Balanitis (inflammation of the head of the penis)

If the glans and foreskin are inflamed, the tip of the penis is red and often swollen and warmer than usual. The glans and foreskin may itch, sting or be painful, especially when you touch them or move the foreskin across the glans.

In some boys and men, fluid or pus collects between the foreskin and glans. The inflammation can also cause an unusual, unpleasant smell. Some people develop a coating on their penis, or sore patches that bleed and later scab over. That can make the glans and foreskin stick together. The swollen or stuck foreskin can often no longer be completely pulled back over the glans, even if the foreskin wasn't too tight before.

Some boys and men also have discharge or feel a burning pain when peeing. That may be a sign that the balanitis inflammation has spread to the urethra (the “pee tube”). Especially in children, the entire penis may become swollen.

Balanitis is often caused by a bacterial or yeast (fungal) infection. Yeast infections are especially common in young children who still wear diapers. Other possible causes include viruses such as human papillomavirus (HPV) or bacteria from sexually transmitted infections (STIs) like syphilis or gonorrhea.

The inflammation may also come from small wounds caused by rubbing or squashing the head of the penis too much, or by overstretching the foreskin.

Allergies sometimes cause balanitis as well – for example, allergies to latex condoms or ingredients in personal care products or lubricants.

Skin conditions like psoriasis or chronic inflammations can spread to the glans and foreskin, too. In rare cases, balanitis is a side effect of medications, such as some antibiotics.

If the glans and foreskin are not cleaned regularly, the following may build up there:

• Urine
• Sweat
• Smegma (made up of skin oil and dead skin cells)
• Sperm residue

These then become a breeding ground for germs. That increases the risk of balanitis.

It can be more difficult to keep the glans clean if the foreskin is tight and can’t be pulled back properly (or at all). So people who have a tight foreskin (phimosis) are more likely to develop balanitis.

But cleaning the area too much isn’t good, either: “Harsh” cleaning products such as hand soap – and vigorous rubbing and drying – can weaken the skin and cause inflammations.

Generally speaking, people with diabetes or a weakened immune system (due to medications, for example) have an increased risk of inflammations, including on the glans and foreskin.

Balanitis can develop at all ages, from infancy to old age. Experts believe that a total of 12 to 20 percent of the male population have already had balanitis.

If the inflamed area is carefully (but thoroughly) cleaned several times a day, balanitis usually clears up without any further treatment. It is a good idea to see a doctor if there is no improvement after one week.

Balanitis usually clears up without causing any other problems. If any complications do occur, it is usually

• a urinary tract infection (UTI): The inflammation has then spread to the urethra (“pee tube”) or bladder.
• a tight foreskin (phimosis): The inflammation may lead to scarring in the foreskin tissue, especially in boys and men who get balanitis often. That can lead to phimosis, even if the foreskin was loose enough before (secondary phimosis). In turn, that might make balanitis occur more frequently because phimosis increases the risk.

In very rare cases, the inflammation and swelling prevent urine (pee) from flowing out. That’s an emergency that has to be treated quickly so the urine doesn’t build up in the bladder and kidneys.

Balanitis can usually be diagnosed based on the painful swelling and redness of the glans and foreskin.

Babies and toddlers can’t describe their symptoms, but crying a lot may be a sign that they’re in pain. At that age, many boys still have a very tight foreskin, or it might even still be stuck to the glans. That is totally normal. So, parents who think their child might have balanitis shouldn’t forcefully pull the foreskin back to take a closer look at the glans. It is advisable to see your pediatrician or family doctor instead.

It is also a good idea for teenagers and men to seek medical advice, especially if

• the symptoms don’t go away within one week, or
• the glans and foreskin have often been inflamed in the past, too.

You can then see your family doctor or go to a urologist or dermatologist.

If necessary, the doctor will take a swab from the glans, foreskin and opening of the urethra (“pee tube”) with a cotton bud or small brush. A laboratory test can then find out if – and which – germs have caused the inflammation. Further examinations, such as blood or urine tests, are sometimes done to check if the inflammation has spread to the urinary tract or whether the symptoms are being caused by an STI (a sexually transmitted infection). Risk factors such as diabetes can also be detected that way.

The right amount of hygiene can prevent balanitis: Gently rinsing the glans and foreskin regularly with clear, lukewarm water (for example, in the shower) is enough. But you shouldn't “scrub” yourself or pull the foreskin back too hard. It is important to avoid using soaps or “harsh” body washes or shower gels, scrubs or aftershave.

It is also a good idea to gently clean those areas if there might be any build-up between the glans and foreskin – like sweat after sports, smegma, sperm residue or lube after sex.

Young boys’ diapers should be changed often enough, cleaning the tip of the penis when doing so. Here again, the key is to be thorough but gentle: Don’t use any products that might irritate the skin and don’t pull the foreskin back if it’s tight or stuck to the glans.

In some teenagers and men, the foreskin is still so tight after puberty that it can’t even be pulled back when their penis is flaccid (soft). They can then talk to a doctor about the option of having treatment for the tight foreskin – for instance, using steroid creams or surgery (circumcision).

Carefully cleaning the inflamed area about 2 to 3 times a day (ideally using clear, lukewarm water) is usually enough to get rid of balanitis. You can dry the area with single-use cotton pads or dry cotton wipes from a pharmacy or drugstore.

You can try to speed up the healing process with compresses and sitz baths containing an antiseptic like octenidine, for example. Painkillers such as ibuprofen or acetaminophen (paracetamol) can be used if the pain is more severe.

If the symptoms don’t improve, it’s a good idea to see a doctor after one week at the latest. The doctor can then find the exact cause and recommend suitable products to apply to the affected area:

• Steroid creams and ointments can be used if the balanitis is caused by irritation or allergies.
• Antibiotic products are an option for bacterial infections.
• Antifungal products (antimycotics) are recommended for yeast infections.

These products are typically used until the inflammation has cleared up. But if the symptoms haven’t changed after 7 days or haven't completely gone away after 14 days, it’s a good idea to see your doctor again.

Important: Ointments and creams can damage latex condoms. Then the condoms no longer provide safe protection.

If the inflammation is caused by bacteria, your doctor might prescribe antibiotic tablets or an antibiotic syrup. These oral medications can also be used if it’s too difficult to apply creams to the glans and inside the foreskin because the foreskin is too tight. The tablets or syrup are usually taken for a week. Again, if the symptoms don’t improve despite the treatment, you should go back to your doctor.

If you keep getting balanitis because your foreskin is too tight, you can ask your doctor about the treatment options – like circumcision. But this surgical procedure can only be done once the inflammation has cleared up completely.

Balanitis rarely leads to complications. You should see a doctor if you develop any of the following symptoms:

• Fever, very severe pain or swollen lymph nodes in the groin.
• Swelling of the whole penis.
• Being unable to pee because of the inflammation. Urgent treatment is needed here.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. You can read about how to find the right doctor in our topic "Health care in Germany" – and our list of questions can help you to prepare for your appointment.