For the last year I've been dealing with a balanitis problem, although it doesn't perfectly fit the description. This is totally invisible to the naked eye - no rash, no smegma, no blotches. The foreskin seems to get injured way too easily during sex, it often feels bruised afterwards and then it takes way too long to heal. The foreskin is also sometimes abruptly very tight and which leads to tiny cracks. If I ignore these problems and continue to have sex then the cracks get worse and very painful. Most strangely I have sometimes felt the skin crack when not even erect, ie in the shower.
I'm in my early 40s and up until now I was quite capable of having sex three times in a day. At the moment, sex means extra lube and taking it easy, days off in between. It's very hard to feel sexually confident because the problems come and go quite randomly. For example, everything will be normal and I'll be good Monday and Tuesday. Then suddenly, without warning, sex will really hurt on Wednesday.
I have seen a doctor and was prescribed hydrocortisone and clotrimazole. This worked the first time, but over the last year it has returned several times and at the moment these medications don't seem to work at all.
Where I live the health system is not good at solving tricky problems. If it takes more than five minutes to diagnose - you're more or less on your own. Also because there's nothing visibly out of the ordinary I'm reluctant to see a doctor again without as bringing as many ideas as possible with me. So that's why I'm here, looking for ideas, advice or at least moral support. Anyone?
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arctic_fox
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As you problem is atypical for balanitis, it would be sensible to arrange to see a dermatologist. You need to have biopsies to find out what is actually going on.
Hey mate , I had similar issue and I am around your age too . I tried steroid cream and even my foreskin issue was barely visible to naked eye . Seems the foreskin tightness increased for me and I went for a circumcision . Still in post recovery phase so can’t advise results yet . But doc def advised circumcision .
Hi, reading your very helpful description, I think it would be worthwhile seeing a dermatologist, with an interest in genital skin If possible, and specifically ask him/her to consider lichen sclerosus as a possible cause. You are describing symptoms very similar to my own, including the absence of any skin whitening which is one of the “classic” symptoms, but the rest of symptoms described are very similar. I am being treated, successfully, with corticosteroids and I am now on a low potency maintenance regime. I wish you all the best.
Yes, I suspect this is a mild or atypical case of LS. It seems to improve with hydrocortisone but clotrimazole does nothing. So far I've been reluctant to believe it's LS because so little is known about it. It's more intuitive to imagine that it's bacteria or fungus that can be killed off. Also two doctors have told me that it's probably fungal. I think a low maintenance dose of hydrocortisone is the way to go from here.
If you want to go with topical corticosteroids, which I would recommend, you need to increase the strength of the medication. Consider talking to your doctor about a course of clobestol/dermovate 2x/day for a month and then review. All the best.
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I think rather more is known about it now. There is a very strong link to urine and autoimmune disease however the mechanism is, as you say, not understood. At this point the only options are ultra potent corticosteroids and/or circumcision. For me, circumcision is very much a last resort option however other will feel differently.
Thanks for the useful advice, very much appreciated. Do you think there are any side-effects from the steroid creams, especially long-term? I've noticed a dull ache sometimes and some odd sensations. Does the application of steroid creams need to be precisely to the area? I have an appointment for a dermatologist but it's still two months away.
Steroid creams come in a wide variety of strengths and you do have to be very respectful with the stronger ones. There are risks if they are abused but they can also be used very successfully long term by alternating their use and frequency of use.
The treatment of women with LS is only medical, as surgery is not a curative option, and will involve the very long term use of these drugs.
They are best applied to the targeted area only, washing your hands afterwards.
Hydrocortisone is at the weak end of the scale and can be bought without prescription. If you do have LS, a dermatologist will prescribe an ultra potent steroid such as clobetasol which will probably temporarily slightly thin and bleach the skin.
Could I also suggest, at least until you have seen a dermatologist, that:
you stop using soap in the genital area, or whole body ideally, and use an unscented emollient instead to avoid any drying of the skin; and
Consider using an emollient barrier cream under the foreskin such as epaderm; and
ensure that you do not let any urine become trapped within the foreskin, ideally washing with water and drying post urinating as a reaction to ones own urine is believed to causal for lichen sclerosus.
Here's an update: I did eventually get to see a dermatologist. They diagnosed it as dermatitis and thoroughly convinced me that this is not lichen sclerosus. So now I see this as a dermatitis problem. I'm still using hydrocortisone daily and I have not had balanitis since then, but I do sometimes get discomfort during sex. So I don't think I can reduce the dose at all, at least not yet. I was also prescribed elidel (pimecrolimus) and have just started trying that out. I can't see any other information about pimecrolimus on here though, in fact a search turns up a fat zero.
That's good news so, you have been diagnosed and it's not LS. Stick with the treatment any skin problems can take a long time to go or get under control.
Thanks for the update and do keep us informed of your progress
Very pleased that you got a definitive diagnosis and it’s not LS. Pimecrolimus is mostly prescribed for conditions like eczema when topical corticosteroids are not considered appropriate. I did a quick search as well and I came up with a number of results. I thought this one more helpful.
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