PRIVATE UROLOGY & ANDROLOGY • LONDON
Specialist diagnosis and advanced treatment by Mr Giulio Garaffa – internationally recognised reconstructive urologist and andrologist.
Lichen sclerosus is a chronic, progressive, inflammatory skin condition of unclear exact cause. Approximately 83% of cases involve the genitalia. When it affects the male genitalia, it has traditionally been called balanitis xerotica obliterans (BXO). Modern medical terminology more accurately refers to it as male genital or penile lichen sclerosus.
The condition primarily affects the foreskin, glans (head of the penis), coronal sulcus, and in some cases the urethral meatus. It can lead to progressive scarring, phimosis (inability to retract the foreskin), painful erections, reduced penile sensitivity, and urinary difficulties if left untreated.
Researchers believe autoimmune mechanisms, genetic predisposition, and chronic irritation play a role in its development. Early recognition and specialist management are important to prevent long-term complications.
Lichen sclerosus can present in two main forms:
Genital lichen sclerosus (BXO) occurs in men and typically affects the head of the penis (glans), foreskin, urethral meatus, and coronal sulcus. Patients may experience painful erections, reduced penile sensitivity, difficulty retracting the foreskin, and urinary problems.
Non-genital lichen sclerosus can appear on other parts of the body, including the trunk, thighs, and upper extremities. It usually presents as white, waxy, or thin patches of skin that may feel itchy, fragile, and uncomfortable.
Symptoms vary depending on the severity and stage of progression.
Many men mistake these early signs for minor irritation or a fungal infection. If left untreated, BXO can become much more serious.
Important: If you notice any of these worsening symptoms, consult a specialist urologist promptly before irreversible scarring occurs.
There is no single known cause of balanitis xerotica obliterans, but medical research points to several contributing factors. You may be at higher risk if:
Early action, such as monitoring skin changes and maintaining good hygiene, can help reduce the risk of complications.
Because lichen sclerosus / BXO can resemble other dermatological and urological conditions, a thorough evaluation is necessary. Early and accurate diagnosis can prevent future complications such as progressive scarring, worsening urinary function, and an increased risk of penile cancer.
At Mr Giulio Garaffa’s private practice in London, assessment begins with a complete medical history and a careful physical examination. If lichen sclerosus / BXO is suspected, additional diagnostic tests may be recommended.
1. Skin Biopsy
A skin biopsy is the most definitive way to confirm the diagnosis, especially in unclear or advanced cases, or when symptoms persist despite initial treatment. A small sample of affected skin is taken under local anaesthesia and examined under a microscope.
2. Urinary Flow Tests & Urethroscopy
Since BXO can cause narrowing of the urethra, further tests may be required:
The sooner specialist advice is sought, the better the potential outcome.
Concerned about symptoms of penile lichen sclerosus?
Book a private and discreet consultation with Mr Giulio Garaffa in London.
Treatment depends on how far the disease has progressed and how the individual patient responds. Mr Giulio Garaffa will recommend the most appropriate plan after careful assessment.
For many patients, treatment starts with high-potency topical corticosteroid creams. In mild cases these can reduce inflammation and irritation, slow disease progression, and improve comfort during urination and sexual activity. Some patients experience good long-term control, while others find symptoms return once treatment is stopped. If symptoms persist or worsen, a more advanced approach may be needed.
If lichen sclerosus is limited to the foreskin, circumcision is often a highly effective option. Removing the affected foreskin can prevent further scarring and inflammation. Many patients experience significant and lasting relief after circumcision.
If the disease has spread beyond the foreskin, the affected skin may need to be removed and replaced with a skin graft (commonly taken from the thigh or forearm). This procedure aims to restore both the appearance and function of the penis.
When BXO causes urethral strictures (narrowing of the urethra), patients may notice a weak stream, difficulty urinating, or discomfort. In these cases, urethroplasty may be required. This reconstructive procedure often uses a graft of buccal mucosa (tissue from inside the cheek) to rebuild the urethra. For milder strictures, a urethrotomy may provide temporary relief.
Mr Giulio Garaffa is a highly experienced consultant urologist and andrologist with international recognition in complex penile reconstructive surgery and male urogenital health. He has extensive experience managing penile lichen sclerosus and related conditions.
Patients choose Mr Garaffa for:
During your private consultation, Mr Garaffa will:
The consultation is conducted with complete discretion and professionalism in a private London setting.
Is BXO the same as lichen sclerosus?
Yes. Balanitis xerotica obliterans (BXO) is the term used when lichen sclerosus affects the male genitalia. It is essentially the same condition with a location-specific name.
What other diseases are linked to lichen sclerosus?
Lichen sclerosus is considered an autoimmune-related condition and has associations with other autoimmune diseases such as thyroid disorders, vitiligo, and alopecia areata. There is also research linking it to diabetes.
Does lichen sclerosus / BXO affect children and adolescents?
Yes, it can affect children and adolescents, although it is often underdiagnosed. In boys it can present at any age, including infancy, and may increase around puberty.
What are the long-term risks associated with lichen sclerosus / BXO?
Long-term risks include progressive scarring, urethral strictures (narrowing of the urethra), and a small increased risk of squamous cell carcinoma (a type of skin cancer). Regular monitoring is important.
Do urologists treat lichen sclerosus?
Yes. Urologists, particularly those specialising in andrology and penile reconstruction, treat BXO when it affects the male genitals and causes complications such as phimosis or urethral strictures. In London, private specialists such as Mr Giulio Garaffa have particular expertise in the diagnosis and surgical management of these conditions.
Living with penile lichen sclerosus or balanitis xerotica obliterans can feel isolating, but expert care and lasting relief are available. Early specialist assessment can help control symptoms, prevent further scarring, and restore comfort and function.
Book a private and discreet consultation with Mr Giulio Garaffa in London.