Causes and pathogenesis of balanitis

Differences in the structure of the female and male body explain the existence of a separate group of diseases inherent in a particular sex. Most of these pathologies are inflammatory and affect the human reproductive system. One of the diseases of the male genitalia is balanitis - a disease characterized by localization of the inflammatory process on the head of the penis. Faced with unpleasant symptoms of pathology, such as redness and swelling of the mucous membrane of the penis, itching and burning in the intimate area, aggravated during sex and urination, the appearance of painful erosions and purulent plaque, many men begin to torment the question, what kind of attack is this and what are her the reasons. That's just with this question, and we will try to figure it out.

Balanitis and balanoposthitis

Balanitis is a disease whose main symptom is inflammation of the tissues of the head of the penis. The head is the cone-shaped end of the free end of the penis, where the external opening of the urethra is located, which explains pain and burning during urination during balanitis.

From human anatomy, it is known that the skin of the penis is loosely attached to his body and is considered a moving organ, in contrast to the fixed, gentle covering of the head. At the point of attachment of the body of the penis to the head (neck of the head), the skin gathers in a fold, forming a peculiar bag (preputial bag). This is the so-called foreskin, partially covering the head.

On the inner surface of the foreskin, the skin is more tender, so the inflammation in the skin of the head rather quickly passes to this part of the foreskin, and balanitis passes into another disease - balanoposthitis, characterized by combined inflammation of the glans penis and the foreskin.

To avoid the development of these two inflammatory diseases allows circumcision of the foreskin in boys and men, popular among Jews, as well as other Jewish and Muslim peoples. In this case, it is not only about the national religious tradition, but about this hygienic procedure, which is gradually gaining popularity. Today, 1/6 of the male population resorts to a circumcision procedure, which facilitates penile hygiene and is the prevention of many diseases, including oncology of the genital organ.

As for the prevalence of balanitis and balanoposthitis, there is no clear statistics on this. Doctors say that at least once in a lifetime at least 50% of men face inflammation of the glans of the penis and the foreskin. And in most cases we are talking about the fungal nature of the disease. True, they usually seek medical help only in severe cases of purulent inflammation, when simple organ hygiene, which involves careful removal of the secretion of the sebaceous glands under the foreskin, semen residues, epithelial cells, bacteria, fungi, etc., does not solve the problem.

[1], [2], [3], [4], [5]

Why does inflammation of the glans penis occur?

Balanitis and balanoposthitis are considered diseases with identical pathogenesis, in which the poor hygiene of the male sexual organ comes to the fore. In the bag formed by the foreskin, bacteria that are present on our skin (conditionally pathogenic microorganisms) can accumulate and multiply. By themselves, they are not a strong irritant and with good local immunity can not harm the sexual organ. Another thing is if the delicate skin is affected by a stronger irritant that causes the appearance of edema and wounds on it, and any wound is the optimal nutrient medium for bacteria and fungi ..

This is the irritant that is smegma. This is a physiological substance in the form of a fat-like substance, produced in the body of a man and representing the secret of the sebaceous glands, which the foreskin is richly supplied with.

Smegma is necessary to ensure safe sliding of the penis head inside the foreskin and, it would seem, should protect the delicate fabric of the head from rubbing and irritation. But if the oily secret accumulates under the foreskin in large quantities, mixing with urine particles, cholesterol crystals, exfoliated epithelial cells and microorganisms present on the skin, it acts as the strongest irritant. Uric acid, which falls under the foreskin from the urethra, eats away the delicate skin of the head and foreskin, and coarse particles during the movement of the foreskin relative to the head injure the skin with the formation of redness, swelling and erosions. Smegma itself acts as a nutrient medium for bacteria and fungi, which multiply rapidly and help maintain the inflammatory process.

Poor-quality underwear materials, penis injuries, special spermicidal creams-contraceptives and lubricants used during sexual intercourse, etc. May also act as irritants. In this case we are talking about non-infectious inflammation.

Regardless of what nature balanitis has: infectious or non-infectious, the disease gives the man considerable discomfort. However, infectious balanitis, which has a more severe course and requires serious treatment, is much more common. Moreover, the disease develops mainly against the background of a weakened immunity and insufficient hygiene of the male organ, which can be called the main risk factors for the development of the disease.

Non-infectious balanitis develops through direct contact of a chemical or mechanical stimulus. How quickly symptoms of the disease appear depends on the time of contact and the response of the immune system. For example, an allergic reaction to components of creams, lubricants and underwear materials usually develops during the second or third contact. Their first use can be painless. But sensitization of the body will already occur, and subsequent contact with the allergen may cause irritation of the skin. But in the case of injury to the tissues of the penis, inflammation usually occurs within the first few hours.

The incubation period for infectious balanitis can vary considerably. It all depends on the strength of immunity and the type of infectious agent. In some cases, acute symptoms appear only a couple of days after infection, and in other patients, the infection may be dormant until immunity gives up the slack. Moreover, this applies to both conditionally pathogenic microorganisms and more powerful pathogens that provoke the development of venereal diseases.

Common Causes of Balanitis and Balanoposthitis

So, we figured out that balanitis in men can have both infectious and non-infectious etiology. In the first case, the weakened local and general immunity plays a decisive role, therefore the line between non-infectious and infectious forms of the disease is very thin.

Primary (most often non-infectious) balanitis may develop in the background:

• Inadequate hygiene of the penis (it is necessary not only to wash it daily with soap and water outside, but also to clean the head under the foreskin, such procedures are also necessary after each sexual intercourse).
• Wearing too thick underwear, compressing the penis (impaired blood circulation of the organ can cause trophic disturbances and inflammation of its tissues).
• The use of uncomfortable underwear that rubs the genital organ (at the site of friction redness forms, which can eventually turn into inflammation).
• Substandard materials and synthetics in underwear (some components of the fabric and the chemical dyes used can cause allergic reactions, and synthetics create a greenhouse effect that negatively affects the skin of the penis and the reproductive ability of spermatozoa).
• Allergic and autoimmune diseases: urticaria, eczema, psoriasis, etc. (people with inadequate work of the immune system are susceptible to balanitis more than others, because allergies are a special case of an inflammatory reaction). In this case, the reaction usually occurs when using creams and lubricants, latex materials (condoms), less often in response to the use of detergents (soap, shower gel, washing powder). An allergy to laundry detergent may occur after wearing the laundry washed by it.
• Diabetes mellitus, contributing to the chronization of the inflammatory process, because elevated blood sugar prevents the healing of inflamed tissue and erosions. By itself, diabetes does not provoke inflammation of the delicate skin of the head and foreskin of the male genital organ, but makes the treatment of acute balanitis and balanoposthitis extremely difficult and most often contributes to the development of the chronic form of the disease, which is diagnosed in seventy percent of patients with diabetes. But the main risk factor for the development of inflammation again remains the lack of hygiene of the penis.
• Pathologies in which there is fluid retention in the body and tissue swelling (various kidney diseases that violate the functionality of the organ, cirrhosis of the liver, heart failure, etc.).
• Diathesis increasing susceptibility to inflammatory reactions. In boys, exudative diathesis, characterized by a hereditary predisposition to allergic reactions, becomes a common cause of balanitis. In children and adults, forms of diathesis such as oxaluria (oxalate), phosphaturia (phosphate) and uraturia (urate) can cause balanitis. In these cases, the patient's urine contains a high concentration of irritants (uric acid crystals, sand, salts of oxalic acid or oxalates), which, falling under the foreskin, can cause inflammation of the tissues of the head.
• Phimosis is a congenital progressive pathology characterized by a narrowing of the foreskin, which prevents the outgrowth of smegma, particles of urine, etc. From it. The consequences of the disease during puberty are particularly noticeable, with its characteristic active release of smegma. It is this oily liquid, lingering under the foreskin, promotes the reproduction of conditionally pathogenic and pathogenic microflora.
• Penis injuries when inflammation is caused by impaired blood circulation in the tissues or the formation of wounds on the skin. In the latter case, there is a high risk of a bacterial, fungal or viral infection.

In most cases of non-infectious balanitis, improper care of the penis becomes a predisposing factor. Patients who have not undergone the procedure of circumcision and who neglect the hygiene of the penis are at risk to get acquainted with this disease at any time. And those who do not pay attention to the first signs of pathology are at risk of earning infectious balanitis when the skin’s defenses will no longer be able to withstand specific and non-specific infectious agents.

Infectious balanitis develops in cases when fungi, bacteria or viruses get on the skin of the penis, and local immunity is not able to restrain their reproduction. It is infections that cause the development of secondary (infectious) balanitis. In this case, we can talk about different types of infection:

• non-specific bacterial agents (anaerobes, streptococci, staphylococci, and other opportunistic microflora that are present on our skin and are capable of provoking tissue inflammation in large quantities),
• specific infections or STIs (pathogens responsible for the development of such STIs as gonorrhea, syphilis, trichomoniasis, chlamydia, etc.),
• yeast (the cause of candidiasis),
• viral infections (for example, herpes virus, less often the human papilloma virus with the formation of genital warts).

Some types of virus themselves are not capable of causing balanitis or balanoposthitis, but they contribute to a strong decrease in the body's defenses, making it possible for bacterial and fungal infections to multiply uncontrollably on the skin and in the patient's body. Such immunity killers include the human immunodeficiency virus (HIV).

Quite a common cause of balanitis is considered to be such a popular disease affecting the urogenital system, such as urethritis (inflammation of the urethra, which in men lies inside the penis and ends with a urethral opening in the head of the organ). Most often, urethritis has an infectious nature, which means that the infection can easily migrate from the urethra to the tissue of the head and into the preputial sac, causing inflammation and damage to the delicate skin.

Nonspecific urethritis can cause chlamydia, myco-and ureaplasma, trachomodany, gardnerella and other types of STDs. Representatives of conditionally pathogenic microflora are considered to be the culprits of a specific form of the disease: coccal microflora (for example, streptococcus and staphylococcus), various strains of E. Coli, fungal infection (candidiasis), which multiplied against the background of weakened immunity. If the urethral discharge is not regularly removed from the surface of the penis, bacteria and fungi will settle on sensitive skin and irritate it with the products of their vital activity, provoking the development and progression of the inflammatory process.

As you can see, balanitis can be considered as a disease resulting from inattention to one's health (development of chronic diseases, bad habits, physical inactivity and stagnation) and improper care of the sexual organ, the foundations of which are laid in childhood. His development is promoted by an irresponsible attitude to the choice of underwear, promiscuity in sexual intercourse, ignoring the requirements of STI prevention and all-consuming laziness, which prevents taking a shower and conducting hygienic procedures after intercourse. And here a lot depends on the man himself.

[6], [7], [8], [9]

Is balanitis transmitted from person to person?

If inflammation of the non-infectious glans head is a purely male problem, then with infectious pathology, everything is not so simple. Therefore, it is worth knowing how balanitis is transmitted, and whether a woman can encounter a similar disease if the sexual partner has inflammation of the penis.

It is clear that when the cause of inflammation is not an infection, there is nothing to fear. In itself, inflammation cannot be transmitted to another person even through sexual contact. Another thing is that the accession of infection can occur only later (secondary balanitis), because the irritation and inflammation of the tissues is a noticeable impact on local immunity. And whether general immunity can restrain the reproduction of the infection is another question.

If during the development of non-infectious inflammation nothing is done, then it is likely that it will soon acquire an infectious nature, because a lot of germs nest on the human body, especially in intimate places. And some of the microorganisms can join during sexual contact. For example, if a woman is diagnosed with an STD, then the infection can easily go to the skin of a man and, with weakened immunity, support the inflammatory process. If there are microdamages on the skin (and they are almost always present during inflammation), the infection penetrates the bloodstream and causes the appearance of not only local, but also general symptoms.

Sexually transmitted and fungal infections, such as candidiasis. Although fungi of the genus Candida are considered representatives of opportunistic microflora, in large quantities they can become a serious problem. When it comes into contact with inflamed skin or wounds (and this is always a weakened local immunity), fungi begin to multiply actively, and their metabolic products act as strong stimuli that potentiate inflammation.

Doctors give the diagnosis of "balanitis" to men, despite the fact that this disease can also develop in women. For example, the female form of balanitis can be considered thrush or candidiasis of the genital organs, accompanied by irritation of the skin and mucous membrane of the female genitalia and vagina, the appearance of itching, and sometimes erosion.

Candida balanitis in men develops mainly after sexual contact with a woman with thrush. If a man’s immunity is strong, he will remain a carrier of the infection, but with a weakened immunity, the development of an inflammatory process on the tender tissues of the penis is likely. And since the head and the inner part of the foreskin remain the most sensitive and vulnerable places of the penis, inflammation occurs there.

If the cause of inflammation is a sexually transmitted infection (fungi, pathogens of gonorrhea and syphilis, Trichomonas, etc.), both sexual partners are affected. In this case, balanitis in men will develop against the background of the underlying disease (STD). In women, the diagnosis may sound slightly different, which does not change the nature of the disease.

If balanitis is triggered by the reproduction of conditionally pathogenic bacteria, for example, staphylococci, then it is not about infection (microbes are on the skin of every person), but about a simple weakening of the male immunity, which made possible the multiplication of bacteria. And blame the sexual partner in this case is inappropriate.

It turns out that infectious balanitis is transmitted sexually. But for the development of the disease, transmission alone is not enough. For reproduction of pathogens, it is very important that the body's defenses and in particular the skin are weakened. It is for this reason that balanitis rarely occurs as an independent disease. In most cases, it acts as a complication of existing pathologies that weaken the work of the immune system.