Balanoposthitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 3 Jun 2025

Last updated: 01 Feb 2024

Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term and not a diagnosis.

There are numerous causes; these can be broadly divided into inflammatory, infective, and precancerous.

The aim of diagnosis and management should be to exclude STI, mitigate sexual and urinary dysfunction, and reduce the risk of cancer of the penis.

A specific causative condition should be identified and treated effectively. Nonspecific balanoposthitis is a diagnosis of exclusion.

Patients will typically present in a primary care setting. Input from specialists, particularly dermatologists and urologists, may be very helpful in the management of poorly responsive or complex cases.

Definition

Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term rather than a diagnosis. It can be regarded as a special sort of dermatosis that occurs within a skin fold (also known as an intertrigo). By definition, balanoposthitis cannot occur in a circumcised male, although balanitis (inflammation of the glans penis) might. There are many possible causes of balanoposthitis, and these can be broadly divided into inflammatory, infective, and precancerous.[1]

History and exam

Key diagnostic factors

uncircumcised state

Full details

Other diagnostic factors

multiple sexual partners or high-risk sexual behaviors
postinflammatory hypo- or hyperpigmentation
pruritus
red scaly patches
erosions
personal/family history of atopy (eczema, hay fever, asthma, type I allergies)
personal/family history of psoriasis
urinary dribbling
hypopigmentation
purpura
red plaques
blisters
papules or micropapules
pustules

Full details

Risk factors

congenital or acquired dysfunctional foreskin
uncircumcised state
poor hygiene; urinary dribbling or leakage
overwashing
human papillomavirus (HPV) infection
inflammatory skin diseases

Full details

Diagnostic tests

1st tests to order

swab for microbiology (Gram stain and culture) and Nucleic acid amplification test (NAAT)
swab for virology
dark-field microscopy

Full details

Tests to consider

skin biopsy
patch testing

Full details

Emerging tests

dermoscopy

Treatment algorithm

ACUTE

atopic eczema

seborrheic dermatitis

irritant contact dermatitis

allergic contact dermatitis

psoriasis

reactive arthritis (Reiter disease)

lichen sclerosus

gonorrhea

candidiasis

nonspecific balanoposthitis

Zoon balanitis

carcinoma in situ/penile intraepithelial neoplasia (PeIN)

Contributors

Authors

Ien Chan, MD, FRCP

Consultant Dermatologist

Chelsea and Westminster Hospital

London

Disclosures

IC declares that he has no competing interests.

David Hawkins, FRCP

Consultant Genitourinary Physician

Chelsea and Westminster Hospital

London

Disclosures

DH declares that he has no competing interests.

Christopher B. Bunker, MA, MD, FRCP

Consultant Dermatologist

Honorary Professor of Dermatology

University College London

Chelsea & Westminster Hospitals

London

Disclosures

CBB is the owner and CEO of Bruce Shrink Ltd., the publisher of Male Genital Skin Disease, an e-book authored by CBB. He has done consultancy work for the British Skin Foundation. The fee for this work is usually paid to the British Skin Foundation. He is the honorary secretary of the British Skin Foundation, the senior Medical Trustee. CBB has provided advice to MC2, with a pipeline lichens sclerosis product, for which he has not received payment. CBB does a dedicated weekly male genital clinic at University College London Hospitals from which his employer receives income. CBB has a private practice and patients with male genital skin disorders consult him, for which he is remunerated. CBB is a frequent speaker at meetings on male genital dermatology (occasionally, his travel and accommodation are subsidised and he received honoraria) and is in receipt of a grant from a private donor, administered by the British Skin Foundation, to investigate the relationship of lichen sclerosus to penis cancer. He has been appointed to lead the 2024 reiterate of the British Association of Dermatology Guidelines on lichen sclerosus; he has previously been contributor. Occasionally, CBB provides expert advice medical litigation, for which he receives remuneration. He is an author of a number of references cited in this topic.

Peer reviewers

Jesse Mills, MD

Professor of Urology

Director of the Men's Clinic at UCLA

University of California Los Angeles

Los Angeles

Disclosures

JM declares that he has no competing interests.

Colm O'Mahony, MD, FRCP, BSc, DIPVen

Consultant in Sexual Health

Department of Sexual Health

Countess of Chester Hospital NHS Foundation Trust

Chester

Disclosures

CO declares that he has no competing interests.

Sarah Edwards, MD

Consultant

Department of GU Medicine

West Suffolk Hospital

Suffolk

Disclosures

SE declares that she has no competing interests.

David Paige, MD

Consultant Dermatologist and Honorary Senior Lecturer

Dermatology Department

The Royal London Hospital

London

Disclosures

DP declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Edwards SK, Bunker CB, van der Snoek EM, et al. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol. 2023 Jun;37(6):1104-17.Full text Abstract

Bunker CB, Watchorn RE. Dermatoses of the male genitalia. In: Griffiths C, Barker J, Bleiker T, et al. Rook's textbook of dermatology. 10th ed. Oxford: Wiley; 2024 (in press).

Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus 2018. Br J Dermatol 2018;178:839-53.Full text

Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines. Jul 2021 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Eczema and dermatitis
- Atopic dermatitis
- Seborrheic dermatitis
More Differentials
Guidelines
- European guideline for the management of balanoposthitis
- European guideline for the management of balanoposthitis
More Guidelines
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Balanoposthitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

atopic eczema

seborrheic dermatitis

irritant contact dermatitis

allergic contact dermatitis

psoriasis

reactive arthritis (Reiter disease)

lichen sclerosus

gonorrhea

candidiasis

nonspecific balanoposthitis

Zoon balanitis

carcinoma in situ/penile intraepithelial neoplasia (PeIN)

Contributors

Authors

Ien Chan, MD, FRCP

Disclosures

David Hawkins, FRCP

Disclosures

Christopher B. Bunker, MA, MD, FRCP

Disclosures

Peer reviewers

Jesse Mills, MD

Disclosures

Colm O'Mahony, MD, FRCP, BSc, DIPVen

Disclosures

Sarah Edwards, MD

Disclosures

David Paige, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice