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DIABETES & BALANITIS

By Nomalungelo Ginindza | 2020-08-01

Balanitis is an infection that can make you uncomfortable in one of the most sensitive areas — the end of your penis and the loose flap of skin that covers the tip. It can be treated, and it’s often easy to prevent with some TLC (Tender Loving Care).

You can get balanitis at any age. If you’re circumcised, you’re not likely to get it. But if you still have your foreskin, you need to take extra care of the head of your penis.

Causes

If you don’t keep that area clean, you raise your chances of getting the infection. Use a mild soap, because harsh chemicals can irritate the skin on your penis and trigger balanitis, too.

It can also happen if your diabetes isn’t under control, or as a side effect of certain drugs prescribed to treat type 2 diabetes. For example, if you take dapagliflozin (Farxiga), you’re more likely to get balanitis, because the drug works by flushing sugar out of your body in the urine. Sugar creates a breeding place for yeast to grow. Bacteria can also cause the infection. Make sure to keep your penis clean after you use to bathroom.

It can also be caused by a type of arthritis known as reactive arthritis or Reiter’s syndrome, which can also affect the joints and the eyes, says Diabetes U K.

Some medications can cause allergic reactions that can lead to balanitis, too, including tetracycline and aspirin-type medicines.

You’re also more likely to get the infection if you’re overweight or have a condition that makes your body retain water, such as heart, liver, or kidney disease.

Symptoms

Signs and symptoms of balanitis include:

n Tight, shiny skin on the glans.

n Redness around the glans.

n Inflammation, soreness, itchiness, or irritation of the glans.

n A thick, lumpy discharge under the foreskin.

n An unpleasant smell.

n Tight foreskin that cannot be pulled back

n Painful urination.

n Swollen glands near the penis.

n Sores on the glans.

n Soreness, irritation, and discharge may occur under the foreskin two to three days after sexual intercourse.

Some of the signs and symptoms of balanitis are similar to those of an STI or thrush.

You might have redness, swelling, pain, itching, or discharge in the tip of your penis. Skin folds can trap dead cells, discharge, and oils. If you don’t wash regularly, this debris can build up and form smegma, which smells bad.

If it gets worse, it can start to hurt when you pee or cause problems with your sex life. You might not be able to get an erection.

Diagnosis

In most cases, your doctor can diagnose balanitis based on the symptoms you describe and by doing a physical exam. He may run these tests to be sure, such as:

n Serum glucose test (to screen for diabetes)

n Lab tests of any discharge.

n Tests to see if you have a sexually transmitted disease (STD).

n Tests for the medical conditions that cause balanitis.

Balanitis is an inflammation of the glans, or the head, of the penis, due to infection or another cause. Balanitis can be uncomfortable and sometimes painful, but it is not usually serious. It can be relieved with topical medication.

It is a common condition, affecting approximately one in every 25 boys and one in 30 uncircumcised males at some time in their life. Boys under the age of four years and uncircumcised men are at the highest risk, but it can happen at any age.

It is more likely if there is phimosis, a condition where the foreskin of the penis is too tight. When boys reach the age of five years, the foreskin becomes easy to retract, and the risk of balanitis falls.

Women can also have balanitis, as the term is used to describe an inflammation of the clitoris. However, this column is focusing on the glans of the penis.

Treatments

Treatment for balanitis depends on the cause. In most cases, the doctor will advise on what substances to avoid, and give the patient information on hygiene.

The treatment for balanitis depends on what is causing the condition. Treatments can include:

Antifungal creams: If a yeast infection is causing balanitis, your provider will prescribe an antifungal cream such as clotrimazole to treat the infection. You will need to apply the cream to the glans (head of the penis) and foreskin as prescribed.

Antibiotics: If a sexually transmitted disease is the cause of your symptoms, your provider will treat the infection with antibiotics. The antibiotic will depend on the type of infection.

Improved hygiene: Your provider will recommend that you wash and dry under your foreskin often to reduce the risk of balanitis returning.

Diabetes management: If you have diabetes, your provider will show you how to manage -the condition.

Circumcision: If you have recurring symptoms of balanitis, your provider may recommend circumcision. Circumcision is a surgical procedure in which a provider removes the foreskin covering the penis. Providers recommend this treatment most often for men who have an especially tight foreskin (phimosis).

Allergic reaction

If the inflammation appears to be due to an allergic reaction or irritant, the doctor may prescribe a mild steroid cream, such as one percent hydrocortisone, for the swelling.

An antifungal or antibiotic medication may also be prescribed. These may be available over-the-counter, or can be purchased online.

If there is an infection, the patient should not use a steroid cream on its own.

All soaps and other potential irritants should be avoided during treatment, and until signs and symptoms have completely gone.

Candida

Candida is a yeast infection. The doctor will prescribe an antifungal cream, such as clotrimazole or miconazole. The patient’s sex partner should also be treated. While treatment is underway, he should either abstain from sex or use a condom.

Bacterial infection

If there is a bacterial infection, the doctor will prescribe an antibiotic.

If there is no infection and no irritant has been identified, the patient may be referred to a dermatologist, who specialises in skin conditions, or a genitourinary clinic.

Recurrence

If the patient has a tight foreskin and the balanitis keeps coming back, the doctor might suggest circumcision.

Complications

Untreated balanitis can cause chronic (long-term) inflammation (redness and irritation). Lasting inflammation can cause health issues, including:

Balanoposthitis: Balanitis can lead to balanoposthitis (inflammation of the foreskin and glans). This only occurs in uncircumcised males. Signs of balanoposthitis include itching, irritation, and swollen foreskin and glans. Balanoposthitis occurs more often in males who have diabetes or a tight foreskin.

Balanitis xerotica obliterans (BXO): Also called lichen sclerosus, BXO occurs when skin on the glans hardens and turns white. The hard tissue can make it difficult or impossible for urine and semen to flow through the urethra (the tube that allows fluids to exit the penis).

Phimosis: Long-term inflammation can lead to scarring on the penis, which can cause the foreskin to become constricted. The foreskin can become so tight that it cannot retract (pull back) over the glans.

Balanitis is easy to treat, but complications can occur in some cases.

These may include:

n Scarring of the opening of the penis.

n Inadequate blood supply to the penis.

n Retracting the foreskin is painful.

n A foreskin that does not retract can be the result of long-term, untreated balanitis.

n The earlier treatment is sought, the better the outlook will be.

Types of balanitis

There are three types of balanitis:

Zoon’s balanitis: inflammation of the head of the penis and the foreskin. Usually affects middle-aged to older men who have not been circumcised.

Circinate balanitis: normally occurs as a result of reactive arthritis.

Pseudoepitheliomatous keratotic and micaceous balanitis: characterised by scaly, wart-like skin lesions on the head of the penis.

Home remedies

There are no real home remedies for balanitis, other than good hygiene:

n Clean the penis every day.

n Do not use soap or bubble bath or anything that could act as an irritant.

n After peeing, dry underneath the foreskin gently.

n Instead of soap, use an emollient (these can be purchased over-the-counter or online).

n A dry mouth coupled with a higher amount of glucose in the saliva can also make for favourable conditions for thrush.

WHAT CAUSES THRUSH?

High blood sugar levels is one of the main causes of thrush and so is a weakened immune system, which is also common in people with diabetes.

Damaged or irritated skin also promotes the growth of thrush.

Smoking increases the chance of oral thrush and certain oral contraceptives may cause vaginal thrush.

SYMPTOMS OF THRUSH

Vaginal thrush (vulvovaginal candidiasis) symptoms include:

n Soreness and irritation.

n White curd appearance on the skin.

n Pain during sexual intercourse.

n White vaginal discharge.

n Reddening of the vulva (the outer parts of the vagina).

n Itching around the vagina (infectious vaginitis).

Oral thrush (oral candidiasis) symptoms include:

n A nasty or bitter taste.

n Redness or bleeding inside the mouth.

n Creamy white coloured patches (lesions) in the mouth (cheeks, lips, tongue or the back of the mouth).

n Painful and sore mouth (can include the throat).

n Cracks at the corners of the lips (angular cheilitis).

THRUSH IN MEN

(CANDIDA BALANITIS)

Symptoms of thrush in men include:

n Reddening or swelling or soreness of the glans (head) of the penis

n Itching around the tip of the penis.

n Discharge beneath the foreskin.

n Nasty odour.

n Pain during urination.

n White curd-like appearance on the skin

n Painful experience during sex.

n Candidal skin infections can also occur around folds of skin such as armpits and the groin.

IS THRUSH A COMMON PROBLEM?

Thrush is a common problem and particularly for people with diabetes. Higher levels of glucose in the blood make candida all the more likely, so diabetics who have difficulty controlling their blood sugar may find themselves particularly prone to yeast infections.

IS THRUSH SERIOUS?

Occasional periods of thrush may not be a cause to worry. However, regular episodes which go untreated can lead to more serious infections. Thrush is an uncomfortable problem and it is possible to pass on to a partner.

what treatments are available for thrush (candida)?: Thrush may be treated by anti-fungal creams or by orally taken thrush treatments.

how can i prevent thrush from occurring?: For people with diabetes, keeping blood sugar levels under control will certainly help to reduce the frequency and severity of outbreaks of yeast infections.

Genital infections can be reduced by wearing looser fitting clothing (particularly underwear), washing your genitals regularly but avoiding the use of scented soaps and shampoos.

Oral candidiasis can be prevented by:

n Maintaining good dental hygiene.

n Brushing twice a day.

n Rinsing your mouth after eating.

n Flossing regularly.

n Using mouthwash.

n Maintaining clean dentures.

n Regularly visiting a dentist.

Since the foreskin is removed during circumcision, balanoposthitis only affects uncircumcised males. It can appear at any age. It has many causes, but poor hygiene and a tight foreskin can make it easier to get balanoposthitis. Balanoposthitis is treatable.

Keep reading to understand the difference between balanoposthitis and other related conditions.

Balanoposthitis vs. phimosis vs. balanitis

Balanoposthitis is often confused with two similar conditions: phimosis and balanitis. All three conditions affect the penis. However, each condition affects a different part of the penis.

Phimosis is a condition that makes it difficult to retract the foreskin.

Balanitis is inflammation of the head of the penis.

Balanoposthitis is inflammation of both the penis head and the foreskin.

Phimosis can occur alongside either balanitis or balanoposthitis. In many cases, it acts as both a symptom and a cause. For example, having phimosis makes it easier to develop irritation of the glans and foreskin. Once this irritation occurs, symptoms such as pain and swelling may make it more difficult to retract the foreskin.

What causes it?

A number of factors can increase your risk of balanoposthitis. In people who have balanoposthitis, more than one cause is often identified.

Infections are among the most common causes of balanoposthitis. Infections that can cause balanoposthitis include:

penile yeast infections

chlamydia

fungal infections

gonorrhea

herpes simplex

human papillomavirus (HPV)

primary or secondary syphilis

trichomoniasis

chancroid

Penile yeast infections are among the most common causes of balanoposthitis. They’re caused by candida, a type of fungus that’s normally found in small quantities in the human body Non- infectious conditions can also increase your risk of balanoposthitis. Some of these conditions include:

chronic balanitis (balanitis xerotica obliterans)

eczema

injuries and accidents

irritation caused by rubbing or scratching

irritation from exposure to chemicals

psoriasis

reactive arthritis

tight foreskin

In other cases, balanoposthitis will appear a few days after sexual intercourse and might be the result of rubbing or use of latex condoms.

Signs of balanoposthitis appear near the penis head and foreskin and can range from mild to severe. They can make urinating or having sexual intercourse uncomfortable.

The combination of symptoms usually depends on the cause of balanoposthitis. For example, balanoposthitis caused by a penile yeast infection might include symptoms such as itching, burning, and white discoloration around the penis head and foreskin.

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