Foreskin problems and circumcision

What is balanitis?

Balanitis (bal-an-eye-tis) is a common infection that occurs at the head of the penis. It can happen at any age, but it’s more likely to develop if you have a foreskin.

What are the symptoms of balanitis?

Balanitis can cause the following symptoms:

• A foreskin that can’t be pulled back
• Itchiness or a rash
• Pain or tenderness at the head of the penis
• A red or swollen foreskin
• Discharge from the penis.

What causes balanitis?

Balanitis happens when you don’t keep the inside of your foreskin clean. This can be because your foreskin isn’t pulled back, or can’t be pulled back when washing the penis. It’s common for the inflammation to be caused by bacteria or fungus.

Balanitis can also be caused by irritation from chemicals — the kinds found in household soap, clothing, washing powder, and the latex in condoms. Other causes include allergies to certain medicines, viruses such as HPV (human papillomavirus), and diabetes.

In adults, balanitis can be a sign of diabetes. Because diabetic people have increased levels of sugar in their urine, the combination of sugar and moisture can lead to bacterial or fungal growth if urine gets trapped under their foreskin. If you have a problem with recurring balanitis, it’s a good idea to ask your doctor about a test for diabetes.

What treatments are there for balanitis?

Usually, washing the penis and the inside of your foreskin with soap and warm water will help prevent balanitis. If balanitis is caused by an infection, you can use antibiotics or antifungal ointments/creams to treat it.

What is phimosis?

Phimosis (fi-mo-sis) is a condition where your foreskin is too tight, or the tip of your foreskin has narrowed and can’t be pulled back to expose the head of the penis.

What are the symptoms of phimosis?

Phimosis is often found in children or young adults, usually before puberty.

Boys and men with phimosis can have the following symptoms:

• Pain when urinating
• Urinary retention (when the bladder is not completely emptied during urination)
• Urinary tract infections (UTIs)
• Skin infection of the penis.

Phimosis can cause you to experience severe pain when you have an erection or during sexual intercourse. It can also cause injury to the foreskin, leading to minor bleeding and infection. In these situations, you might need to be circumcised.

What causes phimosis?

Phimosis can happen after an infection or as a result of inflammation (balanitis).

Phimosis can also happen after an injury that causes your foreskin to tear (called secondary or acquired phimosis). As the tear heals, scar tissue can make it more difficult for your foreskin to stretch. Scarring from BXO can also cause phimosis.

What treatments are there for phimosis?

You can treat phimosis with steroid creams, applied once or twice daily for a couple of weeks.

If steroid creams don’t work, or the phimosis is severe, circumcision might be the best option. If you have phimosis, you should also be checked by your doctor for balanitis, BXO, diabetes, and penis cancer.

What is circumcision?

Circumcision is the surgical removal of the foreskin.

In Australia, circumcision was once widespread, but now only around one in seven infant males (10-20%) have it done. Most parents choose to circumcise their children for family, religious, and cultural traditions.

Older people usually only get circumcised to treat a medical condition, such as balanitis, phimosis, paraphimosis or BXO. Some people choose to be circumcised for personal reasons.

Circumcision in older people is a more complex operation, although it’s usually successful. In infants, about one in 200 circumcisions have some complication, but in older people, the risk of complications is roughly ten times higher.

Serious complications are rare. The most common problems are inflammation, bleeding and infection, which are easily treated in most cases.

Circumcision lowers the risk of urinary tract infections (UTIs), infections under the foreskin, tearing of the foreskin, and sexually transmissible infections (STIs) such as HPV, genital herpes and HIV. Circumcised men also have a lower risk of penis cancer.