What could cause my penis to be red & itchy?

Q. My penis has redness, itching and a white discharge - other than an STI [sexually transmitted infection], what could be the cause?

A. Balanitis is a dermatological condition that affects the skin of the head of the penis. Balanitis is more likely to occur if there is phimosis, a condition where a tight foreskin can't retract back over the penis. It can occur often as a personal hygiene issue in boys and in men, especially those who are not circumcised. If the foreskin is not washed regularly, bacteria, dead skin cells, and sweat can accumulate.

The foreskin and the head of the penis may be sore, itchy and have an unpleasant smell. The skin could be red and swollen, and there may be pain when urinating. One of the classic symptoms is smegma, a whitish sebaceous secretion composed of accumulated dead skin and oily secretions. Balanitis can be caused by irritation under the foreskin caused by urine, soaps, shower gels and other skin irritants.

Other skin conditions such as eczema, psoriasis and reactive arthritis can also result in balanitis.

Young children and older boys may not yet be able to clean under their foreskin because it may not fully pull back yet. It's not usually serious, and although it is not an STI it can occur at the same time as an STI in those who are sexually active.

Treatment involves good or improved personal hygiene. When the doctor gives a diagnosis and if other specific causes are identifiable, direct management is required. Condom use for safer sex is important. Management generally consists of topical antibiotics for bacterial infections, topical steroid creams for inflammation and topical antifungals for one to three weeks.

If required, a urologist may be consulted for specialist advice.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za. Mofokeng has been named SA's Commissioner of Gender Equality by President Cyril Ramaphosa.

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