

However, more severe inflammation requires treatment with specific antibiotics and / or antifungals, in addition to controlling related diseases, such as diabetes. All this, however, can be avoided with daily hygiene, local humidity control and the use of condoms.

Understand what balanitis and balanoposthitis are

Inflammation of the penis can affect the gland (head) or foreskin, the skin that covers this region.

When this inflammatory process appears in the “head” of the organ, it is called balanitis; when this occurs in the preposition, it is defined as postite.

Inflammation may occur in the gland and foreskin at the same time. In these cases, the disease is called balanoposthitis.

Why does it happen?

Among adults, the most common cause of these inflammations is poor local hygiene. In children, most of the origin is due to a bacterial infection.

However, these diseases can be related to the following conditions:

Inflammatory skin diseases (eg contact dermatitis)
Bacterial or fungal infections (e.g. Candida albicans, Staphylococcus aureus, Streptococcusanaerobic bacteria and sexually transmitted infections)
trauma
Viruses (HPV)
Phimosis
Use of certain medications (non-steroidal anti-inflammatory drugs, sulfa drugs, barbiturates, etc.)
Pre-cancerous lesions and penile cancer (less)
Exposure to irritants or allergies (more aggressive soaps)

“One of the major risk factors is diabetes,” says urologist André Biondi Ferraz, a medical assistant at the HU-UFPI Urology Clinic. “These diseases are caused by a change in the body’s defenses, which in turn can lead to colonization and infection of pathogens, for example. Candida albicans. In some cases, they will be the first symptoms of diabetes, a diagnosis that was previously unknown to patients, ”added the specialist.

Who should take care of it?

Balanitis and balanoposthitis can occur in men of all ages. They are more common in children between the ages of 2 and 5, due to phimosis or local hygiene problems. In adults, the conditions that increase the risk of these swellings are:

Diabetes
Inability to reveal the head of the penis (phimosis)
Immunodepression due to the use of drugs by people with a transplant or chemotherapy
malnutrition
Presence of cancer (cancer)

Knowing the symptoms

The most common manifestations of balanitis and balanoposthitis are:

Mine
Itching
Redness (redness)
Inflammation
a foul-smelling discharge
Inconsolable crying (among young children)
Local odor change
Narrowing of the urethra (stenosis)
Pain when urinating
Minor wounds or minor skin lesions
Healing
Cracks (cracks)
blisters, blisters

When should I seek medical help?

These swellings can change the intensity. Therefore, in some cases, paying more attention to hygiene can solve the problem. However, the image may be more intense and the symptoms will evolve.

If symptoms persist, worsen, and you still have a fever, fatigue, and discomfort, you should seek medical attention.

The specialist you are referring to is a urologist or dermatologist, but if you do not have access to these specialists in your area, a general practitioner (general practitioner) can examine you and refer you accordingly.

How is the diagnosis made?

At the time of the appointment, the professional will hear your complaint, take your health history and perform a physical examination. The diagnosis is made based on these data, so it is called a clinical diagnosis.

When in doubt about the origin of the inflammation, your doctor may request additional tests to identify infectious agents (culture, bacteriological research, STI identification tests), undiagnosed autoimmune diseases, and even a biopsy to investigate the presence of pre-existing lesions. carcinogens.

How is the treatment done?

It will depend on the cause of the inflammation, but the goal of the treatment is to relieve the symptoms and stop the inflammation process.

The strategies that doctors can take are:

Hygiene and local care guidelines
Treatment of predisposing conditions (phimosis, diabetes, for example)
Medications (oral and topical [antibióticos, antifúngicos, corticoides de baixa potência]depending on the severity of the situation)
Surgery (in cases where phimosis is diagnosed)

When treatment is effective, symptoms are expected to subside within 2 to 3 days. In 1 or 2 weeks and up to 30 days, recovery should be complete.

Possible complications

Although rare, inflammation can worsen in the surrounding areas, including deeper regions of the skin, with progression.

“One of the possible complications among recurrent inflammation is a prepuce scarring, which prevents proper exposure of the gland (phimosis), especially when the penis is erect,” explains urologist Francisco Kanasiro, a member of the Department of Urogeriatrics. Head of the Pixategi, Urodynamic and Urethral Disorders Group at SBU and Santa Marcelina Hospital (SP).

Why do some patients not respond to treatment?

Failure to respond to treatment can be a result of a number of factors, such as poor identification of the cause, failure to follow medical guidelines and therapy, and the maintenance of a possible inflammatory cause, such as diabetes that is difficult to control. .or when there is an indication to remove the presence of the foreskin (circumcision). The explanation comes from Carlos Augusto Fernandes Molina, Professor of Surgery and Anatomy at FMRP-USP.

“Determining the cause of the inflammation, educating the patient about the importance of proper treatment, as well as proper systemic control (controlling blood glucose, for example) or local control (removing the foreskin covering the penis gland) are the solutions,” Molina said.

What is balanitis xerotica obliterans?

It is a chronic inflammatory disease that affects the gland and foreskin. Pale or reddish spots, whitening or reddening of the gland, foreskin and crown, as well as thickening of the gland and foreskin.

Sometimes a ring – similar to a scar – may appear at the tip of the foreskin, a condition that can prevent its retraction, which can turn into phimosis and cause painful erections. Doctors may also call this condition as lichen sclerosus.

The disease can lead to narrowing of the urethra, which can lead to difficulty urinating, weak currents, and urinary retention.

Are balanoposthitis and balanitis a contagious disease?

The experts consulted say that, in principle, these diseases are not contagious. However, some STIs may have similar pain, redness, discharge, blisters, or ulcers in the penis. Therefore, these symptoms should not be ignored and should motivate you to seek medical attention to make a correct diagnosis and to indicate the appropriate treatment.

Can it be prevented?

Yes, and the best prevention is to pay attention to local hygiene. To do this, the gland should be soaked and rinsed with soap and water daily, including after sexual intercourse. Keeping the area dry and free of moisture also greatly reduces the chance of local inflammation. Remember to wash your hands before urinating and touching your penis.

Another precautionary measure is to use a condom. This measure reduces the risk of STIs like gonorrhea and HPV.

Sources: André Biondi FerrazSBU (Brazilian Urology Association) and Ebserh (Brazilian Hospital Services Company) Network Assistant HU-UFPI (Piauí Federal University Hospital) Urinary Clinic and HILP (Children’s Hospital Lucidio Portela); Carlos Augusto Fernandes MolinaProfessor in the Department of Surgery and Anatomy at FMRP-USP (Ribeirão Preto School of Medicine, University of São Paulo); Francisco Kanasiro, Specialist urologist at SBU and member of the Department of Urogeriatrics of the same organization; He is also the head of the Urinary, Urodynamic and Urethral Disorders Group at Santa Marcelina Hospital (SP). Medical review: André Biondi Ferraz.

References: REIS, Rodolfo B. et al. Urology Quick Guide – GRU, SBU-SP. Lemar. Sao Paulo. 2012. Available at https://seb-sp.org.br/admin/upload/manual_gru_completo.pdf; Perkins OS, Cortes S. Balanoposthitis. [Atualizado em 2022 May 8]. Here: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2022-. Available here: https://www.ncbi.nlm.nih.gov/books/NBK553050/.

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