What is Balanitis Xerotica Obliterans (BXO) foreskin?

BXO is a thin white scaly patch which appears on the foreskin. It can cause the skin to look cracked and feel sore. This is also known lichen sclerosis atrophicus.

Who gets BXO

BXO is a disease affecting uncircumcised males ranging from young boys to adolescent and adults. This is the commonest cause of an acquired tight foreskin (BXO phimosis)

What causes BXO?

The exact cause of BXO is not known. Sometimes it is associated with diseases in which the body’s immune system attacks normal tissues.

Despite the tendency to affect genital skin, BXO is not an infection – the disease is not contagious, so sexual partners cannot pick it up. Rarely, BXO can be hereditary.

What are the symptoms of BXO?

Many patients have none, but the most common symptom of BXO is itching. As a rule the patches on the foreskin itch and can also be sore if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin, and this can interfere with sexual intercourse in affected men. BXO can make the foreskin tight and difficult to retract, and can even partly block the flow of urine.

What does BXO look like?

On the main areas of the foreskin, the spots of BXO look like small ivory-coloured, slightly raised areas, which can join up to form white patches. Some have tiny yellowish horny plugs within the pale areas. After a while the surface of the spots can look like wrinkled tissue paper. The other common sites where lichen sclerosis (the name for the same condition when it affects other parts of the body) are the wrists, the upper trunk, around the breasts, the neck and armpits.

If untreated BXO can cause the foreskin opening to tighten and shrink, leading to pain on intercourse. Less often BXO can develop in children. It can make retraction of the foreskin difficult and interfere with passing water.

How will BXO be diagnosed?

The diagnosis of BXO can usually be made from the typical appearance of the condition. This will be confirmed after the examination of the foreskin skin (a biopsy) under the microscope.

Can BXO be cured?

No treatment is likely to reverse the changes of BXO completely, but the symptoms and signs of the disease can usually be well controlled with a steroid application.

How can BXO be treated?

A variety of treatments are available for BXO. Your symptoms can be relieved by the use of steroid creams or ointments. Bland moisturisers help to soften and protect the skin.

In men, tightening of the foreskin will often respond to steroid ointments; if not, a circumcision may be worth considering. In children, circumcision is usually required.

The fragile skin of BXO may be more susceptible than normal skin to infection with Candida yeasts (thrush) or bacteria, and may split or even bleed. We will treat these problems if they arise.

What can I do?

It is thought that long standing untreated BXO can lead to a higher incidence of cancer of the penis. If you have any lumps or non-healing sores in that area, you should ask your doctor to look at them. It is very important that your GP or Urologist reviews you if BXO persists after circumcision and treatment.

Please contact us for further information & BXO treatment.