Balanitis: Symptoms, Causes and Treatment

Balanitis means a sore, swollen head of the penis (the glans). It causes redness, itching, pain and sometimes discharge or a bad smell under the foreskin. The most common causes are thrush (a yeast called candida) and irritation from soap. It usually gets better with gentle washing and the right treatment. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280).

What is balanitis and what are the symptoms?

It is swelling of the skin on the head of the penis. It can affect men and boys of any age. It is more common if you are not circumcised.

• A red, swollen or shiny head of the penis.
• Itching, stinging or pain.
• Thick discharge under the foreskin, or a bad smell.
• Pain when you pee.
• A tight foreskin that is hard to pull back.

In Spain doctors write balanitis, or balanopostitis when the foreskin is swollen too. The words are the same in the UK and the US.

What causes balanitis?

There is nearly always a clear cause, and treating it is what clears the problem. The most common are:

• Thrush: a yeast that grows in warm, damp skin. It is the most common infection.
• Irritation: soap, shower gel, lube or condoms.
• Washing: too little leaves a build-up under the foreskin; too much soap dries and irritates the skin.
• A tight foreskin: it makes cleaning hard.
• Sexually transmitted infections: such as gonorrhoea or chlamydia.
• Diabetes: sugar in the urine helps yeast grow. Balanitis that keeps coming back can be the first clue.

Is balanitis contagious?

The swelling itself is not catching, but the cause can pass to a partner. Thrush and sexually transmitted infections spread through sex. Avoid sex until it has cleared. If the cause is a sexually transmitted infection, your partner should be checked too.

What can I do at home?

• Wash the penis once a day with warm water or an emollient, not soap or shower gel.
• Gently pull back the foreskin to clean under it, then pat it dry.
• Wash your hands before you pee or touch your penis.
• If condoms irritate you, try ones made for sensitive skin.
• For boys: warm water only, no soap, bubble bath or baby wipes, and change nappies often. Do not pull back a foreskin that does not move yet.

How is balanitis treated?

Treatment depends on the cause, so it is worth seeing a doctor. Thrush is treated with an antifungal cream. A germ or a sexually transmitted infection may need antibiotics, which are prescription-only in Spain, as in the UK and the US. For irritation, stopping the product is often enough, sometimes with a mild steroid cream. The doctor or the leaflet sets the dose; ask your pharmacist.

If it keeps coming back, the doctor may check your blood sugar or test for sexually transmitted infections. At a Spanish farmacia, ask for a crema antifúngica (antifungal cream).

What is phimosis in boys and in men?

Phimosis means a tight foreskin that will not pull back over the head of the penis. In boys it is normal. The foreskin often does not pull back until about age 5, and sometimes not until 10 or later. It loosens on its own, so it rarely needs treatment. Never force it back: this hurts and can cause small tears.

In men, a tight foreskin can cause balanitis that keeps coming back, painful erections or trouble peeing. The doctor may suggest a steroid cream. If that does not help, a urologist may discuss circumcision. In Spain it is called fimosis.

What are Fordyce spots?

They are tiny yellow or white dots on the shaft or head of the penis, or on the lips. They are normal oil glands that show through the skin. They are not a sexually transmitted infection, you cannot pass them on and they need no treatment. See a doctor if a spot changes, bleeds, becomes a sore or looks like a wart. In Spanish they are manchas de Fordyce.

When should I see a doctor?

• The head of the penis or the foreskin is red, swollen, itchy or sore.
• There is thick discharge, blood or a bad smell.
• It hurts to pee, or erections hurt.
• It is not better after a few days of gentle washing, or it comes back.
• You have had sex without a condom with a new partner.

When should I go to A&E or call 112?

Go to A&E (urgencias) if the foreskin is stuck behind the head of the penis and will not go back (paraphimosis). Do not drive yourself. Go too if you cannot pee, or if you have a fever with redness that spreads fast. If you feel very unwell, confused or short of breath, call 112.

Frequently asked questions about balanitis

Getting a medical assessment

If you are in Spain and you have a sore or swollen penis head or foreskin, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about sexual health, thrush and chlamydia testing in Spain. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.