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Balanitis, Posthitis, and Balanoposthitis

By Patrick J. Shenot, MD, Associate Professor and Deputy Chair, Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University

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Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both.

Inflammation of the head of the penis has both infectious and noninfectious causes (see Table: Causes of Penile Inflammation). Often, no cause can be found.

Balanitis usually leads to posthitis except in circumcised patients.

Balanoposthitis is predisposed to by

  • Diabetes mellitus

  • Phimosis (tight, nonretractable prepuce)

Phimosis interferes with adequate hygiene. Subpreputial secretions may become infected with anaerobic bacteria, resulting in inflammation.

Chronic balanoposthitis increases the risk of

  • Balanitis xerotica obliterans

  • Phimosis

  • Paraphimosis

  • Cancer

Causes of Penile Inflammation






Chlamydial urethritis

Gonococcal urethritis

Herpes simplex virus infection

Molluscum contagiosum


Syphilis, primary or secondary



Balanitis xerotica obliterans

Contact dermatitis

Fixed drug eruptions

Lichen planus

Lichen simplex chronicus


Reactive arthritis*

Seborrheic dermatitis

*Reactive arthritis can cause shallow, painless ulcers of the glans (balanitis circinata).

Symptoms and Signs

Pain, irritation, and a subpreputial discharge often occur 2 or 3 days after sexual intercourse. Phimosis, superficial ulcerations, and inguinal adenopathy may follow.


  • Clinical evaluation and selective testing

History should include investigation of latex condom use. The skin should be examined for lesions that suggest a dermatosis capable of genital involvement. Patients should be tested for both infectious and noninfectious causes, especially candidiasis. Blood should be tested for glucose.


  • Hygiene and treatment of specific causes

  • Sometimes subpreputial irrigation

  • Sometimes circumcision

Hygiene measures should be instituted and specific causes treated. Subpreputial irrigation to remove secretions and detritus may be necessary. If phimosis persists after inflammation has resolved, circumcision should be considered.

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