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Balanitis in children
Published by Bupa's health information team, June 2008.
This factsheet is for parents of boys who have balanitis, or who would like information about it.
Balanitis is an inflammation of the head of the penis (glans or glans penis). Often the foreskin is affected, and the inflammation can spread down the shaft of the penis. When both the glans and the foreskin are inflamed the condition is balanoposthitis, however, this is often also referred to as balanitis.
Balanitis is an inflammation of the glans penis. The foreskin is often affected, as well as the shaft of the penis. The glans is the head of the penis underneath the foreskin (the sleeve of skin that surrounds the head of the penis). The urethra, the tube for passing urine and semen, goes through the centre of the glans penis.
During childhood and sometimes into puberty, the inner surface of the foreskin is attached to the glans. From about the age of two, the foreskin begins to naturally separate from the glans until it can be pulled back - this is a completely natural process which should not be forced. Most boys can pull back their foreskin by the age of 10, and 95 percent of boys can do this by the age of 17.
Balanitis is common in boys who haven't been circumcised, and those who are not yet able to pull back their foreskin.
Balanitis can be acute, lasting for only a short period of time, or it can be chronic lasting for several weeks, months or longer - the term chronic refers to time, not how serious the condition is. Also, it can be recurrent, which means the condition keeps coming back.
Symptoms of balanitis mainly affect the penis, although they can sometimes affect other parts of the body.
The symptoms of balanitis affecting the penis are:
- a red rash at the tip - this may be scaly or ulcerated
- pain, tenderness and swelling
- itching and discomfort
- discharge or pus from underneath the foreskin, which may smell unpleasant
- your son may be unable to pull back his foreskin
Other symptoms, affecting the rest of the body, include:
- a sore mouth
- pain in your son's joints
- swollen or painful glands
- a rash on another part of your son's body (not just his penis)
- your son may feel generally unwell
If your son has any of these symptoms, particularly those affecting his penis, you should take him to see your GP.
If your son has been able to pull back his foreskin, he may find that he can no longer do so (this is known as phimosis). This is more likely if symptoms last a long time (chronic balanitis) or if they keep coming back (recurrent balanitis).
Also, inflammation at the tip of the penis can cause your son's urethra to narrow. This causes pain when your son urinates and can make aiming difficult.
The most common cause of balanitis in children is infection.
We have many harmless organisms (such as bacteria) living on our skin which usually don't cause us any bother. However, if the conditions on the skin are right (warm and moist) they can multiply very quickly to cause infection. The foreskin can provide the perfect environment for organisms to multiply, especially if your son has poor genital hygiene.
There are many types of organisms that cause balanitis - the most common is Candida albicans. Candida albicans causes candidal balanitis a yeast-like infection that mainly affects boys who haven't been circumcised.
Diabetes can increase the likelihood of balanitis because of the amount of sugar in your son's urine, especially if it's uncontrolled or you don't know he has it. It's a common cause of recurrent balanitis.
Recurrent balanitis is most often caused by skin irritants. This might include soaps, detergents or antiseptics.
Side-effect of medication
Side-effects of certain medicines can cause balanitis - these include certain types of painkillers, sleeping tablets, laxatives and antibiotics.
Injury (trauma) to the penis or fiddling with the foreskin can sometimes cause balanitis.
Balanitis xerotica obliterans (BXO)
BXO is an inflammatory skin disorder affecting the foreskin, and sometimes the glans. It's rare in children under the age of five.
Common symptoms of BXO include:
white scarring on the tip of the foreskin
the foreskin may become tough and stiff
pain when urinating
unable to pull back the foreskin (if your son was able to before)
The cause of BXO is uncertain; it may be the result of a viral infection. If left untreated, it may eventually cause the urethra to narrow, making it very difficult for your son to pass urine.
In adults, if BXO is left untreated, there is a five percent chance that it may turn malignant (cancerous). However, there is no evidence of this in children.
Your GP will examine your son's penis and talk to you about his symptoms. The symptoms can sometimes indicate the cause of balanitis, so it's helpful to keep a note of your son's symptoms for your GP.
Your GP may refer your son to a urologist for further tests and treatment. A urologist is a doctor who specialises in identifying and treating conditions of the urinary tract.
Balanitis can sometimes indicate diabetes. If your son has recurrent balanitis, your GP will take a urine sample to test for this.
Firstly, your GP will advise you to keep the head of your son's penis and foreskin as clean as possible, and not to use anything that might irritate the area, such as soap or detergent.
Making sure your son's penis is cleaned twice a day with a weak saline solution (salt water) can be soothing and relieve discomfort. To make a weak saline solution, mix a teaspoon of salt into half a litre (500ml) of warm water. He could also try using an aqueous cream (eg E45 cream) to soothe and clean the area.
With irritant-contact balanitis, once your son stops using the product causing his irritation, symptoms usually clear up within a couple of days. But be careful, as symptoms can come back if he starts using it again.
Depending on what has caused your son's balanitis, he will be prescribed either antifungal cream, antibiotics or a mild steroid cream.
The treatment for candidal balanitis is an antifungal cream, such clotrimazole cream (eg Canesten). This should be applied twice daily until your son's symptoms have settled, and then for two to three days after.
For balanitis caused by bacteria your son may be given an antibiotic ointment, such as chloramphenicol. Antibiotic tablets or liquid such as erythromycin (eg Erythrocin or Erythroped), are occasionally given. Whether he is given tablets or liquid and the dosage will depend on his age.
A mild steroid cream or ointment (eg Hc45 Hydrocortisone Cream) may be prescribed to help reduce the inflammation on your son's glans, especially if he has irritant-contact balanitis. Steroid creams are sometimes given in addition to other medication. You can buy mild steroid creams from your pharmacist. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice
If your son's symptoms are not responding to treatment or they keep coming back despite treatment (recurrent balanitis) you should tell your GP. He or she may give your son a different medicine or refer him to a urologist so his symptoms can be investigated further.
Very occasionally, circumcision is used to treat balanitis. This treatment is used if the condition is recurrent and symptoms are extremely troublesome, especially if your son has BXO. Circumcision is an operation to remove the foreskin from the penis. It's usually done as a day case under general anaesthesia - this means your son will be asleep during the procedure.
Good hygiene is essential in preventing balanitis. You or your son should try to keep the head of his penis and foreskin clean and dry. If your son is still in nappies, make sure he is changed regularly and apply a barrier cream to his genital area.
Also, make sure your son washes his hands after using the toilet.
- Management of foreskin conditions. British Association of Paediatric Urologists. www.baps.org.uk, accessed 22 February 2008
- Balanitis. Clinical Knowledge Summaries. cks.library.nhs.uk, accessed 14 February 2008
- Davenport M, ABC of General Surgery in Children: Problems with the penis and prepuce. BMJ, 1996. 312: 299-301
- Balanitis. GP Notebook. www.gpnotebook.co.uk, accessed 14 February 2008
- 2001 National Guideline on the Management of Balanitis. British Association for Sexual Health and HIV. www.bashh.org, accessed 12 February 2008
- Balanitis. New Zealand Dermatological Society Incorporated. www.dermnetnz.org, accessed 14 February 2008
- Balanitis. eMedicine. www.emedicine.com, accessed 14 February 2008
- Clark C, Huntley J, Munro F, et al., Managing the paediatric foreskin. Practitioner, 2004. 248(1665): 888-894
- Stoppard M, Complete baby & childcare. 2nd ed. London: Dorling Kindersley, 2001
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Mark Woodward MD FRCS (Paed) Consultant Paediatric Urologist, Bristol, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: June 2008