Causes and pathogenesis of balanitis

The differences in the structure of the female and male organisms explain the existence of a separate group of diseases inherent in a certain sex. Most of these pathologies are inflammatory in nature and concern the human reproductive system. One of the diseases of the male genital area is balanitis - a disease characterized by the localization of the inflammatory process on the head of the penis. Faced with unpleasant symptoms of pathology, such as redness and swelling of the penis mucosa, itching and burning in the intimate area, intensifying during sex and urination, the appearance of painful erosions and purulent plaque, many men begin to be tormented by the question of what kind of misfortune this is and what are its causes. This is exactly the question we will try to figure 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 the pain and burning during urination with balanitis.

It is known from human anatomy that the skin of the penis does not adhere tightly to its body and is considered a mobile organ, unlike the immobile delicate covering of the head. At the point where the body of the penis attaches to the head (the neck of the head), the skin gathers into a fold, forming a kind of pouch (preputial sac). This is the so-called foreskin, partially covering the head.

The skin on the inner surface of the foreskin is more delicate, so inflammation in the skin of the head quickly spreads to this part of the foreskin, and balanitis develops into another disease - balanoposthitis, characterized by combined inflammation of the head of the penis and the foreskin.

Circumcision of the foreskin in boys and men, popular among Jews, as well as other Jewish and Muslim peoples, helps avoid the development of these two inflammatory diseases. At the same time, we are talking not only about a national religious tradition, but about a real hygienic procedure, gradually gaining popularity. Today, 1/6 of the male population resorts to the circumcision procedure, which facilitates penile hygiene and is a preventive measure against many diseases, including oncology of the genital organ.

As for the prevalence of balanitis and balanoposthitis, there are no clear statistics on this matter. Doctors claim that at least 50% of men experience inflammation of the glans penis and foreskin at least once in their lives. And in most cases, we are talking about a fungal nature of the disease. True, they usually seek medical help only in severe cases of purulent inflammation, when simple hygiene of the organ, which involves careful removal of sebaceous gland secretion, sperm residues, rejected epithelial cells, bacteria, fungi, etc., accumulating under the foreskin, no longer solves the problem.

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Why does inflammation of the head of the penis occur?

Balanitis and balanoposthitis are considered to be diseases with identical pathogenesis, in which poor hygiene of the male genital organ comes to the fore. Bacteria present on our skin (opportunistic microorganisms) can accumulate and multiply in the sac formed by the foreskin. They are not a strong irritant in themselves and, with good local immunity, cannot harm the genital organ. It is another matter if a stronger irritant affects the delicate skin, causing swelling and wounds on it, and any wound is an optimal breeding ground for bacteria and fungi.

Smegma is exactly such an irritant. It is a physiological substance in the form of a fat-like substance, produced in the male body and representing a secretion of the sebaceous glands, with which the foreskin is abundantly supplied.

Smegma is necessary to ensure safe sliding of the glans penis inside the foreskin and, it would seem, should protect the delicate tissue of the glans from rubbing and irritation. But if the oily secretion 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 a strong irritant. Uric acid, getting under the foreskin from the urethra, corrodes the delicate skin of the glans and foreskin, and rough particles, when the foreskin moves relative to the glans, injure the skin with the formation of redness, swelling and erosion. Smegma itself acts as a breeding ground for bacteria and fungi, which quickly multiply and help maintain the inflammatory process.

Irritants may also include poor-quality underwear materials, penile injuries, special spermicidal contraceptive creams and lubricants used during sexual intercourse, etc. In this case, we are talking about non-infectious inflammation.

Regardless of the nature of balanitis: infectious or non-infectious, the disease causes significant discomfort to a man. 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 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 with direct contact with a chemical or mechanical irritant. How quickly symptoms of the disease appear depends on the time of contact and the immune system's response. For example, an allergic reaction to components of creams, lubricants, and underwear materials usually develops with the second or third contact. Their first use may be painless. But the body will already be sensitized, and subsequent contacts with the allergen may cause skin irritation. But with trauma to penile tissue, inflammation usually occurs within the first few hours.

The incubation period of infectious balanitis can vary significantly. It all depends on the strength of the immune system and the type of infectious agent. In some cases, acute symptoms appear a couple of days after infection, while in other patients the infection can remain dormant until the immune system weakens. Moreover, this applies to both opportunistic microorganisms and more powerful pathogens that provoke the development of sexually transmitted diseases.

Common Causes of Balanitis and Balanoposthitis

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

Primary (usually non-infectious) balanitis can develop against the background of:

• Insufficient hygiene of the penis (it should not only be washed daily with soap and water on the outside, but also the head under the foreskin should be cleaned; such procedures are also mandatory after each sexual intercourse).
• Wearing underwear that is too tight and compresses the penis (impaired blood circulation in the organ can cause trophic disorders and inflammation of its tissues).
• Using uncomfortable underwear that rubs the genitals (redness forms at the site of friction, which over time can develop into inflammation).
• Low-quality materials and synthetics in underwear (some components of the fabric and the chemical dyes used can cause allergic reactions, and synthetics can create a greenhouse effect, which negatively affects the condition of the skin of the penis and the reproductive capacity of sperm).
• Allergic and autoimmune diseases: urticaria, eczema, psoriasis, etc. (people with inadequate immune system function are more susceptible to balanitis than others, because allergy is a special case of 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 washing powder can appear after wearing underwear washed with it.
• Diabetes mellitus, which contributes to the chronicity of the inflammatory process, because high blood sugar prevents the healing of inflamed tissues and erosions. Diabetes mellitus itself does not provoke inflammation of the delicate skin of the head and foreskin of the male genital organ, but it 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 is again the lack of hygiene of the penis.
• Pathologies in which fluid retention in the body and tissue swelling occur (various kidney diseases that impair the functionality of the organ, liver cirrhosis, heart failure, etc.).
• Diathesis, which increases the predisposition to inflammatory reactions. In boys, a common cause of balanitis is exudative diathesis, characterized by a hereditary predisposition to allergic reactions. In children and adults, balanitis can be caused by such forms of diathesis as oxaluria (oxalate), phosphaturia (phosphate) and uraturia (uric acid). In these cases, the patient's urine contains a high concentration of irritants (uric acid crystals, sand, oxalic acid salts or oxalates), which, getting under the foreskin, can cause inflammation of the tissues of the head.
• Phimosis is a congenital progressive pathology characterized by narrowing of the foreskin, which disrupts the outflow of smegma, urine particles, etc. from under it. The consequences of the disease are especially noticeable during puberty with its characteristic active secretion of smegma. It is this oily liquid, retained under the foreskin, that promotes the proliferation of opportunistic and pathogenic microflora.
• Penile trauma, 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 bacterial, fungal or viral infection.

In most cases of non-infectious balanitis, the predisposing factor is improper care of the penis. Patients who have not undergone circumcision and neglect genital hygiene risk becoming more closely acquainted with this disease at any time. And those who do not pay attention to the first signs of pathology risk getting infectious balanitis, when the skin's defenses can no longer resist specific and non-specific infectious agents.

Infectious balanitis develops when fungi, bacteria or viruses get on the skin of the genital organ, and local immunity is unable 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 representatives of opportunistic microflora present on our skin and capable of provoking tissue inflammation in large quantities),
• specific infections or STIs (pathogens responsible for the development of STIs such as gonorrhea, syphilis, trichomoniasis, chlamydia, etc.),
• yeast fungi (the cause of candidiasis),
• viral infections (for example, the herpes virus, less often the human papilloma virus with the formation of genital warts).

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

A fairly common cause of balanitis is considered to be such a popular disease affecting the genitourinary system as urethritis (inflammation of the urethra, which in men runs inside the penis and ends with the 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 tissues of the head and to the prepuce, causing inflammation and damage to the delicate skin there.

Non-specific urethritis can be caused by chlamydia, mycoplasma and ureaplasma, trachomodans, gardnerella and other types of STD pathogens. The culprits of the specific form of the disease are considered to be representatives of opportunistic microflora: coccal microflora (for example, strepto- and staphylococci), various strains of E. coli, fungal infection (candidiasis), which have multiplied against the background of weakened immunity. If urethral discharge is not regularly removed from the surface of the genital organ, 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 we can see, balanitis can be considered as a disease that occurs as a result of inattentive attitude to one's health (development of chronic diseases, bad habits, physical inactivity and congestion) and improper care of the genitals, the foundations of which are laid in childhood. Its development is facilitated by an irresponsible attitude to the choice of underwear, promiscuity in sexual intercourse, ignoring the requirements for the prevention of STIs and all-consuming laziness, which prevents taking a shower and performing hygienic procedures after intercourse. And here a lot depends on the man himself.

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Is balanitis transmitted from person to person?

If non-infectious inflammation of the glans penis 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 face such a disease if her sexual partner has inflammation of the penis.

It is clear that when the cause of inflammation is not an infection, there is nothing to be afraid of. Inflammation itself cannot be transmitted to another person even through sexual contact. Another thing is that the addition of an infection can occur later (secondary balanitis), because irritation and inflammation of tissues is a noticeable blow to local immunity. And whether the general immunity will be able to restrain the spread of infection is still a question.

If nothing is done during the development of non-infectious inflammation, it is quite likely that it will soon acquire an infectious nature, because the human body, and especially in intimate places, is home to many microbes waiting for their time. And some of the microorganisms can join during sexual intercourse. For example, if a woman is diagnosed with an STD, the infection can easily spread to the man's skin and, with a weakened immune system, support the inflammatory process. If there are microdamages on the skin (and they are almost always present during inflammation), the infection penetrates the blood and causes not only local but also general symptoms.

Fungal infections, such as candidiasis, are also transmitted sexually. Although Candida fungi are considered opportunistic microflora, they can become a serious problem in large quantities. When they get on inflamed skin or wounds (which always means weakened local immunity), the fungi begin to actively multiply, and their waste products act as strong irritants that potentiate inflammation.

Doctors diagnose men with balanitis, although a similar disease can also develop in women. For example, the female variety of balanitis can be considered thrush or candidiasis of the genitals, accompanied by irritation of the skin and mucous membrane of the female genitals and vagina, the appearance of itching, and sometimes erosions.

Candidal balanitis in men develops mainly after sexual contact with a woman who has thrush. If a man's immunity is strong, he will remain a carrier of the infection, but with a weakened immunity, it is quite likely that an inflammatory process will develop on the delicate tissues of the penis. And since the head and the inner part of the foreskin remain the most sensitive and vulnerable parts of the genital organ, inflammation occurs there.

If the inflammation is caused by a sexually transmitted infection (fungi, gonorrhea and syphilis pathogens, trichomonads, etc.), both sexual partners are at risk. 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 caused by the proliferation of opportunistic bacteria, such as staphylococci, then we are not talking about infection (microbes are present on the skin of every person), but about a simple weakening of the man's immunity, which made the proliferation of bacteria possible. And blaming the sexual partner in this case is inappropriate.

It turns out that infectious balanitis is transmitted sexually. But for the disease to develop, the transmission of infection alone is not enough. For pathogens to multiply, 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 immune system.