Foreskin problems and circumcision

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What is lichen sclerosus?

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

Symptoms of lichen sclerosus

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

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

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

Causes of lichen sclerosus

Lichen sclerosus 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 tissue.

Like balanitis and balanoposthitis, lichen sclerosus 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 disease.

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

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

Diagnosis of lichen sclerosus

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

Treatment of lichen sclerosus

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

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

Health effects of lichen sclerosus

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

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

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

What to do about lichen sclerosus

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 sclerosus is ignored, you can develop serious complications that will affect your sexual and urinary function, and your health more widely.