Persistent Inflammation and Red Spots on the Glans

After the inflammation of the foreskin, there are red spots on the glans?

Hello, doctor.
My situation started with occasional pain on the right side of my penis or foreskin.
When I pulled back the foreskin to observe, there didn't seem to be any abnormalities, but I noticed a few small white spots near the frenulum under the glans.
After about six days, the condition persisted, so I went to see a urologist.
The doctor asked if I had engaged in sexual activity, but I have never done so, only manual stimulation.
After examining me, the doctor said my foreskin was inflamed and red, and the white spots were a normal secretion of oil.
The doctor prescribed a topical cream (Bacitracin) to apply twice daily, advising me to wash with clean water before application, and to return in a week if I still felt discomfort.
When I got home, I retracted the foreskin completely to take a closer look, and I noticed two very red areas on the skin behind the glans.
I applied the ointment to the inflamed areas.
Normally, when I urinate, the glans is covered by the foreskin, and some urine tends to remain.
After applying the ointment, I would retract the foreskin during urination, shake off any remaining urine, and dry with tissue paper.
After ten days, I felt no improvement; lying down or having my pants press against the area caused discomfort.
I returned to the clinic, and the doctor mentioned that my foreskin seemed to be too long, suggesting I continue applying the ointment for another week.
Seven days later, with no improvement, I went back to the clinic.
The doctor prescribed Clotrimazole ointment and Neomycin ointment, instructing me to apply them twice daily and to return next week if there was no improvement, at which point we would consider circumcision.
Two days later, which is now, I have developed red spots on the glans, and there is some discharge from these spots.
Previously, I would wash under the foreskin daily, and I had experienced redness and irritation of the foreskin less than five times, with recovery in two days each time.
I have never had such extensive redness and inflammation of the foreskin as I do now, and despite following the instructions to apply the ointment for a month, there has been no improvement.
Doctor, what could be the cause of this persistent inflammation? If the redness and swelling continue, should I consider circumcision?

A De, 30~39 year old female. Ask Date: 2016/01/02

Dr. Xu Weikai reply Urology

Hello, here are the recommended cleaning methods for the glans and foreskin:
1.
Clean the glans several times a day.
2.
It is best to clean any urine residue after each urination; washing is preferable, but if that's not convenient, simply patting dry is sufficient.
3.
Cleaning method: Use only cool, clean water.
Absolutely avoid using soap, body wash, or any cleaning agents.
If you experience dryness, you may apply a small amount of petroleum jelly, baby oil, or a gentle, non-irritating moisturizer.
4.
If this issue occurs frequently, there may be other underlying problems, and it is advisable to seek professional medical advice.
If you have any further questions, feel free to ask for more discussion and research.
Information obtained online should only serve as a reference; if necessary, you should visit a medical facility for treatment.
Sincerely,
Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/02

More Info

Persistent inflammation and red spots on the glans can be concerning and uncomfortable. Based on your description, it seems that you have been experiencing ongoing symptoms, including pain, redness, and the presence of small white spots, which have not improved despite treatment.
First, it's important to understand that inflammation of the glans (the head of the penis) and the foreskin can have several causes. Common causes include infections (such as bacterial or fungal infections), irritations (from soaps, lotions, or other products), and conditions like balanitis or posthitis. In your case, the initial assessment by your urologist suggested that the small white spots were likely normal sebaceous glands, which can be mistaken for something abnormal.

The treatment you received, including the use of topical ointments like the "益四聯乳膏" (a combination ointment), is typically aimed at reducing inflammation and treating any potential infection. However, if there is no improvement after a reasonable period, further investigation is warranted.
The fact that you are experiencing persistent symptoms, including the development of red spots with exudate, raises the possibility of a more significant underlying issue. It could be a sign of a persistent infection, an allergic reaction, or another dermatological condition that requires a different approach to treatment.
Regarding your question about circumcision, this is often considered when there are recurrent infections or significant inflammation that does not respond to conservative treatments. Circumcision can help by removing the foreskin, which may harbor bacteria and contribute to ongoing irritation. However, this decision should be made in consultation with a healthcare provider who can assess your specific situation, including the severity of your symptoms and the effectiveness of previous treatments.

In the meantime, here are some recommendations:
1. Maintain Hygiene: Continue to keep the area clean. Gently wash the glans and foreskin with mild soap and water. Avoid harsh soaps or products that may irritate the skin.

2. Avoid Irritants: Be cautious with any products you apply to the area, including lotions, creams, or even certain types of underwear that may cause friction or irritation.

3. Follow-Up: Since your symptoms have not improved, it is crucial to follow up with your urologist or a dermatologist. They may consider performing a culture to identify any infectious agents or recommend a biopsy if they suspect a more serious condition.

4. Monitor Symptoms: Keep track of any changes in your symptoms, including the appearance of new lesions, changes in pain levels, or any systemic symptoms like fever or malaise.

5. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another urologist or dermatologist may provide additional insights or treatment options.

In summary, persistent inflammation and red spots on the glans can be due to various factors, and it is essential to work closely with your healthcare provider to determine the underlying cause and appropriate treatment. If conservative measures fail, circumcision may be a viable option, but this should be discussed thoroughly with your doctor.

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