Ask the Doctor: ‘My partner has chronic balanitis — what are his treatment options?’

“Dear Doctor, my partner has had balanitis for years now, and it continues to persist. Sex is very painful for him, and it has impacted our sex life. He’s been to the GP repeatedly, and he has just prescribed him two tablets and a week’s worth of a topical cream. On his third visit, the doctor told him there was nothing more he could do for him. He has taken STI tests, all negative, and is losing hope. What should he do next?. Thank you.”

Answer from Mr Mohammud Shakeel Inder, Consultant Urologist, Beacon Hospital

Recurrent balanitis can be very distressing, with a negative impact on overall quality of life and sexual and urinary function. Balanitis affects 3-11% of men during their lifetime and can occur at any age. It is not an uncommon issue, and adequate assessment and management are key.

The causes of balanitis can be subdivided into infectious (fungal, bacterial and viral), and non-infectious. The most common presentation is that of an uncircumcised man with poor personal hygiene and the presence of smegma (a collection of dead skin and secretions) beneath a tight foreskin. It is important to note that the presence of the foreskin itself is a risk factor with 1 in 30 uncircumcised men diagnosed with balanitis during their lifetime.

Patients with recurrent balanitis need to be seen by a urologist for expert advice. The goal here is to exclude any sinister cause and offer tailored treatment to minimise problems with sexual and urinary function.

Initial assessment includes tests to rule out sexually transmitted infection and ensuring that there are no abnormal penile or foreskin lesions. If these are negative, I would recommend lifestyle changes that help to both alleviate symptoms and reduce recurrence.

1. Keeping the head of the penis clean and dry.
2. Ensuring that foreskin is fully retracted and is cleansed regularly. If the foreskin is tight and can only be partially. retracted, I would advise salt baths with gentle retraction of the foreskin, thus allowing saline water to reach areas. under the foreskin that were previously inaccessible.
3. Avoid skin irritants like shower gel, shampoo, and perfumes over the genitalia.
4. Change the type of condoms being used.

If basic lifestyle changes fail to control the issue, I advocate the use of topical or oral medications. The use of topical ointment can indeed help to treat an infectious cause and improve elasticity of the foreskin.

If the problem persists despite all the above measures, I would discuss surgical management with my patients. Studies have shown that circumcised males have a 70% lower risk of developing balanitis when compared to uncircumcised men.

Circumcision is a minor surgical procedure performed as a day case and is very successful in the management of recurrent balanitis. Information regarding the above can be found on the British Association of Urological Surgeons website.

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