White spots on the foreskin can be concerning. While initially alarming, their causes range from harmless occurrences to conditions requiring medical attention. This guide clarifies the various reasons behind white spots on the foreskin.
Common and Benign Causes
White spots on the foreskin often stem from harmless skin conditions. One frequent cause is smegma buildup, a natural substance of dead skin cells, oils, and moisture that accumulates under the foreskin. Smegma can appear as white, cheesy, or lumpy deposits, and in infants, it might resemble white dots or “pearls” under the foreskin. While normal, excessive smegma can lead to an odor or irritation if not regularly cleaned.
Another common reason for white spots is Fordyce spots. These are small, yellowish-white, raised spots that are enlarged sebaceous (oil-producing) glands. Fordyce spots are normal, harmless, and generally painless, though they can sometimes become itchy or inflamed during sexual activity. They can appear individually or in clusters and are not sexually transmitted.
Infectious Causes
White spots on the foreskin can also indicate various infections. Fungal infections, such as thrush (candidiasis), are common, caused by an overgrowth of Candida yeast. These infections often manifest as white, cottage-cheese-like patches, accompanied by redness, itching, burning, and soreness of the foreskin and glans. Factors contributing to fungal overgrowth include poor hygiene, antibiotic use, uncontrolled diabetes, or a weakened immune system.
Bacterial infections can lead to balanitis, an inflammation of the glans and foreskin (balanoposthitis). This condition can present with white discharge or spots, often alongside pain, irritation, swelling, a foul smell, and difficulty retracting the foreskin. Bacterial overgrowth is linked to inadequate hygiene, especially in uncircumcised males, where the moist, warm environment under the foreskin provides a breeding ground.
Viral infections can also cause white spots or lesions on the foreskin. Genital warts, caused by human papillomavirus (HPV), appear as small, rough, skin-colored or whitish lumps. They may occur individually or in clusters, sometimes resembling a cauliflower, and can occasionally cause itching or bleeding. Molluscum contagiosum, a viral skin infection, produces small, pearly, dome-shaped papules often with a central dimple. These bumps can be white, skin-colored, or pink and spread through direct contact.
Other Medical Conditions
Less common but more serious medical conditions can also cause white spots on the foreskin. Lichen sclerosus is a chronic inflammatory skin condition characterized by whitish, thickened, or shiny patches on the foreskin and glans. It can cause itching, soreness, pain during urination or sex, and may lead to scarring and foreskin tightening, making retraction difficult. Untreated, it can increase the risk of certain skin cancers.
Psoriasis, an autoimmune skin condition, can affect the genital area, including the foreskin. While typical psoriasis plaques are red with silvery scales, on the moist foreskin, patches may appear as bright red, smooth, and shiny areas with less prominent scales. Genital psoriasis can cause intense itching, burning, and pain, worsened by friction. It is not contagious or sexually transmitted.
When to Seek Medical Attention and Treatment
Seek medical attention if white spots are accompanied by concerning symptoms, persist despite good hygiene, or cause discomfort. Warning signs include:
Pain
Swelling
Soreness
Redness
Unusual discharge (especially pus-like)
Foul odor
Difficulty urinating
Changes in spot appearance (e.g., blistering, cauliflower-like shape)
Medical evaluation is also recommended if symptoms appear after new sexual activity or with new partners.
A healthcare professional can diagnose the cause through examination or testing. Self-diagnosis is not recommended; proper identification is key to effective treatment. Treatment varies depending on the cause. For infections, antifungals treat fungal issues, while antibiotics address bacterial infections. Inflammatory conditions like lichen sclerosus or psoriasis are managed with topical steroid creams. In some cases, such as with warts or molluscum contagiosum, removal procedures may be considered.
Maintaining good foreskin hygiene can help prevent some issues. This involves gently retracting the foreskin daily during showering or bathing and rinsing with warm water. If using soap, choose a mild, low-irritant option and rinse thoroughly. After washing, gently pat the area dry before returning the foreskin to its normal position. Never forcibly retract the foreskin, especially in children, as this can cause pain, tears, or scarring.