- Classification depending on the cause of development
- Forms and symptoms of balanoposthitis
Balanoposthitis is an inflammation of the head of the penis and the surrounding foreskin caused by one or several pathogens. The disease brings a lot of inconvenience in intimate and everyday life, as well as fraught with serious complications.
Classification depending on the cause of development
In fact, balanoposthitis is a synchronous inflammation of the head and the foreskin (balanitis and post respectively), although these pathologies are extremely rare in the local version. Balanoposthitis occurs in 1/6 of the male population. Especially often it develops against the background of existing systemic diseases (psoriasis, versicolor, diabetes) and in immunodeficient states. Often, inflammation is caused by infections in the body that are transmitted through sexual contact. Provocateur can act and hormonal failure.
Depending on the source of the provocation, balanoposthitis is divided into two main types:
- primary , in which the pathogen enters from the outside (sexually or through the household) and begins active development in the fold of the preputial sac;
- secondary , when the pathogen penetrates from other organs through the blood, lymph or urogenital channels.
Balanopostitis occurs as a reaction to infection, toxins, medications, allergens. For the separation of these characteristics there is a detailed classification of the disease.
Infectious and inflammatory
The foreskin forms a preputial sac around the glans head, the purpose of which is to protect the most sensitive part of the penis from damage. In this fold, smegma accumulates – a white or grayish substance consisting of peeled epithelium, urine drops, and secretions of the sebaceous glands. With a small cluster, it looks like a thin coating on the head, which is easily washed off during hygiene procedures. However, if the genital organ is not thoroughly diluted, smegma begins to actively reproduce various kinds of microorganisms, including pathogens. This is the cause of the development of infectious-inflammatory type of balanoposthitis. In some men, the foreskin (phimosis) is narrowed from birth, which makes it impossible to fully implement the hygiene of a preputial sac and promotes the accumulation of bacteria.
Balanoposthitis can also be triggered by excessive enthusiasm for washing the penis (including antiseptics: Chlorhexidine, Miramistin), resulting in damage to the surface of the epithelium. As a result, the integrity of the natural protective barrier against pathogens is disrupted.
A common cause of development of balanoposthitis is sexual contact, during which seeding of the head and foreskin with infections of the partner occurs. Immune protection does not always cope with the suppression of expanding colonies of pathogens, resulting in the development of various types of infectious-inflammatory balanoposthitis, for example:
- Chlamydia : clearly defined red spots on the head and foreskin;
- Trichomonas : accumulation of pus in the preputial sac;
- herpetic : small groups of transparent itchy blisters near the head;
- candidal : cheesy mass along the coronary grooves and in the urethra, swelling of the head.
Balanoposthitis, caused by Candida fungi , usually occurs on the background of reduced immunity or with long-term use of substances that disturb the balance of microflora: antibiotics, hormones, alcohol. Unprotected sexual intercourse in such cases acts as a catalyst.
The cause of balanoposthitis can be an allergic reaction to certain substances:
- latex (the material from which condoms are made);
- spermicides (drugs that cause the death of spermatozoa);
- synthetic underwear;
- means of local use, contributing to long-term and high-quality erection.
Allergic balanoposthitis usually goes away by itself some time after the removal of the stimulus, but special ointments significantly speed up the process.
Toxic (medical) balanoposthitis develops due to toxic substances coming from outside. These can be medications that a man takes for a long time to treat diseases, or toxins that are regularly ingested or directly on the head of the penis.
Forms and symptoms of balanoposthitis
Depending on the symptoms and degree of damage to the tissues of the penis, acute and chronic types of balanopostitis are distinguished . In the first case, the disease proceeds against the background of a bright clinical picture, and in the second, periodic relapses of varying severity are replaced by remissions. Balanoposthitis is transferred to the chronic form due to improper uncontrolled treatment, including antibiotics.
Symptoms of the acute form of balanopostitis depend on the type of pathogen. The first signs of incipient inflammation:
- discomfort and slight itching when the head of the member touches the tissue and when the foreskin is removed;
- redness, swelling in the area of the preputial sac;
- appearance of repulsive odor, increased accumulation of smegma.
Further, the symptoms become more pronounced, which can determine the type of balanoposthitis.
Catarrhal balanoposthitis occurs more frequently than others. Main symptoms (as the disease progresses):
- redness (hyperemia), puffiness of the head;
- desquamation (maceration) of the affected epithelium of the foreskin and head;
- the appearance of cracks , surface erosion, small ulcers, probably their suppuration.
The general condition of catarrhal balanoposthitis does not usually suffer, but there is significant discomfort associated with pain and itching.
Erosive balanoposthitis is also called purulent-ulcerative . On the inflamed areas of the head and on the foreskin, prominent whitened areas of dead epithelium are visible. They gradually disappear, leaving deep bright red ulcers bounded by the contour of the desquamated cells. Any touch on the head causes severe pain and itching.
When erosive balanopostitis is often observed an increase and tenderness of the inguinal lymph nodes, which indicates the spread of infection.
The reason for the development of gangrenous balanoposthitis are anaerobic microorganisms that live on the mucous membranes of the oral cavity and genitals. This form spontaneously occurs rarely. As a rule, the first symptoms appear within a day or two after sexual contact with a carrier of pathogens.
Gangrenous balanoposthitis differs in its severe course: the general condition worsens, the temperature rises, periodically headaches occur. The head of the penis and the foreskin at the beginning of the disease turn red and swell, and then become covered with deep and painful ulcerations of various shapes. Multiple foci of dying tissue appear, swelling increases, pus is abundantly secreted from the preputial sac. The inguinal lymph nodes, lymph vessels of the penis are inflamed. In some cases, ulcers erupt (perforate), causing severe pain, prolonged bleeding. The most serious consequence characteristic of the gangrenous form of balanoposthitis is the death of the penis.
Chronic balanoposthitis becomes for several reasons:
- ineffective treatment (without control tests), adaptation of pathogens to antibiotics used;
- periodic ingestion of new pathogens during unprotected sex with carriers;
- permanent microtrauma of the head of the penis, as well as the foreskin;
- chronic diseases that violate the barrier functions of the epithelium and reduce overall immunity (AIDS, diabetes).
For the chronic form of balanoposthitis, a wave-like course is characteristic: symptoms in the form of redness of the head, ulcers, burning sensation, painful urination periodically appear and die out. But the main danger of this nature of the disease is not in discomfort, but in the gradual emergence of fatal defects of the penis.
Balanopostitis with timely treatment does not cause complications, but with long attempts to independently combat this disease or if the symptoms are ignored, the inflammation will take on a severe or chronic form.
Possible complications of balanoposthitis:
- phimosis is the impossibility of exposing the head of the penis due to a narrowed preputial sac. When persistent attempts to remove the skin there is a risk of infringement of the head by the resulting ring of foreskin (paraphimosis);
- stricture (narrowing) of the lumen of the urethra due to cicatricial changes of the mucous epithelium;
- urethritis , nephritis, inflammation of the prostate and bladder due to the migration of the infection up the ureter;
- decrease or complete loss of sensitivity of the glans penis due to atrophied nerve endings;
- deformation of the head due to severe scarring of the damaged tissue;
- urosepsis leading to kidney failure, genital necrosis.
Against the background of chronic balanoposthitis, an ulcer-hyper-tophic form of the disease may develop, a feature of which are chronically non-healing ulcers on the head, as well as on the inside of the foreskin.
Chronic balanoposthitis sometimes takes on an indurative form, in which the head of the penis loses sensitivity, becomes wrinkled and gradually dries out. This type develops rarely, mainly in older men.
An orrologist or a urologist diagnoses balanoposthitis by visual inspection, but the main task is to identify the cause of its development. To do this, take a sample of the contents of the preputial sac, pus, plaque, discharge from the urethra, as well as scraping it to determine the type of pathogen. A study of urine and blood for the presence of infections and antibodies. In some cases, it is required to donate blood for sugar to rule out diabetes. If necessary, a consultation of an endocrinologist or an allergist is appointed.
In some cases, balanopostitis dies out spontaneously with regular hygiene, but in order to prevent the disease from going into the chronic phase, tests should still be taken.
Many men, especially young ones, when they detect signs of inflammation on the head of the penis, begin to self-medicate in the form of washing the preputial sac and urethra with Chlorhexidine and Miramistin solutions. Such measures are able to temporarily relieve symptoms and are useful against the reproduction of pathogens. There are proven ways to:
- Chlorophyllipt successfully fights with staphylococcus on a water and oil basis;
- Inflammation relieve baths on calendula decoction, succession, chamomile, St. John’s wort;
- peeled aloe leaves promote the regeneration of ulcerative lesions and have an antiseptic effect.
Any independent manipulations can only be carried out as auxiliary ones after setting an accurate diagnosis. Otherwise, the clinical picture will be blurred, the concentration of the pathogen will decrease. The consequence can be chronic balanoposthitis and the spread of infection.
Depending on the type of pathogen detected by the analyzes, the doctor individually paints the treatment regimen, including various means.
Tablets used for balanoposthitis:
- Acyclovir in herpetic;
- Fluconazole, Natamycin with fungal (candidal);
- Metronidazole with trichomonas;
- Penicillin antibiotics for gonorrhea;
- Wide spectrum antibacterial drugs ( Azithromycin, Ceftriaxone ) actions with other types of pathogens.
Remedies for local use:
- ointment against fungal infections: Clotrimazole, Pimafukort, Miconazole, Terbinafine, Dekaminovaya ointment ;
- ointment broad-spectrum: Levomekol, Triderm ;
- antibiotics for bacterial balanoposthitis: tetracycline and syntomycin ointments ;
- against gangrenous balanoposthitis: treatment with silver nitrate solution (pharmaceutical preparation);
- Allergic glucocorticosteroids for allergic reactions: Prednisolone ointment .
Anti-inflammatory baths and washing with antiseptic solutions are a mandatory element of treatment in order to prevent an increase in the concentration of the pathogen on the head and foreskin, as well as to relieve inflammation and pain symptoms.
The course of therapy lasts 1-2 weeks, with chronic forms prescribed repeated. At the time of illness, you should refuse to visit the baths, saunas, pools and open ponds, since overheating and hypothermia can cause an increase in symptoms of balanoposthitis. It is also necessary to refrain from coffee and alcohol in order to avoid additional irritation of the urethra.
A complication in the form of paraphimosis will require early intervention by a specialist, since the blood supply to the head of the penis is disrupted. If attempts to correct the infringement by hand were unsuccessful, a longitudinal dissection of the skin and release of the head is performed. With phimosis, as with often recurrent balanoposthitis, the foreskin is usually excised. A gangrenous lesion also requires surgery to remove all parts of dead tissue. With the help of radio wave and laser installations, such operations are carried out quickly and without blood, with minimal risk of complications.
The simplest way to prevent balanoposthitis for a man with a normal immune status is to maintain intimate hygiene. In the morning and in the evening, gently rinse the penis, not only outside, but also behind the foreskin. For this, it is desirable to use special soft means, it is possible for children.
A condom can help prevent infection through sexual intercourse . If for some reason an unprotected act has occurred with an untested partner, then development of balanoposthitis can be prevented by flushing the urethra and the preputial sac with Miramistin or Chlorhexidine. Carry out the procedure as soon as possible.
For persons with systemic diseases (psoriasis, diabetes), as well as with congenital and acquired phimosis, an effective means of preventing permanent recurrence is to remove the foreskin.