Doctors for Balanitis

Balanitis is a urological condition that is characterized by inflammation of the penis glans or the head of the penis. Balanitis is a fairly common condition, with studies suggesting that approximately 3-11% of males are affected with balanitis at least once in their lifetime. Balanitis can occur due to several reasons. In most cases, balanitis infection is caused by fungal or bacterial infections. However, poor hygiene, allergic reactions to latex condoms, sexually transmitted infections, and certain medications can also be potential balanitis causes. In most cases, balanitis is not very serious and can be treated with non-surgical alternatives such as antibiotics and antifungal creams. But, for severe or recurrent cases of the condition, circumcision surgery may be the only balanitis cure.

• Types of Balanitis
• Balanitis is classified into 3 different types:Zoon’s balanitis ,Circinate balanitis, andPseudoepitheliomatous keratotic and micaceous balanitis (PKMB) .
1. Zoon's Balanitis: Zoon's balanitis is a type of balanitis that usually affects middle-aged men who are uncircumcised. In most cases, a non-surgical approach with antibiotic cream for balanitis and maintaining good genital hygiene is considered to be an effective balanitis treatment. However, recurrent or severe cases usually require circumcision.
2. Circinate Balanitis: Circinate balanitis typically occurs due to reactive arthritis or arthritis triggered by an infection. Symptoms of circinate balanitis include redness, inflammation, and formation of small lesions or sores on the tip of the penis.
3. Pseudoepitheliomatous Keratotic and Micaceous Balanitis: Often referred to as PKMB, this is a rare type of balanitis that causes warts on the penile glans. PKMB is generally asymptomatic, but in some cases, fissures and irritation may occur. PKMB is found most commonly in people over the age of 60.

Symptoms of Balanitis

Symptoms of balanitis can vary depending on its underlying cause and your response to the inflammation. Some common balanitis symptions are given below:

• Redness on foreskin and around the head of the penis
• Shiny, tight skin on the glans
• Foul smell
• Tight foreskin
• Irritation, soreness, inflammation, or itchiness around the penis glans
• Lumpy, thick discharge coming from under the foreskin
• Pain while urinating
• Sores around the head of the penis
• Swollen glans near the penis
• If you are experiencing any of the above-given balanitis symptoms, it is advised to get in touch with your nearest healthcare provider.

Preoperative diagnostics for balanitis is a fairly easy and short procedure that your urologist will likely perform to assess your overall health and determine the cause of your condition. Preoperative diagnosis for balanitis usually concludes with a simple physical examination. The urologist will simply inspect the penis and look for balanitis symptoms such as redness, discharge, swelling, and sores around the head of the penis. The urologist will also likely ask you about your surgical and medical history and if you are on any preexisting prescriptions. In most cases, the preoperative diagnosis procedure for balanitis will conclude here.

However, in some cases, your doctor may perform some additional diagnostic tests to better understand your condition. Some additional tests that your urologist may perform include:

• Urethral Discharge Swab: A urethral discharge swab is a commonly performed diagnostic test that will help your urologist identify signs of bacteria and viruses. In this test, the urologist will insert a small cotton swab (about 3/4th of an inch) into your urethral opening and slowly rotate it. This cotton swab will then be sent to a laboratory for testing.
• Tissue Biopsy: In order to determine the exact reason behind your condition, the urologist may perform a tissue biopsy. In this test, the doctor will take a small sample of cells from the site of infection and analyze it under a microscope.
• Urinalysis: Urinalysis or urine test is a diagnostic test that involves the visual, chemical, and microscopic examination of your urine. In this test, you will be asked to urinate into a small cup that is provided to you by your healthcare provider. The urine sample will then be sent to a laboratory for further testing and analysis.
• Blood Tests: A blood test is one of the most common tests that your urologist may perform to monitor your overall health and check for signs of any infection that may have caused balanitis. In a blood test, the urologist will use a thin needle to draw a small amount of blood from a vein in your arm. This blood sample will then be sent to a laboratory for testing and analysis.

Circumcision or balanitis surgery is typically considered to be the best and the most effective treatment for balanitis infection. Circumcision is a commonly performed urological procedure that involves partial or complete removal of the foreskin. There are primarily 3 methods of performing circumcision surgery. While all 3 methods are considered to be safe and effective, they vary in their overall procedure and equipment.

• Laser Circumcision: Often referred to as laser-assisted circumcision, laser circumcision surgery is an advanced and minimally invasive surgical procedure that utilizes a medical laser to remove the foreskin. The entire procedure is typically performed under local anesthesia and does not take more than 10-15 minutes to complete.
• In a laser circumcision procedure, the laser is manually operated by the surgeon and is slowly moved along a predetermined incision line. Laser circumcision is an extremely precise procedure and, as a result, is recommended by most urologists for smooth wound edges and preservation of tissue around the penis. Additionally, due to its high operating temperature, it also ensures minimal bleeding. This results in better cosmetic results, minimal risk of complications, and shorter recovery periods compared to traditional methods. Laser circumcision is commonly recommended by most urologists for its better results and faster recovery. Chances of complications in laser circumcision are negligible, and the procedure has proven to provide patients with a better postoperative quality of life.
• Stapler Circumcision: Stapler circumcision is another method of balanitis surgery that your urologist may recommend to treat balanitis. A stapler circumcision procedure utilizes a stapler device, an advanced and disposable surgical tool, to remove the foreskin. This stapler device is placed over the penis glans and fits snugly over the head of the penis. As the stapler is fired, the foreskin is removed in one quick motion while simultaneously closing the incision wound with a silicone ring. This silicone ring helps minimize bleeding and promote healing. When the incision wound has completely healed, which generally takes anywhere from 7 to 14 days, the silicone ring will fall off on its own as well. Once the foreskin has been successfully removed, the device is taken off, and you will likely be moved to a recovery area. If your condition is stable after the surgery, you can go home.
• Open Circumcision: Often referred to as open-dorsal slit technique, an open circumcision surgery is a more conventional form of balanitis treatment. In an open circumcision procedure, the urologist utilizes a scalpel or surgical scissors to make incisions along the upper length of the foreskin from the tip of the corona. Once the incision is made, the foreskin is pulled back to expose the penile glans. The entire procedure typically lasts for about 40-50 minutes and is usually performed under general anesthesia. Compared to laser or stapler procedures, open circumcision is also more invasive. As a result, it requires longer to heal and carries a slightly increased risk of complications such as excessive bleeding or infection. However, actual cases of any major postoperative complications are rare.

To ensure smooth recovery and minimize the chances of any complications as much as possible, your urologist will likely ask you to follow some simple tips and guidelines before arriving at the hospital, such as:

• Refrain from eating or drinking anything for at least 6 hours leading up to the surgery
• Leave any jewelry or ornaments you wear at home. You do not need them in a hospital, and they may also interfere with the procedure.
• Make sure to take a shower before arriving at the hospital. It is also advisable to trim down any pubic hair you may have before arriving at the hospital. Pubic hair could interfere with the dressing and cause you additional discomfort after the procedure.
• Wear loose, comfortable clothes. It is also imperative that you bring an extra pair of snug, comfortable briefs. You will need to wear these briefs after the surgery and continue to wear them until some of the soreness and swelling have eased.
• Refrain from smoking or drinking alcohol for at least 48 hours prior to surgery. Smoking and alcohol could leave you dehydrated, slow down your recovery, and also reduce the effectiveness of the anesthetic.
• Make sure to take a few days off from work. While most patients can return to their daily lives in just 2-3 days after balanitis surgery, each patient has different healing capabilities, and depending on several factors, recovery time after your balanitis surgery may vary.
• It is imperative that you avoid driving home after your balanitis surgery. Due to anesthetic after-effects, you may feel disoriented, nauseous, and blurred vision. It is advisable to plan ahead and have someone drive you home or at least accompany you in a cab.

Some benefits that are commonly associated with balanitis surgery are given below:

• Easier Penile Hygiene: With the removal of the foreskin, it becomes much easier to regularly clean the penis and prevent excess accumulation of any bacteria or smegma on the penis glans. Maintaining good penile hygiene can help you significantly reduce balanitis symptoms and prevent it from recurring.
• Negligible Chance of Recurrence: A balanitis surgery is typically considered to be the best and the most effective balanitis treatment. In a balanitis surgery, the foreskin is removed completely. As a result, it becomes much easier to prevent bacterial or fungal infections of any kind to accumulate over the penis.
• Prevention of Foreskin-Related Issues: If left untreated, balanitis can make it difficult or even impossible to retract the foreskin, leading to a urological condition known as phimosis. This can cause pain and inflammation of the foreskin or head of the penis.
• Decreased Risk of Urinary Tract Infection: A Urinary Tract Infection or UTI is an infection that can occur in any part of the urinary system. Studies suggest that compared to uncircumcised men, circumcised men are at a slightly reduced risk of contracting UTIs.
• Decreased Risk of Sexually Transmitted Infections: Studies suggest that compared to uncircumcised adults, circumcised adults are at a reduced risk of certain STIs such as HIV and HPV. However, this protection is considered to be modest, and safe sex practices such as the use of condoms during sexual intercourse remain essential.
• Reduced Risk of Penile Cancer: Penile cancer is a very rare condition. However, it is found to be even less common among circumcised males.

In most cases, a complete recovery after a balanitis surgery can take anywhere from 7 to 14 days to complete. Most patients are able to return to their daily lifestyle in just 2 to 3 days after surgery. But it is to be kept in mind that every patient's healing capabilities are different, and depending on your overall health, quality of postoperative care, and method of surgery, recovery time may differ. If your recovery is taking longer than 2 weeks, do not panic. Let your healthcare provider know and proceed as instructed.

After the surgery, it is normal to have slight swelling, pain, bruising, and minor bleeding around the incision site. These side effects are not considered to be indicative of any complications and should subside on their own in a few days after surgery. To help with the swelling, your urologist may also advise you to place an ice pack on the groin every 2 hours for at least 10 to 20 minutes. To further help with recovery and minimize the chances of any complications as much as possible, your urologist may also instruct you to follow some simple tips and guidelines such as:

• Drink plenty of water. After your balanitis treatment, it is crucial to stay hydrated and increase your intake of healthy fluids such as coconut water and fresh fruit juice.
• Avoid excessive consumption of any junk food. Instead, prioritize nutritious food in your diet.
• While it is recommended to perform low-impact exercises such as walking, avoid strenuous activities or exercises. Such exercises may exert excessive force on the surgical site and hinder recovery.
• Avoid swimming pools and public lavatories for at least a few weeks after surgery.
• Refrain from sexual intercourse for at least 4-5 weeks after balanitis surgery. Engaging in sexual intercourse or activities before giving your penis sufficient time to heal could lead to an infection.
• Avoid wearing baggy boxer shorts. It is advisable to wear comfortable, snug underwear that can hold the penis in place.
• Make sure to attend every follow-up consultation scheduled by your doctor. If there are any complications during your recovery, these consultations will allow your doctor to identify and address them.

Balanitis surgery is typically considered to be a safe and effective procedure with minimal chances of any complications. However, as is the case with any other surgery, they can still happen and should not be taken lightly. Some complications that are associated with balanitis surgery are given below:

• Excessive Bleeding: After your balanitis surgery, mild to moderate bleeding is to be expected and considered normal. However, if bleeding seems to e excessive and persistent, it could be a sign of a complication. In such a case, it is advised to apply direct, firm pressure on the surgical site for a couple of minutes and try to control the bleeding. Once the bleeding has stopped, contact your healthcare provider.
• Infection: Prior to your balanitis surgery, the urologist will make sure to maintain sterile conditions and minimize chances of an infection as much as possible. However, in some cases, surgical wounds can become infected despite the safety measures. If caught early, most infections can be treated with antibiotics and topical creams. Signs of infection after balanitis surgery include fever, chills, redness and drainage of yellowish pus from the incision site.
• Excessive or Insufficient Removal of the Foreskin: Normally, balanitis surgery only removes the foreskin to the level where the glans are completely exposed. However, in some rare cases, there may be excessive or insufficient removal of the foreskin which could lead to cosmetic dissatisfaction andd functional problems. In such cases, you will likely require to undergo revision surgery for treatment.
• Wound Complications: In most cases, it takes 7-14 days for surgical wound after balanitis surgery to heal completely. But in some rare cases, the healing may be hindered or slowed down by poor quality of postoperative care or some other causes. Such a complication would cause you further discomfort and may also lead to skin issues and formation of problematic circumcision scars.
• Meatal Stenosis: Meatal stenosis is an uncommon complication that may occur after balanitis surgery. Meatal stenosis is a condition where the opening at the end of the penis becomes narrower than normal, leading to difficulty urinating. Steroid creams may provide you with some relief. However, in most cases, a surgical procedure known as meatotomy is considered to be the best treatment.

In most cases, balanitis can be treated with antibiotics and antifungal creams. Therefore, before moving onto more surgical options, your urologist will likely try a non-surgical approach first with antibiotics and antifungal creams such as:

• Antifungal creams
• If your urologist suspects a fungal infection to be the reason behind your condition, he or she may prescribe you with some antifungal creams for treatment. Some of the most commonly prescribed antifungal cream for balanitis treatment are given below:
1. Clotrimazole: Topical clotrimazole is a medicated antifungal skin cream that belongs to the imidazole class of medications. This antifungal cream is commonly prescribed for the management and treatment of fungal infections and can be effective in treating balanitis caused by fungal infections. It is to be kept in mind that clotrimazole is for external use only and should not be taken by mouth. Make sure to follow the directions on the prescription label and consult with your doctor if you have any queries.
2. Econazole: Econazole is a topical cream that is commonly used to treat candida balanitis or balanitis caused by yeast. Econazole primarily works by killing fungus and preventing it from growing any further. Econazole generally comes as a cream to apply to the skin and should be used once or twice a day (in the morning and evening) for 2 weeks.
3. Miconazole: Miconazole is an antifungal medication that typically comes as a skin cream. You can simply apply this cream over the affected area as directed by your urologist to treat candida balanitis. Miconazole falls in the class of antifungal medications called imidazoles and works by stopping the growth of fungi that cause infection.
4. Elocon: Elocon primarily consists of a mild steroid named mometasone furoate 0.01%, which is known for its anti-inflammatory effect. Elocon can help you get significant relief from swelling, redness, and itching caused by balanitis.
5. Mupirocin 2%: Mupirocin ointment is a topical antibacterial agent that is commonly prescribed by healthcare providers as an effective balanitis treatment. Mupirocin can effectively prevent bacteria growth and kill existing bacteria on your skin. It is to be noted that this medication is for external use only and should be rubbed on the affected skin.

Infections are one of the most common balanitis causes and can usually be treated with antibiotics. Some antibiotics that your urologist may prescribe to treat balanitis are given below:

• Amoxicillin: Amoxicillin is a commonly prescribed urologist that can treat various bacterial infections. Amoxicillin is a penicillin-type of antibiotic that typically comes as a capsule or chewable tablet. It is to be taken by mouth with or without water and as directed by your doctor. It is also imperative that you continue to take these medications until the fully prescribed amount is finished.
• Doxycycline: Doxycycline is a medication that belongs to the tetracycline class of drugs and is used to treat various types of infections. Doxycycline is also prescribed by healthcare providers to treat certain sexually transmitted infections such as chlamydia, gonorrhea, and syphilis. This medication is typically taken with a full glass of water. It is also advised not to drink alcohol while taking doxycycline because it can stop it from working properly.
• Metronidazole: Metronidazole is another antibiotic that your urologist may recommend to treat balanitis caused by bacterial infection. Metronidazole belongs to a class of drugs called nitroimidazole antimicrobials and can be effective in treating anaerobic bacterial infections and protozoal infections. Typically, urologists advise to take 400 mg of metronidazole twice daily for one week for effective balanitis treatment.
• Clarithromycin: Clarithromycin is a macrolide antibiotic that is used to treat various different types of bacterial infections. Similar to doxycycline, clarithromycin is considered effective in treating bacterial infections and will not work against viral infections. Clarithromycin should be taken exactly as prescribed by your doctor. It is important to avoid taking this medication in smaller or larger amounts than what is recommended.

Some home remedies that your urologist may recommend in order to help you manage and relieve some of the balanitis symptoms you may be facing are given below:

• Yogurt: Yogurt is a known probiotic, and hence, adding it to your diet can help you relieve balanitis symptoms. Yogurt also promotes the growth of positive bacteria, which can counteract infections such as candida and thrush. You can also apply a small amount of plain yogurt directly over the penis.
• Coconut Oil: Coconut oil consists of lauric and caprylic acid, which are considered to be effective in soothing irritated skin. One of the major benefits of coconut oil is that it is easily available while not being overly expensive.
• Garlic: Garlic is known to have antifungal and antibacterial uses. Adding garlic to your diet can help you reduce balanoposthitis symptoms significantly.
• Proper Hygiene: Regularly and thoroughly washing your penis is an excellent way of not only reducing balanitis symptoms but also preventing it from reoccurring. Make sure to clean under the foreskin regularly and wash off any excess smegma or bacteria. It is also advisable to use mild soap and lukewarm water.
• Tea Tree Oil: Applying tea tree oil on the head of the penis can help you manage balanitis symptoms. Tea tree oil has several healing properties and is considered especially effective against candida balanitis due to its antifungal properties.
• Apple Cider Vinegar: Apple cider vinegar is generally considered to have good antifungal properties. Applying some diluted apple cider vinegar on the infected area can help you relieve some symptoms related to fungal balanitis.