Foreskin problems and circumcision

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What is lichen sclerosis?

Lichen sclerosis in men, also known as balanitis xerotica obliterans (or BXO), is a skin disorder characterised by white patches on the head and foreskin of the penis.

Lichen sclerosis affects around 1 in 250-1000 boys (average age of 7 years) and up to around 1 in 1000 men1.

Symptoms of lichen sclerosis

If you have lichen sclerosis, you might not have any symptoms, or you might experience:

  • Altered sensation in your penis
  • Itchiness
  • Pain during urination1.

Usually, the end of the foreskin is white and hardened, which can lead to phimosis or paraphimosis1.

Causes of lichen sclerosis

Lichen sclerosis is usually caused by long-term irritation and inflammation of the foreskin and head of the penis. Over time, the irritation and inflammation can lead to accumulation of scar tissue1.

Like balanitis and balanoposthitis, lichen sclerosis occurs more commonly in males who are uncircumcised. This suggests that the collection of skin secretions and cells (smegma) between the foreskin and the head of the penis can lead to the irritation and inflammation that start the disease1.

In uncircumcised males, urine can become trapped between the foreskin and head of the penis, which may also lead to skin irritation1.

Lichen sclerosis is associated with obesity, smoking and cardiovascular disease. There may also be a genetic component to the risk of lichen sclerosis1,2.

Diagnosis of lichen sclerosis

Lichen sclerosis is usually diagnosed based on the appearance of your foreskin3. If circumcision is required, the diagnosis may be confirmed by examining the foreskin in a laboratory after surgery.

Treatment of lichen sclerosis

Treatment of lichen sclerosis usually involves the application of steroid cream for two to three months. If this doesn’t improve or cure your lichen sclerosis, you may need a biopsy to help with further diagnosis.

Circumcision may be necessary if your lichen sclerosis results in phimosis or paraphimosis.

Health effects of lichen sclerosis

Lichen sclerosis rarely goes away on its own. If untreated, lichen sclerosis can get worse and cause phimosis, paraphimosis, painful erections and urinary problems that usually require surgery1.

Lichen sclerosis is associated with an increased risk of penis cancer, which develops in 4-8% of men who have the disease1.

A yearly review by your doctor will be necessary to keep an eye on whether your lichen sclerosis returns or progresses4.

What to do about lichen sclerosis

The appearance of white, hardened areas of skin on your foreskin or the head of the penis needs to be assessed by your doctor. If lichen sclerosis is ignored, you can develop serious complications that will affect your sexual and urinary function, and your health more widely.