BalanitisBalanitisBalanitis (or Balanoposthitis). This is inflammation of the glans penis (the tip of the penis) and male foreskin. It rarely, but can occur, in the female clitoris. It has been shown that uncircumcised males have a higher incidence of penile inflammatory disorders and that 5-10% of all uncircumcised boys eventually undergo circumcision because of the complications of balanitis. Careful hygiene and cleansing of uncircumcised boys may reduce this infection and its complications, which is often thought to be caused by the accumulation of smegma. Routine circumcision completely eliminates these problems.
Alternative name: balanoposthitis
Causes, incidence, and risk factors:
Balanitis is usually caused by poor hygiene in uncircumcised men. However, exposure to
caustic soaps or failure to properly rinse the soap while bathing may result in
inflammation.
Prevention:
The foreskin should be retracted daily to adequately clean and dry the area under
the foreskin. Alternatively, circumcision completely eliminates this problem.
Symptoms:
*redness of foreskin or penis
*foul-smelling discharge
*painful penis and foreskin
Treatment:
In cases of inflammation that is causing problems with urination, an immediate
circumcision may be recommended. Several topical ointments are also available and
may provide temporary relief of this problem. However, reoccurring
balanitis should
be treated with a complete circumcision prior to permanent
scarring of the glans penis, as shown below.
Complications:
Chronic inflammation can result in scarring and narrowing of the meatal opening
(urethral stricture). Also, chronic inflammation or infection can make it difficult and
painful to reposition the retracted foreskin to its normal position covering the head of
the penis. Inflammation can also cause the retracted foreskin to swell, leading to
constriction of the penis and possibly penile injury.
Calling your health care provider:
Notify your health care provider if you are experiencing any signs of balanitis
including swelling of the foreskin or pain.
| Difficult to retract scarred foreskin in the uncircumcised male who has suffered from balanitis. This often causes further infections due to the inability or pain caused by retraction of the foreskin, which in turn further degrades penile hygiene. |  |
| Scarring of the glans (or head) of the penis can occur as shown here by the patch of dark cells on the glans and on the rolled back foreskin. Scarring may also look white in color. |  |
| This photo shows the severely scarred and currently balanitis infection glans of a teen male. Considerable scarring has occurred and immediate circumcision was recommended after the first Balanitis episode. Unfortunately, the procedure was not accepted until after the third, and most severe episode, above. |  |
Uncut Indian Contemplates Probable Balanitis
Q. I read Justin's Article about Circumcision. I noted he also had balanitis. I am writing to seek help from you regarding circumcision. I am originally from India but came to US to do my Masters degree in computer science. I graduated last December. I am 26 years old uncircumcised male and started getting rashes on my glans and the inside of my shaft skin. I learned those are due to my uncircumcised penis. My question is can I get circumcised at this age ?? is 26 ok? And I am a working guy now, so I want to know how long is a bed rest required without going to office. Please see attached a pic of my uncircumcised cock.
Ramesh
A. Circumcision can be successfully performed at any age on most healthy males. But as you noted you are starting to have problems caused by your foreskin, and these likely appear to be related to balanitis episodes. As you can see from the photos (above) this can become quite serious. While some physicians may initially try to treat you with creams and admonish you to wash more regularly, these usually do not provide long-term relief that is 100% effective. Only circumcision can really do that, and you may wish to give serious consideration to a full, tight circumcision as soon as possible. Bed rest, only a few hours after the procedure, is required and than you can return to normal office work. Your physician will give you full instructions.
Brian
A Somewhat Uncommon Auto Immune Problem
Many years ago when I was 34 and on a camping trip in Alberta, Canada I noticed some irritation and discovered some strange spots on the inner lining of the foreskin. After the trip was over more of these spots appeared, and continued to appear thereafter.
After several months I visited an urologist. I learned I was the victim of a somewhat uncommon ailment called balanitis xerotica obliterans (BXO). The standard treatment is what is referred to as ``radical circumcision''--removal of a lot of skin! Sometimes pharmaceuticals are employed, but they are often not effective.
The urologist indeed performed a circumcision, and he used a technique which really must be about the worst one ever designed: He slit the foreskin on top and bottom and cut away the two resulting flaps of skin with a scissors. Then he sutured the outer skin to the ``collar'' of residual skin still attached to the glans using gut sutures. He sutured it very irregularly, so that there was a large flap of skin in the residual inner skin on the lower surface that resembled a shark fin. There was a similar flap near the top in the outer skin.
Unfortunately, probably because of the original ailment, the sutures induced a tissue destroying immune response around the points where they passed through the inner foreskin. After a few days there was a ring of holes all the way around the inner foreskin remnant with diameters between about 3 to 8 mm. These holes took a long time to heal--in fact it was over three weeks until it was healed entirely.
The result was less than attractive. The residual collar of residual inner foreskin was only about 3 or 4 mm wide on the left side, but about 20 mm on the right. However, he had removed about 25 mm more total skin from the right, giving a lop sided appearance. There was a ring of lumps of scar tissue all around the base of the head where the holes from the tissue destruction had filled in.
The bright side of this was that the procedure did cure the BXO completely.
I consulted the urologist again and he assured me that it would be okay in a few months. It was NOT!
After having this unattractive penis for well over a year, I began to think about what could be done to improve the appearance. The more I thought about it, the more I became convinced that I could find a way to do this myself that would be certain to produce a perfect result rather than trust the surgical correction to a possibly even more careless physician than the first one.
After about two years I began to try to learn everything I could about how circumcisions were performed. Even at a medical school library I could find very few references to the technique my urologist had used. When I learned about special circumcision clamps I realized that I could design and fabricate a special one to clamp the mangled skin and then cut it off.
I took a piece of thin walled steel tubing 33 mm in diameter and 12 cm long and cut it at a 20 degree angle 4 cm from one end. I sanded the cut ends flat and mounted the shorter section rigidly on a metal track and the longer section so that it was movable. I took great care to fabricate the device so that when the two sections came together they came together evenly and tightly all the way around.
I wanted to remove ALL of the scar tissue, that required removing every last vestige of remaining inner foreskin. I carefully mapped out exactly where the incision needed to be on the remaining outer skin and saved the map for reference.
I experimented on how to apply the device, and once I had the technique down I did daily practice applications for about two months. (I wanted to be sure I had the technique down perfectly, and I was somewhat of a coward--as indeed most guys would be!)
The technique that I developed was as follows. I first washed with disinfectant soap. Then I drew a line on the outer skin with a pen where the incision needed to be. The width of skin that needed to be removed to make it even again varied from about 10 to 35 millimeters--because the urologist had cut it so extraordinarily unevenly. I then drew a second line against the base of the head. Then I took a vacuum cleaner and used it to pull the entire shaft into the tubes with them tight together. I made the shaft become erect inside the tube, and wrapped an elastic band around the base below the lower tube to keep it that way. Then I pulled the two tubes apart and carefully arranged the skin, all the way around so that the mark I had made was even. I found that if I tapped the tubes a bit after this step the skin tended to become absolutely even. I then pushed the two tubes tightly together, and tightened screw to lock them together. This pushed the skin between the two lines outside the junction between the tubes. Then I removed the elastic and the shaft deflated.
For the many practice applications, I waited about three or four minutes and then released the screw and removed the clamp. I could check the pressure marks where the skin had been squeezed between the tubes. After a few of these trial applications I discovered that I could consistently apply the device so that just the skin I wanted to remove was trapped outside the tubes.
One Sunday morning I applied the clamp as I had done in dozens of previous practice applications. I had intended this application just to be another practice one. Just as I removed the elastic, I noticed the vial containing the disposable microtome blade that I had gotten to do the actual cutting. I quickly opened the vial, took out the blade, and sliced off all the skin trapped outside the tubes, all the way around. I expected excruciating pain, but there was hardly any pain at all. There also was very little bleeding. Since there was now no inner foreskin left at all, it was not possible to suture. I simply attached the outer skin to the base of the head with an adhesive. I did take great care to align the skin evenly. I dusted the area with an antiseptic powder, and wrapped the incision with gauze.
I was unable to cut the skin between about ``5:30 and 6:30'' because the track was in the way. I waited until the next Thursday when the skin was fairly well knitted to the base of the head to cut that section. I cut this section with a micro dissection scissors. Since it was a short distance, it only took a few snips! There was also very little pain involved in cutting this section.
The outer skin rapidly became reattached to the base of the head. In fact, there were not even any scabs left along the initial incision after a week, and the narrow section cut later with a scissors healed together just as fast. There was no real scar where the skin reattached either.
I had removed all of the bumps which had resulted from my first, poorly done circumcision. I had also gotten it absolutely even! My recircumcision was absolutely perfect!
I certainly would not recommend that other people do this unless they have the skill and knowledge of surgical techniques. I would recommend that if you find yourself with a severe case of BXO and the doctor rightly recommends a low and tight circumcision, you ensure he knows how and has given others, a good cosmetic circumcision result.
The term ``low'' is commonly used to describe a circumcision with only a little inner foreskin remaining. This result goes beyond that!
Robert (Kansas, USA)
Posthitis (inflammation of the foreskin)- as opposed to balanitis (inflammation of the glans)
Selecting a circumcision. style is somewhat more complicated if you are undergoing a therapeutic cut as opposed to a cosmetic cut. If posthitis keeps recurring, the inner foreskin tends to fibrose or harden. Therefore, if you opt for a circumcision you will, no doubt, be more satisfied if somewhat more inner foreskin is removed...not all of it, but just enough to prevent fibrosis from recurring as a result of constant contact with the glans....A moderate style cut is often selected by urologists who perform hundreds of these procedures on guys who have had previous problems.
If you don't want to be having a re-circ, you need to discuss this with your "operator" very carefully. A lot of guys in this group are either RIC or have been cosmetically cut as adults. The high and tight style is appropriate for guys with no previous episodes of posthitis according to most authorities. However, the high method is often not quite tight enough when flaccid, and usually some inner skin touches the glans while the penis is soft but not enough to permit further attacks of inflammation. A low and tight circumcision prevents this problem almost entirely.
Dr. Yosh Toguchi, an eminent Canadian urologist, is also pro-circ. His book , Private Parts, is a good source of information about all kinds of urinary problems and is entertaining as well.
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