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What is Balanitis?

Balanitis is an infection or inflammation of the head of the penis. Posthitis is infection or inflammation of the shaft of the penis. They have similar causes and treatment, and they often happen at the same time, so we will call them “BP.” Infants often get BP from germs that live in the diaper area. The most common cause is a yeast infection, also known as candida. Some bacterial germs can also cause BP in infants. Many infants with BP already have diaper rash. BP often frightens parents because it can develop very quickly, and because it makes the infant’s penis seem very red and swollen. Teenaged boys can also get BP. Yeast is the most common cause of BP in teens and men, but some sexually transmitted infections also cause it.

What is the biggest concern?

Most parents are worried about pain and about whether the penis will be damaged. Fortunately, BP is easy to treat and easy to prevent. It does not cause any damage to the penis itself, although it can cause scarring or tightening of the foreskin in uncircumcised boys . BP in infants is not a sign of sexual abuse or of neglect. It may be best to think about BP in an infant as just one form of diaper rash. BP in teenagers can also be easily treated with medicine. It is a good reminder to sexually active teens that they should use condoms and that they are at risk for many more serious sexually transmitted diseases.

Balanitis Treatments

The treatment for BP in infants is basically the same as treatment for any diaper rash. As with any diaper rash, it is a good idea to change your baby’s diaper frequently so that s/he does not stay wet for long. You may want to stop using baby wipes if they seem to irritate the skin. Plain water works fine. Avoid rubbing the sore areas, and leave the baby’s diaper area open to the air as much as possible. Your doctor may prescribe an anti-fungal ointment like nystatin or mycostatin (many different trade names), clotrimazole (Lotrimin®), or Fluconazole (Diflucan®). If s/he feels the infection has a bacterial cause, s/he may recommend an antibiotic by mouth or an ointment such as Neosporin® or bacitracin. Apply the ointment as directed right after a diaper change. Give your child acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) as directed to help relieve any pain or fussiness (read about giving Oral Medications).

We treat BP in older boys and teens with the same medications, but some doctors prefer to use oral forms of the medicine, which are easier for older boys to take. Fluconazole (Diflucan®) and itraconazole (Sporanox®) are common forms of oral anti-fungal drugs. Boys with BP should have tests for sexually transmitted infections, and should receive treatment if needed. Your teen can take acetaminophen (Tylenol® and others) or ibuprofen (Advil® or Motrin® and others) as directed to help relieve any pain.

How Serious is Balanitis?

BP is a very mild condition in most cases, even though it can look very bad. Some infants and teens have pain when they urinate until the inflammation goes away. If the redness and swelling does not start to go away within 2-3 days of starting treatment, or if the symptoms seem to be getting worse instead of better, please call your doctor.

Other points of concern

Uncircumcised boys tend to get BP a little more often than circumcised boys. One or two episodes of BP is not a reason for circumcision, but if it happens repeatedly you may want to talk with your doctor about circumcision. Generally good hygiene in the diaper and genital area can also help to prevent BP.

Other Conditions that Might Be Present

There are a few conditions that can look like BP but actually have a different cause. If the foreskin is too tight (phymosis, “fie-moe-siss”) it can get trapped around the shaft of the penis and cause swelling and pain of the head of the penis. This condition is called “paraphimosis” (para-fie-moe-siss) and is an emergency. Usually the shaft of the penis is not red or swollen, while the head may be dusky blue or purple. Children who develop paraphimosis get circumcisions right away. Young infants sometimes get an adult hair wrapped around a finger or toe, and occasionally around the penis. This condition is called a “hair tourniquet,” and can be very painful. If the tourniquet remains in place for a long time, the penis can become very red and swollen, and it can be easy to mistake for BP. Your doctor will have checked for a hair tourniquet. Very rarely in older children and adults, a serious illness such as cancer or Crohn’s disease can first show up as BP. If your older child or teen has BP that does not clear up within a week on treatment, please ask your doctor about it.