Diagnosis is made on clinical grounds. Diagnosis may be difficult for the inexperienced because of the diversity of clinical features, which may mimic a variety of conditions.
Although candida and bacteria may be isolated from the inflamed area, medication has a limited role and is best avoided in most cases. The basis of treatment is to keep the foreskin clean and dry. The patient should clean the glans with water 2 to 3 times a day and pat dry. The foreskin should be retracted to expose the glans to the air, a fan or a reading light for 15 minutes. Individuals prone to balanitis should routinely perform this procedure nightly or at least several times a week. The patient should not retract a tight foreskin as paraphimosis is likely to occur.
If this procedure is not effective or if the foreskin is tight, circumcision should be considered.
The following points should be discussed:
- The nature of the condition
- The need for hygiene rather than medications or creams
- Abstinence from sex during episodes as this may flare the condition
- Routine hygiene after sex will help to decrease the chance of developing balanitis
- The foreskin should always be retracted during urination
- Provide literature on balanitis.
Follow up is required only if symptoms do not resolve.