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Balanitis Xerotica Obliterans

Last updated May 6, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Balanitis Xerotica Obliterans (BXO) is a chronic condition in which the foreskin of the penis (prepuce) is scarred and fixed over the head of the penis (the glans penis).


What are the other Names for this Condition? (Also known as/Synonyms)

  • BXO (Balanitis Xerotica Obliterans)
  • Lichen Sclerosis of Penis
  • Penile Lichen Sclerosis

What is Balanitis Xerotica Obliterans? (Definition/Background Information)

  • Balanitis Xerotica Obliterans (BXO) is a chronic condition in which the foreskin of the penis (prepuce) is scarred and fixed over the head of the penis (the glans penis). In other words, it is not possible to retract the foreskin to cover the penis head
  • The cause of the condition is unknown in a majority of cases, but some researchers believe that it is the end-stage of chronic phimosis
  • The signs and symptoms of Balanitis Xerotica Obliterans include itching and pain during urination and sex, leading to complications such as urination difficulties
  • Balanitis Xerotica Obliterans is observed in middle-aged men. An early diagnosis and treatment of BXO is very important to prevent irreversible damage to the penis. The prognosis depends upon several factors and may be guarded

Who gets Balanitis Xerotica Obliterans? (Age and Sex Distribution)

  • Balanitis Xerotica Obliterans is a condition of the penis that usually affects men in the 30-50 years age group. However, older men are also known to be affected. BXO is rarely seen in children
  • The condition is observed worldwide and no geographical preference is seen. Males of all racial and ethnic background may be affected and no definitive predilection exist
  • However, some studies have shown that the condition is more prevalent in African Americans and Hispanics than Caucasians

What are the Risk Factors for Balanitis Xerotica Obliterans? (Predisposing Factors)

The risk factors for Balanitis Xerotica Obliterans may include the following:

  • Chronic phimosis
  • Chronic infections
  • Poor hygiene
  • Vigorous sexual activity
  • Lichen sclerosis
  • Trauma or injury to the groin region
  • Paraphimosis can occur in healthcare facilities during surgical procedures, such as Foley’s catheter insertion

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Balanitis Xerotica Obliterans? (Etiology)

In a majority of the cases, the cause of development of Balanitis Xerotica Obliterans remains unknown. However, it is linked to the following conditions:

  • Chronic phimosis in which the foreskin cannot be retracted over the penis head
  • Some scientists believe that there may be a genetic association, because the incidence of BXO is higher in twins
  • Human papillomavirus (HPV): There is no definite proof though that BXO is caused by HPV

What are the Signs and Symptoms of Balanitis Xerotica Obliterans?

The signs and symptoms of Balanitis Xerotica Obliterans, which is a chronic skin condition, may include:

  • The foreskin is too tight or stuck in a retracted position and the glans penis stays uncovered
  • The foreskin or prepuce is scarred
  • Itching and pain during urination
  • Pain during erection and sexual intercourse
  • Swollen penis head that may be painful

How is Balanitis Xerotica Obliterans Diagnosed?

The following are the diagnostic methods that may be helpful for Balanitis Xerotica Obliterans:

  • A thorough physical examination and a complete medical history is very important
  • Blood tests to rule out infections
  • Tests and examinations as required for underlying conditions or infections

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Balanitis Xerotica Obliterans?

The complications due to Balanitis Xerotica Obliterans may include:

  • Difficulty in urination can cause pooling of the urine within the urethra with the potential risk of urethral stone formation. This can make urination even more difficult or painful
  • BXO can result in urethral stricture that can further cause frequent or recurrent urinary tract infections
  • Individuals may have severe stress and anxiety issues
  • Any attempt by the individual to forcibly close the penis head can cause bleeding, pain, and scarring of the tissue, which makes the condition worse
  • Severe discomfort and pain during sex
  • If emergency medical care is not provided, then it can lead to gangrene formation with permanent tissue death
  • Some studies have shown that Balanitis Xerotica Obliterans increases the risk for squamous cell carcinoma; however, this has not been definitely proven

How is Balanitis Xerotica Obliterans Treated?

In a majority of cases, emergency treatment may be required to address Balanitis Xerotica Obliterans. Nevertheless, in many, BXO remains a progressive condition with no definite cure.

The following treatment measures may be considered for Balanitis Xerotica Obliterans:

  • Application of topical steroid creams and lotions, topical tacrolimus
  • Surgery to remove scar tissue
  • In case of urethral stricture, urethroplasty surgical procedure can be performed that can help the individual to urinate better
  • Under the influence of local anesthesia, the healthcare provider may attempt to pull back the foreskin into its normal position, over the penile head
  • Surgical treatment measures may include prepucioplasty procedure: It is the partial removal of the prepuce to decrease the pressure, making it easier for the prepuce to retract over the glans penis
  • Treatment of the underlying condition that caused BXO
  • Circumcision may be considered after retraction of the foreskin, usually when individuals present with severe signs and symptoms
  • Providing reassurance and helping with anxiety feelings
  • Abstinence from sex, until the condition heals completely

How can Balanitis Xerotica Obliterans be Prevented?

The following factors may be considered towards the preventative steps for Balanitis Xerotica Obliterans:

  • Prevent phimosis by treating any infections early and in a timely fashion
  • Refraining from intense sexual activities or ensuring care during sexual activity may be helpful in some cases
  • Maintain personal hygiene including keeping the genitalia clean, which may prevent the condition from getting worse
  • Circumcision can prevent the occurrence of phimosis
  • Early medical care and treatment of any penile lesions
  • Avoid forcibly pulling the foreskin over the penis head; for this may cause additional complications
  • Follow-up care with regular screening and check-ups are important

What is the Prognosis of Balanitis Xerotica Obliterans? (Outcomes/Resolutions)

  • Balanitis Xerotica Obliterans is a condition that needs to be addressed on an emergency basis. Prompt medical attention and appropriate treatment may help ensure an optimal outcome
  • However, the outcome also depends upon the underlying reason for BXO

Additional and Relevant Useful Information for Balanitis Xerotica Obliterans:

  • There are 2 types of phimosis and these include physiologic phimosis and pathologic phimosis
  • Circumcision is the surgical removal of skin around the tip of the penis, which is also known as the foreskin or prepuce

The following article link will help you understand circumcision:

http://www.dovemed.com/common-procedures/procedures-surgical/circumcision/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 19, 2015
Last updated: May 6, 2018