The real reason why a condition like balanitis exists
Why does balanitis have such poor treatment response rates? Because very few treatment providers understand how truly unique our glans tissue is. There are four main features of our glans that make it different from any other part of our body and unfortunately, these four features are also the reason why balanitis is so common, long lasting and damaging.
Let's see how each one of these things contributes to balanitis...
If you followed the skin from your abdomen or legs all the way up the penile length, you would find that the skin changes quickly as you get to the glans. Starting from the base of the penis, the skin becomes softer and more elastic. As you get to the glans, the change is even more drastic. Compared to its surrounding tissue, the glans seems almost bare.
Indeed, anatomically the glans is much more vulnerable than normal skin and lacks most of the protective features found in normal skin.
The outer layer of normal skin is a lot tougher than the outer surface of our glans. The top surface (stratum corneum) of normal skin is made up of dead skin cells. It is also rich in a tough, fibrous protein called keratin. These two features combine to make our skin impermeable to irritants and defend it from physical injury.
The surface of our glans has no such physical defense..
It's top layer is made of mucocutaneous tissue. Think of it as an in-between (transitional) tissue that connects the delicate insides of our body (intestine, bronchi, urinary tract) to normal skin on the outside. Indeed our glans is one of the few places where the inside of our body comes into contact with the outside world.
The outer surface of the glans is dekeratinized and is made up of living cells. This gives it a soft, delicate feel similar to the inside of our cheeks or eye lids. While this suppleness of our glans is important for the sensory functions of the penis, it also makes our glans much more vulnerable to potential irritants.
The absence of a tough shielding surface allows harmful substances to get direct access to living cells on the glans. This means microbes multiply faster, toxins irritate cells quicker and the tissue is injured easier compared to normal skin.
Besides being more vulnerable than normal skin, our glans also encounters chemical, biological (microbes) and physical irritants more often than other areas of our body.
There are four things that constantly bring our glans across these irritants:
As a reproductive organ, the penis (more specifically our glans) is constantly exposed to friction. Even in the absence of aggressive sexual or masturbatory behavior, the glans experiences some degree of abrasion with each sexual episode. In the presence of existing glans irritation, these abrasions can get worse with further sexual activity.
Another way the penis is commonly put in the path of potential harm is through sexual exposure to your partner. Viruses, bacteria and fungi are easily transferred from one partner to another. Some microbes don't even require penetrative intercourse to expose you to potential microbial threats such as HPV, gonorrhea and genital herpes.
As a urinary organ, the penis (and by extension the glans) is constantly exposed to toxins being eliminated by our body. While our urine consists of metabolic wastes produced by our cells, these wastes don't pose a threat to our penile tissue. However, our kidneys also filter out many other water soluble chemicals that make it into our blood from our environment through food, cosmetics and breathing. A recent study revealed that the average person's urine contains over 3000 compounds out of which almost 75% are chemicals that are not native to our body. Many of these chemicals can have unforeseeable toxic effects on our glans, the final exit point of these compounds.
The location of our glans also contributes to its microbial exposure. The glans is situated in close proximity to our rectum, which contains a large amount of bacteria. There is a higher likelihood of incidental exposure to this bacteria either from cross contamination from clothing that may touch both regions or even through our hands. Our penile region also tends to breed bacteria more easily because it is often kept away from sunlight and it is harder for sweat in the groin region to dry due to the absence of moving air.
Our habits relating to penile hygiene often prove to be damaging to the glans as well. Soaps and body washes are not formulated for the penile region. Their pH is often too high and the perfumes found in them can be very harsh on the glans. Detergents and softeners used during laundry can leave residues on our clothes that can also be irritating to our sensitive glans tissue. Underwear surfaces can be abrasive to the glans and can also affect its moisture balance. All these things are common lifestyle mistakes that expose our penile tissue to irritants.
At the root of all these issues is the fact that we simply don't take special care when dealing with our penile tissue. Take for example the simple act of urinating. While it is common to wash our hands after we urinate, the fact that most people handle their penis without washing their hands first shows how penile hygiene is often looked upon as something that is not all that important. This despite the fact that debris and germs are easily transferred onto penile tissue, which is more vulnerable than normal skin.
Not only is our glans a very vulnerable piece of tissue that is constantly exposed to irritants, it reacts to these irritants in a much harsher way than other parts of our body.
Consider the delicate balance that our body has to maintain when it comes to the glans...
One the one hand, our glans plays a vital role as a sensory organ during sexual reproduction and for this purpose, the body has devoted a rich supply of nerves close to its surface. On the other hand, there is a crucial need to protect this delicate tissue from damage. In exchange for the lack of a protective surface, our body dedicates an increased level of immune surveillance on our glans. This is achieved through a rich network of blood vessels that maintain an abundance of immune system cells capable of detecting any potential threat on the surface of the glans.
Unfortunately, this delicate balance can be easily disrupted and the very things that are meant to support our glans function begin to work against us:
|GLANS FEATURE||BENEFIT||RISK DURING BALANITIS|
|Rich supply of nerves on the surface||Plays sensory function during sexual reproduction||More nerves mean more pain|
|Rich supply of blood vessels close to the surface||Brings protective immune system cells to surface||More blood vessels means more damaging inflammation|
|Increased immune system surveillance on the surface||Faster detection of threats on glans surface||Higher immune sensitivity means immune attack is easily launched|
Add to this the fact that our glans is prone to irritant exposure and you can see why our body has such a difficult time reestablishing the delicate balance of our glans functions.
Usually tissues with rich blood supplies tend to heal faster from injuries, however our glans is an exception to this rule. The reason our glans tends to heal poorly from inflammatory damage has to do with its function.
Even if you abstain from sexual activity, it is difficult to give your glans complete rest. The average person passes urine several times a day which causes the inflamed tissue to repeatedly expand and contract. Studies have shown that physical movement in injured tissue increases scar formation - one of the biggest threats of balanitis.
Scarring leads to a permanent loss of tissue function and makes your glans more prone to damage from future balanitis flare-ups. Scars also have a tendency to grow in areas with frequent movements. That's because scar tissue lacks the ability to stretch as efficiently as healthy tissue and the penile tissue's function relies on its remarkable ability to significantly stretch. This further irritates the region around the scar tissue, causing greater scarring.
While scarring on our skin is usually not a major concern, when it comes to the glans, even a small amount of scar tissue formation can have drastic repercussions. That's because the function of our glans is concentrated on a tissue no bigger than a 2 inch square. It takes very little damage to wipe away a proportionately larger percentage of glans function as compared to the rest of our skin.
As you can see, not only do these unique features make our glans more likely to experience damage but these features often combine to make balanitis the extremely resilient condition that it is.