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THE MERCK MANUAL MEDICAL LIBRARY: The Merck Manual of Diagnosis and Therapy
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Balanitis, Posthitis, and Balanoposthitis

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Balanitis is inflammation of the glans penis; posthitis is inflammation of the prepuce; and balanoposthitis is inflammation of both.

Inflammation of the head of the penis has both infectious and noninfectious causes (see Table 1: Penile and Scrotal Disorders: Causes of Penile InflammationTables). Often, no cause can be found. Balanoposthitis often occurs in patients with a tight prepuce (phimosis), which interferes with adequate hygiene. The subpreputial secretions may become infected with anaerobic bacteria, resulting in inflammation. Diabetes mellitus predisposes to balanoposthitis. Balanitis usually leads to posthitis except in circumcised patients. Chronic balanoposthitis increases the risk of balanitis xerotica obliterans, phimosis, paraphimosis, and cancer.

Table 1

Causes of Penile Inflammation

Category

Examples

Infectious

Candidiasis

Chlamydial urethritis

Chancroid

Gonococcal urethritis

Herpes simplex virus infection

Scabies

Syphilis, primary or secondary

Trichomoniasis

Noninfectious

Balanitis xerotica obliterans

Contact dermatitis

Fixed drug eruptions

Erythroplasia of Queyrat

Lichen planus

Psoriasis

Reactive arthritis*

Seborrheic dermatitis

*Reactive arthritis can cause shallow, painless ulcers of the glans (balanitis circinata).

Soreness, irritation, and a subpreputial discharge often occur 2 or 3 days after sexual intercourse. Phimosis, superficial ulcerations, and inguinal adenopathy may follow.

Patients should be tested for the causes listed, especially candidiasis. Blood should be tested for glucose. The skin should be examined for lesions that suggest a dermatosis capable of genital involvement. History should include investigation of latex condom use. Hygiene measures should be instituted and specific causes treated. Subpreputial irrigation to remove secretions and detritus may be necessary. If phimosis persists after inflammation has resolved, circumcision should be considered.

Last full review/revision October 2008 by Paul D. Lui, MD

Content last modified October 2008

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