Men with BXO may have a very tight phimosis, an inability to retract the foreskin because it’s hard and stiff, as well as affecting the glans skin.

Men may also experience difficulty with urination, either because of severe phimosis or stenosis of the urethral meatus. Sometimes, the foreskin adheres to the glans due to chronic inflammation or underlying balanitis.

The exact causes of BXO are unknown. Balanitis is usually seen in uncircumcised men. Suspected causes are chronic infection and inflammation.

BXO is more commonly seen in patients with severe phimosis.

- Corticosteroid creams are usually the first-line treatment but are often ineffective.
- Platelet-rich plasma (PRP) injections.
- Surgical treatment that may include circumcision.
- Reconstructive surgery with skin grafts or flaps is rarely necessary.
- Meatotomy
- Dilatation of the urethra
- Separating the glans and foreskin may be necessary
- Long-term follow-up is necessary as BXO scars may reappear and require additional treatment.

Men with BXO are at higher risk of developing penile cancer. In addition, the progression of the disease may result in urethral strictures, inability to urinate and bladder and kidney damage. Circumcision is a treatment option for patients with lichen sclerosus. However, it’s not necessarily curative because the disease can reappear on the glans, urinary meatus and urethra and may require additional treatment.

Sometimes, more reconstruction is needed. Recovery after circumcision in patients with BXO tends to be longer than in elective circumcision patients for aesthetic reasons, with surgical dissection being more critical.