Circumcision Surgery: Procedure, Healing Time, and Benefits
Circumcision surgery is a medical procedure that involves the removal of the foreskin, the retractable fold of skin covering the head of the penis. It is commonly performed for medical,
Lichen sclerosus is a chronic, progressive, sclerosing inflammatory skin condition of unclear etiology. If you or someone you know is experiencing changes in the skin of the genital area, it’s important to be aware of this condition.
Approximately, 83% of lichen sclerosus cases involve the genitalia, and in men, this condition has traditionally been called balanitis xerotica obliterans (BXO). This term was first introduced by Stühmer in 1928 as a post circumcision phenomenon. However, modern medical terminology refers to it more accurately as male genital or penile lichen sclerosus.
In this blog article, you will learn about the symptoms, causes, and treatment options for BXO, helping you recognise the signs early and seek the right care.
Lichen sclerosus (LS) is a chronic, inflammatory skin disorder that primarily affects the genital and perianal regions in both men and women. When it affects the male genitalia, it is referred to as balanitis xerotica obliterans (BXO).
If you have LS, you may notice changes in your skin, but the exact cause remains unclear. However, researchers believe that autoimmune mechanisms, genetic predisposition, and chronic irritation play a role in its development.
Lichen sclerosus can present in two primary forms. Genital lichen sclerosus (BXO) occurs in men that affects the head of the penis (glans), foreskin, urethral meatus, and coronal sulcus. If you have BXO, you might experience painful erections, reduced penile sensitivity, and urinary difficulties.
The non-genital lichen sclerosus can appear on any part of the body, including the trunk, thighs, and upper extremities. You might notice white, waxy, or thin patches of skin that feel itchy, fragile, and uncomfortable.
If you suspect you have BXO, it is crucial to recognise the symptoms early. Lichen sclerosus symptoms vary depending on the severity and stage of progression:
At first, LS may not seem like a serious issue. You might just notice changes in your skin texture or color. However, these early signs should not be ignored:
Many men mistake these early signs for minor irritation or a fungal infection. But if left untreated, BXO can become much more serious.
If the condition progresses, you may experience increasing discomfort and structural changes in the penis:
If you notice any of these worsening symptoms, consult a urologist immediately before irreversible scarring occurs.
There is no single balanitis xerotica obliterans cause, but medical research points to several contributing factors. If you fall into any of these categories, you may be at a higher risk:
If you suspect you might be at risk, taking early action, such as monitoring skin changes and maintaining good hygiene, can help prevent complications.
Since LS/BXO can resemble other dermatological and urological conditions, a thorough evaluation is necessary. Early and accurate diagnosis of lichen sclerosus can prevent future complications.
On the other hand, delaying treatment and diagnosis can lead to progressive scarring, worsening urinary function, and increased risk of penile cancer.
At Dr. Garaffa’s best urology clinic in London, we always begin by taking your complete medical history and conducting a thorough physical examination. If LS/BXO is suspected, we conduct additional diagnostic tests to rule out all possibilities.
A skin biopsy is the most definitive way to confirm LS/BXO, especially in unclear or advanced cases. It is also necessary when symptoms persist, despite initial treatment. For the biopsy, a small sample of affected skin tissue is taken under local anesthesia and examined under a microscope. It helps to identify characteristic signs of LS/BXO and rule out other conditions.
Since LS/BXO can cause narrowing of the urethra, a Uroflowmetry or Urethroscopy may be required.
This test measures the speed and volume of urine flow.
A small, flexible camera (cystoscope) is inserted into the urethra to examine the urethral lining for strictures, inflammation, or scarring.
The sooner you seek medical advice, the better your outcome will be. If you recognise any of these symptoms in yourself, do not hesitate to consult a specialist.
If you have been diagnosed with lichen sclerosus or BXO, you might feel uncertain about what comes next. With Dr. Giulio Garaffa, the best treatment options are available to help manage symptoms, restore function, and prevent complications.
The right approach depends on how much the disease has progressed and how well your body responds to treatment.
For many patients, treatment starts with high-potency topical corticosteroid creams. If your symptoms are still mild, your dermatologist may prescribe these creams to:
Whilst some patients experience long-term relief with steroid therapy, others find that symptoms return once they stop using the cream. If that happens to you, or if your symptoms worsen despite treatment, a more advanced approach will be required.
If your condition has progressed to the point where scarring, tightness, or pain are interfering with daily life, surgery may be the best option. The goal is to remove the affected skin and restore both urinary and sexual function.
If your lichen sclerosus is limited to the foreskin, a circumcision may be all that’s needed to resolve the issue. This procedure removes the diseased foreskin, preventing further scarring and inflammation.
Many patients experience tremendous relief and no further progression of the disease after circumcision.
If the disease has spread beyond the foreskin, removing the affected skin may be necessary.
It will be replaced with a skin graft taken from another part of your body, such as your thigh or forearm.
This procedure can restore both the appearance and function of your penis.
If BXO has caused urethral strictures (narrowing of the urethra), you may notice difficulty urinating, a weak stream, or discomfort. In these cases, a urethroplasty may be needed. This procedure rebuilds the urethra using a graft of buccal mucosa (tissue from inside your cheek).
For milder strictures, a urethrotomy can provide temporary relief.
If you are experiencing symptoms, do not delay. Early treatment can prevent complications and help restore your quality of life.
Consult Dr. Giulio Garaffa to explore the best treatment plan for you.
BXO (Balanitis Xerotica Obliterans) is the term used when lichen sclerosus affects the male genitals. Basically, it is the same condition, but with a location-specific name.
Lichen sclerosus is considered an autoimmune condition, and there are links to other autoimmune diseases, such as thyroid disorders, vitiligo, and alopecia areata. There is also research that links it to diabetes.
Yes, lichen sclerosus/BXO can affect children and adolescents, though it is often underdiagnosed. Whilst it can occur at any age, there are two peaks in prevalence: prepubertal girls and postmenopausal women. In boys, it can present at any age, even infancy, but also increases around puberty.
Long-term risks include scarring, urethral strictures (narrowing of the urethra), and an increased risk of squamous cell carcinoma (a type of skin cancer).
Yes, there is treatment of BXO in urology, particularly when it affects the male genitals and causes complications like phimosis or urethral strictures. In London, private urologists like Dr. Giulio Garaffa specialise in the diagnosis and management of these conditions.
Living with lichen sclerosus or balanitis xerotica obliterans (BXO) can feel isolating, but expert care and lasting relief are within your reach. Dr. Giulio Garaffa is a world-renowned expert in penile reconstructive surgery and male urogenital health. With 20 years of international experience in treating complex cases, he offers personalised treatment plans designed to relieve symptoms, restore function, and improve your quality of life.
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Mr Giulio Garaffa is a highly experienced, award-winning Consultant Uro-Andrologist with over 20 years of international medical expertise.
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