Dr.
Rajneesh Kumar Sharma MD
(Homoeopathy)
and Homoe
Balanitis and Homoeopathy
Balanitis
and
Homoeopathy
Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Dr. Swati Vishnoi BHMS
Dr. Preetika Lakhera BHMS
Homoeo Cure Research Institute
NH 74- Moradabad Road
Kashipur (UTTARANCHAL) - INDIA
Ph- 09897618594
E.
maildrrajneeshhom@[Link],
[Link]
[Link],
Contents
Definition............................................................................................................... 2
Etymology.............................................................................................................. 2
Anatomy................................................................................................................ 2
Glans.................................................................................................................. 2
Corpus cavernosum............................................................................................ 3
Corpus spongiosum............................................................................................ 3
Urethra............................................................................................................... 3
Predisposing factors............................................................................................... 3
Pathophysiology..................................................................................................... 3
Epidemiology......................................................................................................... 3
Signs and symptoms............................................................................................. 3
History................................................................................................................ 3
Physical.................................................................................................................. 4
Causes................................................................................................................... 4
Cutaneous / mucocutaneous diseases................................................................4
Phimosis............................................................................................................. 5
Unprotected sex................................................................................................. 5
Metabolic disorders............................................................................................ 5
Hygiene.............................................................................................................. 5
Irritation.............................................................................................................. 5
Organ malfunctions............................................................................................ 5
Allergy................................................................................................................ 5
Infections............................................................................................................ 6
Fixed drug eruptions ....................................................................................... 7
Traumatic ........................................................................................................... 7
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Malignancies....................................................................................................... 7
Other causes ..................................................................................................... 7
Types..................................................................................................................... 8
Balanitis xerotica obliterans...............................................................................8
Zoon balanitis..................................................................................................... 9
Circinate Balanitis............................................................................................... 9
Pseudoepitheliomatous micaceous and Keratotic balanitis of Civatte (PMKB)....9
Atrophic Balanitis................................................................................................ 9
Chronic benign circumscribed plasma cell balanitis.........................................10
Follmans Balanitis of Syphilis...........................................................................10
Psoriatic Balanitis............................................................................................. 10
Differential Diagnosis........................................................................................... 11
Laboratory Studies........................................................................................... 11
Imaging Studies................................................................................................ 11
Prevention............................................................................................................ 11
Complications...................................................................................................... 11
Treatment............................................................................................................ 11
Homoeopathic treatment..................................................................................... 12
Common remedies for Balanitis........................................................................12
Short repertory of Balanitis............................................................................... 12
Bibliography......................................................................................................... 12
Definition
The inflammation of the glans penis is called Balanitis.
Balanitis can also mean inflammation end of the clitoris.
Posthitis is inflammation of the foreskin.
Balanitis involving the foreskin as well as prepuce
balanoposthitis.
is
termed
Etymology
Greek- Balanos- Head of Penis / Glans
Latin- Posthe- Foreskin / Prepuce
+ itis- inflammation
Anatomy
The penis is the male sex as well as excretory organ. It has following parts-
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Glans
It is head of the penis and covered with pink, moist tissue called mucosa.
Covering the glans is the foreskin or prepuce. In circumcised men, the foreskin is
surgically removed and the mucosa on the glans transforms into dry skin.
Corpus cavernosum
These are two columns of tissue running along the sides of the penis. Blood fills
this tissue to cause an erection.
Corpus spongiosum
It is a column of sponge-like tissue running along the front of the penis and
ending at the glans penis. It fills with blood during an erection, keeping the
urethra open.
Urethra
The urethra runs through the corpus spongiosum, conducting urine out of the
body.
Predisposing factors
These include poor hygiene and over washing, use of over-the-counter
medications, and nonretraction of the foreskin.
Pathophysiology
Uncircumcised men with poor personal hygiene (Causa occasionalis) are most
affected by balanitis. Lack of aeration and irritation because of smegma and
discharge surrounding the glans penis causes inflammation and edema (Causa
occasionalis).
Though uncommon, complications of balanitis include phimosis (Psora/ Syphilis)
and cellulitis (Psora). Meatal stenosis (Psora) with urinary retention may rarely
accompany balanitis. In very few cases, balanitis may lead to the buried penis
syndrome (Psora/ Syphilis).
Epidemiology
Balanitis can occur in males at any age. Etiologies differ depending on age.
Signs and symptoms
History
Patient may present with following main complaints-
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Difficulty urinating or controlling urine stream (Psora/ Sycosis/ Syphilis)
Impotence (Psora)
Incapability to insert a Foleys catheter (Psora)
Irritation of the glans (Psora)
Itching (Psora)
Pain or difficulty in retraction of foreskin (Psora)
Painful urination (Psora)
Penile discharge (Sycosis/ Syphilis)
Soreness of the glans (Psora)
Systemic symptoms such as fever and nausea (Psora)
Tenderness and erythema of glans penis (Psora)
The soreness, irritation and discharge under the foreskin typically occurs
two to three days after sexual intercourse (Psora/ Sycosis)
Physical
These may include
An unpleasant smell (Psora)
Ballooning of the foreskin when passing urine (Psora/ Sycosis)
Bladder distension (Psora)
Erythema and edema of glans penis or foreskin (Psora)
Inflammation of the glans (Psora)
Lymphadenopathy (Psora/ Syphilis/ Sycosis)
Meatal stenosis (Psora/ Syphilis)
Phimosis in severe cases (Psora/ Syphilis)
Plaques (Psora/ Sycosis)
Signs of urinary obstruction (Psora/ Syphilis)
Ulceration (Psora/ Syphilis)
Under the foreskin there may be a lumpy, thick discharge (Psora/ Sycosis/
Syphilis)
Causes
Cutaneous / mucocutaneous diseases
Aphthae (Psora/ Syphilis)
Behcets Disease- Annular erythematous moist plaques with ulceration
healing with fibrosis / scarring with preceding oral ulcers / ophthalmic
involvement (Syphilis)
Dermatitis (Psora)
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Dermatitis herpetiformis / Erythema multiforme /
syndrome / Toxic epidermal necrolysis (Psora/ Syphilis)
Eczema (Psora/ Syphilis)
Herpes Zoster (Psora/ Syphilis)
Lichen planus (Psora/ Sycosis)
Pemphigus (Psora/ Syphilis)
Porokeratosis of Mibelli (Psora/ Sycosis/ Syphilis)
Psoriasis (Psora/ Syphilis/ Sycosis)
Varicella Zoster (Psora/ Syphilis)
Stevens-lohnson
Phimosis
Old sweat, urine and other substances may accumulate under the foreskin,
causing irritation and allowing germs to multiply. (Psora/ Syphilis)
Unprotected sex
If the female partner has vaginal thrush, the male may become infected,
increasing the risk of developing balanitis. Genital herpes, Chlamydia and
syphilis may also cause balanitis. (Psora/ Syphilis)
Metabolic disorders
Diabetes is the most common cause (Psora/ Syphilis)
Morbid obesity (Psora/ Sycosis)
Hygiene
Poor personal hygiene (Causa occasionalis)
Irritation
Chemicals that exist in condoms, lubricants and spermicides (Causa
occasionalis)
Some detergents if not completely rinsed (Causa occasionalis)
Some fabric conditioners if not completely rinsed (Causa occasionalis)
Some perfumed soaps (Causa occasionalis)
Some shower gels (Causa occasionalis)
Petroleum jelly (Causa occasionalis)
Podophyllin (Causa occasionalis)
Urine (Causa occasionalis)
Smegma (Causa occasionalis)
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Vesicles / Bullae with Erosions (Contact dermatitis / Fixed Drug Eruptions)
Organ malfunctions
Edematous conditions, such as right-sided congestive heart failure,
cirrhosis, and nephrosis (Psora/ Syphilis/ Sycosis)
Allergy
Drug allergies (Psora)
Infections
Anaerobic infection (Psora/ Syphilis/ Sycosis)
o Corynebacterium diphtheria
o Fusospirochaetes
Aerobic infections (Psora/ Syphilis/ Sycosis)
o Gardenella Vaginalis
o Streptococcus sp. - Beta-hemolytic streptococci of Group B and
group A
o Staphylococcus aureus
o Calymmatobacterium granulomatis
o Neisseria gonorrhoeae- Superficial Erosions with Purulent Urethral
Discharge-
(Neisseria Gonorrhoea)
o
o
o
Chlamydia trachomatis
Hemophilus ducreyi
Pseudomonas
Protozoal (Psora/ Syphilis)
o
Trichomonas vaginalis- Small Gray-White vesicles on erythematous
base +/- Ulceration with Prostatitis / Urethritis
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
(Trichomonas Vaginalis)
o Entamoeba histolytica
Parasitic (Psora)
o Scabies
o Pediculosis
o Creeping eruptions / Cutaneous larva migrans
Fixed drug eruptions (Causa occasionalis)
Tetracyclines / Sulphonamides
Carbamazepines
Dapsone
Salicylates
Erythromycin
Metronidazole
Barbiturates
Traumatic (Causa occasionalis)
Post-coital / Post-masturbation
Zip fastener laceration
Frictional trauma
Teeth bites
Excoriations
Frenal tears / Edema
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Malignancies
Premalignant conditions (Psora/ Syphilis/ Sycosis)
o Erythroplasia of Qeuyrat (Bowens disease)
o Leukoplakia
o Extramammary Pagets
Malignant diseases (Psora/ Syphilis/ Sycosis)
o Squamous cell carcinoma / Basal cell carcinoma
o Melanomas
Other causes (Psora/ Syphilis/ Sycosis)
Borrelia vincentii and Borrelia burgdorferi
Candidal species - Smooth erythematous scaly papules with satellite
pustules (Superadded inf) with peeling of skin +/- Plaques of thrush /
Maceration / Erosions
Candida albicans
Human papilloma virus
Treponema pallidum / refrigens / phaegedenis / balanitidis
Trichomonal species
Mycobacterium tuberculosis / leprae
Circinate Balanitis
Zoons Balanitis
Balanitis Xerotica Obliterans (Lichen Sclerosus et Atrophicus)
Pseudoepitheliomatous micaceous and keratotic balanitis of Civatte
(PMKB)
FB-induced (Beads / Calculi)
Post Intravesical BCG (Granulomatous BP)
Types
Balanitis xerotica obliterans
This is also called as lichen sclerosus and is a chronic dermatosis identified by
whitish plaques involving the glans and foreskin.
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Zoon balanitis
It is a reddish velvety lesion on the glans.
Circinate Balanitis
It is often seen in Reiter disease and consists of circinate and eroding lesions on
the glans with painless, serpiginous, geographic dermatitis of Glans
(uncircumcised) and Hyperkeratotic plaques.
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Pseudoepitheliomatous micaceous and Keratotic balanitis of Civatte
(PMKB)
Pseudoepitheliomatous, keratotic, and micaceous balanitis is a rare condition
characterized by verrucous excrescences with scaling. It is common after
circumcision for phimosis in adult life.
Atrophic Balanitis
It is chronic inflammation followed by atrophic sclerosis, depigmentation,
induration, phimosis and urethral Stricture.
Chronic benign circumscribed plasma cell balanitis
It is characterized by shiny red velvety plaques with cayenne pepper stippling.
Follmans Balanitis of Syphilis
It is marked by erosive indurated painless chancre over prepuce with phimosis
with doughy infiltrate, nodular or diffuse infiltrate.
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Multiple painful shallow non-indurated ulcers with undermined edges over
prepuce / glans +/- Phimosis (Chancroid)
Psoriatic Balanitis
It has bright red micaceous scaly annular plaques with cutaneous / nail / joint
involvement (Penile Psoriasis).
Differential Diagnosis
Candidiasis
Psoriasis
Laboratory Studies
Screening tests for- HIV
VDRL / rapid plasma reagin (RPR) / Treponema pallidum immobilization
test (TPI) / fluorescent Treponemal antibody absorption (FTA-ABS) for
syphilis
Blood Sugar F/PP
Urinalysis / culture
Complete Blood Counts
KOh mount (Candida)
Subpreputial swab for culture (Trichomonas)
Gram stain / ZiehlNeelsen stain (mixed infections)
Pus culture (mixed infections)
Microscopy (Spirochetes)
Tzanck smear (Herpes simplex virus)
Acetowhite test (Human papilloma virus)
Urethral swab (Gonococci)
Patch tests (Contact Dermatitis)
Skin biopsy
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
Imaging Studies
Ultrasonography lower abdomen
Bladder scan to detect urinary obstruction in severe balanitis
Prevention
Deterrence or prevention of balanitis includes the following measures
Proper personal hygiene
Control of diabetes and chronic medical disorders
Weight reduction for obese
Prevention from unsafe sexual activities
Complications
Meatal stenosis
Possible urethral strictures
Urinary retention
Vesicoureteral reflux
Phimosis
Treatment
Gentle retraction of the foreskin daily and soaking in warm water to clean penis
and foreskin is essential part of treatment. Patients presenting to the erectile
dysfunction (ED) with phimosis and severe urinary obstruction as a complication
of balanitis may need help of surgery. Circumcision may be indicated.
Circumcision is not a preventive treatment of balanitis in those younger than 3
years.
Homoeopathic treatment
Common remedies for Balanitis
Acon. alum. ALUMN. antip. APIS arg-met. Arg-n. arn. ars. aur-ar. aur-s. Aur. bell.
bry. CALAD. CALC. Calen. Cann-s. Canth. carbn-s. caust. chin. CINNB. coc-c. con.
Cop. Cor-r. crot-t. CUB. cupr. DIG. elaps Gels. graph. ham. hep. iris JAC-C. Jac-g.
KALI-CHL. kali-p. KALI-S. kreos. LACH. led. Lyc. lys. lyss. m-aust. MERC-C. MERC.
MEZ. mur-ac. nat-ar. NAT-C. Nat-m. nat-sil. Nit-ac. NUX-V. ol-sant. ozone petr. phac. PSOR. puls. RHOD. rhus-t. ros-d. sabin. sars. SEP. sil. staph. Sulph. Sumb. syc.
THUJ. viol-t.
Short repertory of Balanitis
Male - BALANITIS, penis, glans - pus, under prepuce- jac-c.
Male - BALANITIS, penis, glans- Acon. alum. Alumn. antip. Apis Arg-n. arn. ars.
aur-ar. aur-s. Aur. bry. Calad. Calc. Calen. cann-s. canth. carbn-s. caust. chin.
CINNB. Cop. Cor-r. Cub. cupr. Dig. Gels. graph. ham. iris Jac-c. KALI-CHL. kali-p.
Kali-s. lach. led. Lyc. lyss. Merc-c. Merc. mez. nat-ar. Nat-c. Nat-m. nat-sil. Nit-ac.
nux-v. ozone petr. ph-ac. Psor. Rhod. rhus-t. sabin. sars. sep. sil. staph. Sulph.
Thuj.
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
MALE - INFLAMMATION - penis - glans, balanitis gonorrheal- alum. cann-s.
canth. caust. chin. cinnb. COR-R. lach. lyc. MERC. mez. nat-c. nat-m. NIT-AC. NUXV. petr. SEP. staph. SULPH. THUJ.
MALE - INFLAMMATION - Penis - glans, balanitis- Acon. alum. Alumn. antip. Apis
Arg-n. arn. ars. aur-ar. aur-s. Aur. bry. Calad. Calc. Calen. cann-s. canth. carbn-s.
caust. chin. CINNB. Cop. Cor-r. Cub. cupr. Dig. Gels. graph. ham. iris Jac-c. KALICHL. kali-p. Kali-s. lach. led. Lyc. lys. Merc-c. Merc. mez. nat-ar. Nat-c. Nat-m. natsil. Nit-ac. nux-v. ozone petr. ph-ac. Psor. Rhod. rhus-t. sabin. sars. sep. sil. staph.
Sulph. Thuj.
MALE - INFLAMMATION - Penis - prepuce, balanitis erysipelatous- Apis ARS.
LACH. Puls. RHUS-T.
MALE - INFLAMMATION - Penis - prepuce, balanitis frenum- Calc. Nit-ac. sumb.
thuj.
MALE - INFLAMMATION - Penis - prepuce, balanitis - glands of- thuj.
MALE - INFLAMMATION - Penis - prepuce, balanitis - inner surface- crot-t. merc.
Nit-ac.
MALE - INFLAMMATION - Penis - prepuce, balanitis margin- jac-c.
MALE - INFLAMMATION - Penis - prepuce, balanitis- Acon. Apis arn. Ars. aur. bell.
calad. Calc. cann-s. Canth. CINNB. coc-c. con. cor-r. crot-t. dig. elaps Gels. graph.
hep. Jac-c. Jac-g. kreos. lach. lyc. merc-c. MERC. mez. mur-ac. nat-ar. Nat-c. Nitac. ol-sant. puls. Rhus-t. sabin. sep. sil. staph. Sulph. Sumb. syc. Thuj. viol-t.
MALE SEXUAL SYSTEM - Prepuce Inflammation- Acon. apis calad. Cann-s. Canth.
Cinnb. coc-c. con. crot-t. dig. Gels. Jac-c. lyc. merc-c. Merc. Nit-ac. ol-sant. Rhus-t.
sulph. Thuj. viol-t.
Bibliography
Chapter 189. Yeast Infections: Candidiasis, Tinea (Pityriasis) Versicolor, and
Malassezia (Pityrosporum) Folliculitis > Balanitis and Balanoposthitis Fitzpatrick's
Dermatology in General Medicine, 8e... Figure 189-3 Candidal balanoposthitis.
Multiple discrete pustules on the glans penis and inner aspect of the foreskin.
Candida spp. cause 30%35% of infectious balanitis. Factors predisposing to
candidal balanitis include diabetes mellitus, an uncircumcised state, and candidal
vaginal...
Chapter 77. Diseases and Disorders of the Male Genitalia > Zoon Balanitis
Fitzpatrick's Dermatology in General Medicine, 8e ... Zoon Balanitis at a Glance
Zoon plasma cell balanitis (ZB; properly balanoposthitis) affects the middle-aged
and older uncircumcised male. ZB is a chronic, reactive, irritant mucositis. ZB is
characterized by silent symptomatology and florid signs. Zoonoid inflammation is
a common...
Chlamydial Infections > REACTIVE ARTHRITIS Harrison's Principles of
Internal Medicine... usually papules with a central yellow spotmost often
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
Balanitis and Homoeopathy
involve the soles and palms and, in ~25% of patients, eventually epithelialize
and thicken to produce keratoderma blenorrhagicum. Circinate balanitis is
usually painless and occurs in fewer than half of patients. The initial episode of
reactive...
Dermatologic Disorders > 4. Balanitis Current Medical Diagnosis &
Treatment 2016 ... or itching. Chronicity and relapses, especially after sexual
contact, suggest reinfection from a sexual partner who should be treated. Severe
purulent balanitis is usually due to bacteria. If it is so severe that phimosis
occurs, oral antibioticssome with activity against anaerobesare required; if
rapid...
Disorders of the Genitalia, Perineum, and Anus > Phimosis, Paraphimosis,
Balanitis Xerotica Obliterans Fitzpatrick's Color Atlas and Synopsis of Clinical
Dermatology, 7e... lymphedema, Kaposi sarcoma. Precludes examination of glans
for precancerous changes. Balanitis xerotica obliterans (BXO): End stage of
chronic phimosis. Foreskin fibrotic, contracted, fixed over glans and cannot be
retracted over glans. Most often end-stage lichen sclerosus, which...
Disorders of the Genitalia, Perineum, and Anus > Plasma Cell Balanitis and
Vulvitis Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7e....
Plasma cell balanitis Solitary red glistening plaque for 10 years in an
uncircumcised male. Asymptomatic red glistening plaque(s) on glans penis or
vulva. Differentiate from squamous cell carcinoma in situ. Management:
Circumcision...
Encyclopedia Homoeopathica
Gonococcal Infections > Gonococcal Infections in Men Harrison's Principles
of Internal Medicine... inflammatory soft infiltration of the urethral wall,
periurethral abscess or fistula, inflammation or abscess of Cowpers gland, and
seminal vesiculitis. Balanitis may develop in uncircumcised men. ...
Radar 10
The Male Genitalia and Reproductive System> Glansbalanitis DeGowins
Diagnostic Examination, 10e. Acute or chronic irritation, infection, or
inflammation of the glans produces epithelial erosions or thickening with papules
or plaques. In erosive balanitis the skin of the glans desquamates with formation
of erosions and small ulcers which may become confluent, involving the entire
glans...
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Dr. Rajneesh Kumar Sharma MD (Homoeopathy)
