Balanitis

Aim

To guide staff with the assessment and management of balanitis.

Definition

Balanitis refers to inflammation of the glans penis (head of penis), which if also involving the prepuce (foreskin) is referred to as balanoposthitis.

It is a common condition affecting up to 4% of uncircumcised boys aged between 2-5 years.

Causes

• Most cases are caused by irritant contact dermatitis through contact with trapped urine, soiled nappies, or alkaline soaps/bubble baths rather than infection.
• May be exacerbated by infection, most commonly fungal, less frequently bacterial.
• Rarely can be associated with drug eruptions, diabetes, and systemic dermatological problems.

Assessment

• Symptoms may include penile soreness and swelling, itching, dysuria, and if severe urinary retention.
• The glans penis may appear red, swollen with discharge.
• If white plaques present on glans penis, consider lichen sclerosis.

Investigations

• No investigations are usually required.
• In pubertal adolescents, consider STI screen.
• In severe or refractory balanitis, send bacterial and fungal swabs. 

Management^2,3

• Relieve Urinary Retention – usually caused by pain rather than physical obstruction. Try to void whilst sitting in a bath of warm water with suitable oral analgesia. If persistent concern of urinary retention, discuss with urology.
• General Measures
  • Frequent nappy changes to avoid contact dermatitis.
  • Clean penis with lukewarm water twice a day (or if exudative inflammation soak in warm salt water) then allow to dry before dressing.
  • Avoid irritants such as soap and bubble baths; replace these with emollient.
  • Avoid forcibly retracting foreskin.
  • Choose loose fitting underwear made of soft materials like cotton
• Treat Inflammation
  • Most cases are due to contact dermatitis and will respond to hygiene measures and removing the irritant.
  • If significant symptoms; treat with 1% hydrocortisone cream twice a day for duration of symptoms or maximum 14days.
• Treat Infection
  • If concerns of Candida infection; treat with antifungal cream¹ e.g.:
    • Clotrimazole 1% cream – Apply 2 to 3 times daily until resolution of symptoms, then continue for an additional 14 days
    • Terbinafine 1% cream – Apply twice daily for 7 to 14 days
  • If concerns of Bacterial infection; swab and treat with oral Cefalexin for maximum 7days. Topical preparations are not recommended.
  • Exclude STIs in adolescent patients.
• Follow Up – No follow up is usually required, but cases of recurrent or persistent balanitis resistant to medical management can be referred to General Surgery Outpatients to consider circumcision (see Balanitis Pre-referral guideline). 

Referrals and follow-up

Urgent paediatric surgical referral if:

• Urinary retention
• Paraphimosis

Outpatient paediatric surgical referral if:

• Recurrent severe episodes of balanitis. See Balanitis pre-referral guideline.

References

1. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2025 [4/11/25]. Available from: https://amhonline.amh.net.au
2. Javaid AA, Powell K, Awad K Guideline review NICE Clinical Knowledge Summary: balanitis in children. Archives of Disease in Childhood - Education and Practice 2022;107:131-132.
3. Management of Foreskin Conditions: Last updated 2001, Cited November 2025, available from Management of Foreskin Conditions | British Association of Paediatric Surgeons
4. Tu, Christin J., et al. "Balanoposthitis in children: does treatment matter?." The Journal of Emergency Medicine (2025).

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