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Balanitis and posthitis: To paediatric surgeons, the most obvious medical reasons for circumcision are balanitis (inflammation of the glans) and posthitis (inflammation of the foreskin). Both are very painful conditions. The latter is limited to uncircumcised males. Balanitis is seen in 11-13% of uncircumcised men, but in only 2% of those who are circumcised [104, 190]. In uncircumcised diabetic men it is 35% [190]. In boys the incidence of balanitis is twice as high in those who are uncircumcised [116, 156]. In babies, balanitis is caused by soiled diapers, playing and sitting in dirty areas, antibiotic therapy, as well as yeast and other micro-organisms. Balanitis caused by the group A haemolytic variety of Streptococcus is present exclusively in uncircumcised boys [256].
Penile skin diseases also include psoriasis, those arising from penile infections, lichen sclerosis, lichen planus, schorrheic dermatitis, and Zoon balanitis. The various conditions have been extensively reviewed [99, 190] and are either much more common in, or totally confined to, uncircumcised males. For example, all patients with plasma cell (Zoon) balanitis, bowenoid papulosis, and non-specific balanoposthitis were uncircumcised [218]. Mycobacterium smegmatis has been implicated in Zoon balanitis [99]. Typical symptoms of the latter include erythrema (in 100%), swelling (in 91%), discharge (in 73%), dysuria (in 13%), bleeding (in 2%) and ulceration (in 1%) [190]. Lichen sclerosis is found in 4-19% of all foreskins, and in older patients progressive Lichen sclerosis or other inflammatory changes lead to phimosis [24]. Phimosis in older men is, moreover, associated with 80% of cases of penile cancer.
Balanoposthitis: (inflammation of the foreskin and glans) is common in uncircumcised diabetic men, owing to a weakened shrunken penis [104]. Diabetes is common, inherited and rising in incidence, so this, especially when there is a family history of diabetes, may add to considerations about whether to circumcise an infant at birth.
Most cases of inflammatory dermatoses are diagnosed in uncircumcised men (overall odds ratio 3.2). Thus circumcision is protective [218]. The disorders include psoriasis, penile infections, lichen sclerosus, lichen planus, schorrheic dermatitis, and Zoon balanitis (referred to above). All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosis is found in 4-19% of all foreskins. In older patients progressive Lichen sclerosis or other inflammatory changes lead to phimosis [24]. For a more extensive account on diseases of the penis see the references [99, 190].
