Balanitis

A painful or erythematous glans is a clinical sign with several possible causes. Balanitis affects the glans; balanoposthitis affects both the glans and foreskin. Candida, bacteria, irritants, moisture, diabetes, obesity, immunosuppression, and SGLT2-inhibitor therapy can contribute. A similar appearance may also reflect an STI or chronic dermatosis, so treatment should follow the clinical pattern rather than redness alone. The first bedside decision is whether the foreskin is trapped behind the glans or edema is compromising circulation. Paraphimosis requires immediate emergency management. If there is no emergency, examine gently, distinguish infectious from irritant or inflammatory clues, and decide whether selective testing or assessment for diabetes or an STI is warranted. Typical mild candidal disease is managed with hygiene and a topical azole; persistence or recurrence should trigger reassessment rather than repeated empiric treatment. Systemic treatment and emergency foreskin reduction must remain within the clinician’s provincial authority, competence, and local referral pathway.