Never ending balanitis and lichen sclerosus

[GGDm]

It all started about 6 years ago when I began to notice red spots on my penis and foreskin that appeared and disappeared occasionally. They only caused me discomfort when present, in the form of itching and a burning sensation.

I consulted a dermatologist who told me to stop eating sweets and it would go away. I began applying antifungal cream only when I was experiencing symptoms, and they would immediately subside.

After a while, these episodes turned into a permanent presence on my glans and foreskin, but with milder symptoms. A light-colored redness took over the upper area of the glans, around the urethra.

The symptoms also changed; from itching and burning, only a mild burning and irritation remained, plus a new symptom: a total loss of sexual appetite, which occasionally returned.

A year ago, I applied a new antifungal cream for one week and the symptoms went away, but they returned immediately upon the first sign of stress (like flying in a plane).

The dermatologist prescribed an anti-Candida antibiotic which made the situation worse. I felt the burning move from the upper part of the glans to the lower part, along the curvature, and at the same time, the burning began in my legs.

The foreskin remained permanently reddened, and the texture became strange. After several consultations at the urology department, where the doctor said it didn't seem to be anything serious, I was advised to undergo circumcision.

I had this circumcision 30 days ago, and the biopsy result was lichen sclerosus. The surgeon said "It was lichen sclerosus, now it is not."

In the first week after circumcision, all symptoms disappeared and everything was perfect, but after a week, I began to feel pain in the lower part of the glans, where the remaining foreskin makes contact. And since then, it seems like the problem has returned just where the foreskin covers the base of the glans.

I have undergone several tests, and the result is negative; they find neither bacteria nor fungi. Blood and urine tests are fine. No sexually transmitted diseases, and my partner is clean.

Has anyone else experienced similar symptoms? Should I consider another circumcision to permanently expose the glans? I still experience pain and irritation in the lower part of the glans, and my sexual appetite is very low to non-existent. Could it be that my immune system is attacking my glans? Or could it be a fungal strain that cannot be identified by tests? Or could it still be lichen sclerosus? I don't have white patches on the glans, just a dry appearance.

The only pattern I've noticed is the reaction to antibiotics; over time, whenever I took antibiotics, either my symptoms completely disappeared for two weeks and then returned, or they worsened the situation, as in the case of the anti-Candida antibiotic. Another pattern I've observed is that it gets worse when I consume a lot of alcohol or have imbalances in my life.

After circumcision, only the lower part where it contacts the skin is affected.

I appreciate any advice. I should mention that I am 35 years old, Thank you guys. Peace

[Norwich1 Moderator]

Before considering more surgery, you really need to determine what the problem is. More surgery may or may not solve your problem. A sensible way forward may be a biopsy of the affected area.

Do you have diabetes? Have you had an HbA1c test?

[GGDm in reply to Norwich1]

First of all, thank you for your response. I get my general tests done regularly, including the mandatory annual workplace tests, and no one has mentioned any suspicion of diabetes to me. The last time I had a urine analysis, I know that the glucose in the urine was normal.

My curiosity lies in whether these tests for detecting fungi actually check for any fungal strain or only specific common strains. For example, on the analysis of the glans, it says "candida albicans absent," but I know there are over 100 candida strains, not just albicans.

I want to undergo a complete allergy test as well as a test to see if immunity plays a role in these symptoms, if such a test exists...

It's frustrating that in the year 2024, after two years of medical consultations and tests, there's not even a clue as to what might be affecting me. I have never received oral antifungal treatment or more serious topical treatment...

Regarding the biopsy, I don't have a specific fixed spot on the affected gland; it appears normal, and the symptoms are not in one specific location.

My partner says it could be psychological, but sometimes the symptoms are too intense to be induced by the mind, in my opinion.

I want to wait a few months to see how the penis glans behaves after circumcision, maybe it needs some time... Although I read here that most people are relieved of problems instantly after circumcision... that's what I thought too in the first week, but it wasn't like that.

[roddythescot in reply to GGDm]

If you have a fungal infection then antibiotics will do nothing to clear it (you need an anti-fungal medication). In fact the antibiotics can make a fungal infection worse by removing bacteria (some of it highly desirable) that otherwise fights for space in your genital area and can keep some fungus away.

Having a circumcision CAN resolve problems of balanitis and BXO/LS but ONLY if it completely removes ALL of the foreskin (inner and outer layers) so as to leave nowhere for infections to hide. If you were left with any foreskin after your circumcision then you were short-changed by the doctor and it would not be surprising for symptoms to remain.

If you feel that you need a revision of your circumcision, be sure to leave 6-12 months for the initial operation to fully settle down before having more surgery.

[GGDm in reply to roddythescot]

Thank you for the info. I've learned a lot on this forum.

Starting tomorrow, I will begin a topical treatment with an antifungal cream. It's hard to believe that a problem that has been affecting me for so long could disappear after two weeks of cream treatment.

I also found on this forum a treatment using diluted povidone iodine (1ml in 40ml of water) which sounds quite interesting. I will propose this option to the dermatologist as well.

I can't imagine how a revision of the circumcision is done; I would need very little tissue removed or a slight tightening of the foreskin.

I would be interested in learning more methods to combat these genital infections. I'm curious if diet plays any role. There are all sorts of antifungal remedies, but they seem to be for gut overgrowth fungus, like sugar restriction and fermented foods .

[DeltaV]

I am older but have very similar problems. I find the steroid cream helped at first but also irritated the skin and contributed to herpes outbreaks. Things have been great for almost a year now as long as I wash and rinse well with a mild skin sensitive soap like Dove every day. As long as I don't miss a day I'm fine.

[GGDm in reply to DeltaV]

Thanks for sharing. What diagnosis do you have? Lichen sclerosus on the penis glans? I haven't received any diagnosis for my symptoms. All possibilities are valid: fungal infection, bacterial infection, or lichen sclerosus on the glans.

The fact that my circumcision is loose over the base of the glans and keeps it covered when the penis is flaccid makes me think it could be a fungal infection, but it's still strange how it has lasted for so many years.

I am currently using coconut oil on the base of the glans because it has antibacterial and antifungal properties. After that, i'll apply anti-fungical cream

[Thomas67]

Hi. I have surprisingly developed the same problem. I have recently been diagnosed as Diabetic. There is a white layer in my glans. I’ve been prescribed canestan for fungal infection. The foreskin is painful when I retract it. I guess the diabetes has affected my immune system hence the infection. Im single and only masturbate. I don’t want to have a circumsicion and wash my penis every day. It’s coming to a point, where I’m scared to look at my penis. I know circumscision is going to be suggested.

[zara1986 in reply to Thomas67]

im getting cut may 8th for bacterial balanitis...iv been fighting it for 17 years now and im getting tiered of it

[Norwich1 Moderator in reply to Thomas67]

It is more likely that you diabetes means that your urine is sweeter and things like fungal infections love sugar.

[Mann2022 in reply to Thomas67]

Have you tried steroids?

[Thomas67]

yes I’ve got some steroid cream, it reduces the inflammation, but it the infection does return after a while. I don’t want a circumcision, so will do my best to control the diabetes.

[Wellbeing5]

you need to exclude diabetes and recurrent BXO. First line of treatment is steroids cream. Please see about BXO as below. londoncircumcisioncentre.co...

[Karlos_]

For a complete treatment of BXO and yeast, you need to dry on the penis everywhere. No wet folds, no covering the glans. Then the treatment works. Re-circumcision is the solution for you. No need to wait 12 months. Find another surgeon. Who can do a low-tight circumcision. Dry will solve your problem. Me, dry everywhere on my penis, helped 100% perfectly.

[GGDm in reply to Karlos_]

Thank you so much for the advice. At the post-operative check-up, the surgeon mentioned that if he were to remove more of the foreskin, it would shorten the penis. But it seems to be the only solution...

I recently applied an anti-fungal cream recommended by the dermatologist, but, as usual, it worsened the situation. I have come to the conclusion that it is a bacterial condition, not fungal. I have a burning sensation on my hands and feet, and I am afraid it might be something systemic... I don't know whether to give up alcohol altogether; everything is a big unknown, I have no starting point.