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Balanitis Xerotica Obliterans (BXO), also known as lichen sclerosus et atrophicus,  is a rare inflammatory skin disorder that affects the penis. It is especially common in uncircumcised males. The condition can cause inflammation, scarring and potentially lead to phimosis, or narrowing of the foreskin opening. In severe cases, BXO can cause difficulty with urination, pain, sexual dysfunction and the inability to retract the foreskin. 

inflamed penis treatment california

When it comes to penis health, few conditions can be as concerning as BXO. The inflammation it causes can lead to serious complications, so prompt action is required on the part of the patient if they are showing symptoms. 

Fortunately, California Adult Circumcision at Alvarado La Mesa Medical Center is here to help. Our board-certified urologist, Dr. Mo Bidair specializes in circumcision, and he provides compassionate care that helps men find relief from BXO. To schedule an appointment, call (619) 486-5005 or complete our inquiry form for more information.

About BXO

Balanitis xerotica obliterans is an inflammatory condition of the foreskin that results in thickening and hardening of the skin. The affected area becomes shiny and white, often with a “stuck on” appearance. In some cases, the scar tissue can extend all the way to the glans (the head of the penis). It can cause pain, discomfort, and severe itching. In rare cases, it can even lead to erectile dysfunction.

Why Do People Get BXO?

The exact cause of BXO is still unknown, but it is thought to be related to an abnormal response of the immune system to some type of irritant. In fact, recent research proposes that infections, trauma to the penis, or chronic inflammation can lead to the condition’s development.(1) BXO is more common in uncircumcised men and can occur at any age, but it’s most frequently seen in boys between the ages of 4 and 10.

What are the Main Symptoms of BXO?

BXO typically presents with white, patchy lesions on the glans penis (the head) and prepuce (foreskin). These patches are firm but not painful and they may become thickened and leathery over time. BXO can also cause redness, burning, itching, tenderness and occasional bleeding. If left untreated, the lesions can eventually lead to phimosis, which can make urination difficult and increase the risk of infections.

Can I Pass BXO on to My Partner?

Although it is an unpleasant condition, BXO is not a sexually-transmitted infection. It cannot be passed from one person to another through sexual contact or skin-to-skin contact.

A ten-year retrospective study of patients with BXO revealed the following data.(1)

  • 62.6% of study participants had foreskin scarring
  • 47.2% of patients had foreskin and shaft involvement
  • 26.4% had a foreskin, glans, and meatus involvement

At California Adult Circumcision, Dr. Bidair provides safe and effective circumcision procedures to adult males. He uses state-of-the-art techniques and technology to ensure the best possible outcome. To learn more about circumcision and how it can benefit you, contact us to schedule a consultation.

Medications for BXO

Topical Steroids

In cases of BXO, topical steroids like betamethasone and triamcinolone may be used as a first-line treatment to reduce inflammation and shrink the affected tissues. In one study, 35% of patients avoided circumcision because of topical steroid use.(2)

In some cases, however, BXO may become secondarily infected and topical steroids could exacerbate the infection. It is important for patients to be aware of these potential risks before using topical steroids and to seek medical advice from an experienced physician like Dr. Bidair if symptoms worsen or the condition does not improve.

Testosterone Propionate Ointment

Testosterone propionate ointment is applied topically to the affected area. When absorbed through the skin, it binds to androgen receptors, which are proteins found in cells throughout the body. This binding activates the androgen receptor and initiates a chain of events within the cell, which ultimately leads to reduced inflammation, improved circulation, and restored tissue structure.


Long-term antibiotics may be used to treat the symptoms of BXO, however, side-effects vary from patient to patient, and they may not be the best long-term solution.

Why Choose Circumcision?

Circumcision is a surgical procedure that removes the foreskin from the penis. In addition to being a religious tradition, circumcision often provides health and sexual benefits. Additionally, pathological phimosis, or the tightening of the foreskin, is a serious condition that can occur with BXO. Where this happens, it is medically necessary to undergo circumcision.(3) For those who are considering circumcision, there are many other advantages to the procedure. 

Key Benefits of Circumcision

  • Reduced Risk of Infection — BXO can lead to painful erections, difficulty urinating and burning sensations during intercourse. Circumcision eliminates the risk of BXO by removing the foreskin.
  • Improved Hygiene — The foreskin of an uncircumcised man can be difficult to clean, leading to an increased risk of infection. Circumcision removes the potential for dirt and bacteria to become trapped, leading to improved hygiene.
  • Reduced Risk of HIV/STDs — Several studies have shown that circumcised men are less likely to contract HIV or other STDs than uncircumcised men.

Personal Consultation

If you have BXO and are considering circumcision,  discuss it further with Dr. Bidair at California Adult Circumcision. During your visit, Dr. Bidair will thoroughly examine your penis and discuss your BXO concerns. He will also explain the procedure in detail, including what to expect before, during and after surgery. After your consultation, you will have a better understanding of the risks and benefits associated with circumcision and will be able to make an informed decision about whether it is right for you.

To book a one-on-one appointment, call (619) 486-5005. We also offer phone consultations for those unable to make it to our offices. Just follow the prompts and one of our staff members will be in touch.


Once your surgery is scheduled, you’ll receive detailed preoperative instructions. Following these instructions diligently will ensure that your procedure goes smoothly and that you enjoy a quick recovery and the very best results possible.

  • Discontinue blood thinners, supplements, and other medications as instructed.
  • Stop any nicotine use in the weeks leading up to your surgery and remain nicotine-free for the duration of your recovery.
  • Fill prescriptions for pain medication and antibiotics in advance of your procedure.
  • Coordinate a ride home and escort if sedation or general anesthesia will be used.
  • Arrange time off from work and social commitments to ensure adequate time to rest.


Before your circumcision procedure begins, you’ll have the opportunity to review the details of your treatment. Depending on your individual needs, the procedure will involve a one of the following techniques

Dr. Bidair will make a small incision, either around the base of the foreskin or all the way around the circumference of the penis. He will then meticulously remove the foreskin, taking care to preserve the sensitive nerve endings and penile skin. Once the procedure is complete, Dr. Bidair will suture the incision closed.

What Kind of Circumcision is Right for Me?

Recovery & Results

After your circumcision, you’ll need to keep the area clean and dry and wear a tight-fitting pair of underwear to secure the area while you heal. Pain medications can help manage any discomfort and antibiotics may be prescribed if there’s a risk of infection. Most patients experience some swelling and redness in the area and it should heal completely within a few weeks. After recovery, you won’t have to worry about BXO returning and you’ll be able to enjoy all the benefits of an improved appearance and better hygiene.

Cost of Adult Circumcision in San Diego

The cost of your procedure at California Adult Circumcision will depend on the treatment plan drawn up by Dr. Bidair. For more information, and to book your personal consultation with him at our La Mesa offices, call (619) 486-5005 or complete the form on our website.


Is BXO contagious?

No, BXO is not an infectious condition, so it cannot be passed from one person to another.

How rare is BXO?

BXO is a rare condition, affecting an estimated 0.1-0.3% of males. (1)

Is circumcision the only treatment for BXO?

No, mild cases of BXO can often be managed with topical steroids and gentle foreskin care. However, more severe cases may require circumcision to reduce the risk of complications and ensure lasting results.

Can other conditions cause symptoms similar to BXO?

Yes, other conditions such as psoriasis can cause symptoms similar to BXO. A biopsy is the best way to determine an accurate diagnosis.


  1. Carocci K, McIntosh GV. Balanitis Xerotica Obliterans. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK567770/ 
  2. Folaranmi SE, Corbett HJ, Losty PD. Does application of topical steroids for lichen sclerosus (balanitis xerotica obliterans) affect the rate of circumcision? A systematic review. Journal of Pediatric Surgery. 2018;53(11):2225-2227. doi:https://doi.org/10.1016/j.jpedsurg.2017.12.021 
  3. Boksh K, Patwardhan N. Balanitis xerotica obliterans: has its diagnostic accuracy improved with time? JRSM Open. 2017;8(6):205427041769273. doi:https://doi.org/10.1177/2054270417692731