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Diagnosis & Management:

Introduction
Contents
Disclaimer
Please read before using the guidelines
Clinical assessment guidelines

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Balanitis contents

Essential facts

More information

Diagnosis and management
(includes clinical photographs)

Pamphlet
(pdf format)

Balanitis (and Balano-posthitis)
Diagnosis and management

Foreskin hygiene guidelines

Diagnosis

Diagnosis is made on clinical grounds. Diagnosis may be difficult for the inexperienced because of the diversity of clinical features, which may mimic a variety of conditions.


Dry scaly, confluent lesion of balanitis.	Moist scattered lesions of balanitis.

Although candida and bacteria may be isolated from the inflamed area, medication has a limited role and is best avoided in most cases. The basis of treatment is to keep the foreskin clean and dry. The patient should clean the glans with water 2 to 3 times a day and pat dry. The foreskin should be retracted to expose the glans to the air, a fan or a reading light for 15 minutes. Individuals prone to balanitis should routinely perform this procedure nightly or at least several times a week. The patient should not retract a tight foreskin as paraphimosis is likely to occur.

If this procedure is not effective or if the foreskin is tight, circumcision should be considered.

Patient education

The following points should be discussed:

The nature of the condition
The need for hygiene rather than medications or creams
Abstinence from sex during episodes as this may flare the condition
Routine hygiene after sex will help to decrease the chance of developing balanitis
The foreskin should always be retracted during urination
Provide literature on balanitis.

Follow-up

Follow up is required only if symptoms do not resolve.

Foreskin Hygiene

See Essential Facts page for more information

Once a day, ideally when you have a shower, slide your foreskin back towards your body until the glans is completely uncovered (Figures 1a & 1b).
Do not use any force. If there is any resistance or discomfort, check with a doctor.

Wash the end of your penis and foreskin thoroughly using warm water only. Alternatively, sorbolene and glycerine cream (available from chemists and supermarkets) may be used as a substitute for soap.

After washing, dry the end of the penis and foreskin thoroughly. If convenient, sit with the glans exposed to the air for 10 minutes. More thorough drying can be achieved by using a fan or hair dryer (Figure 2).

After drying, replace the foreskin (Figures 3a & 3b).

When you urinate, slide the foreskin back so that urine does not wet the foreskin (Figures 4a & 4b). After urination, dry the end of the penis and replace the foreskin.