Balanitis xerotica obliterans (BXO) is the term used for lichen sclerosus in males. It may occur in males of all ages and typically involves the glans penis and the inner foreskin in uncircumcised males. BXO is a progressive, inflammatory, sclerotic process that results in phimosis and ultimately meatal stenosis of the male genitalia. The etiology is unknown; however, it is more common in uncircumcised males, and exposure to urine may be a factor in the development of lichen sclerosus in males. This is most commonly observed in obese males with urinary microincontinence. It is an uncommon or underreported condition, occurring in less than 1% of males. 

BXO carries a high degree of morbidity, with complications including genital scarring and impaired urinary and sexual function. Recurrent balanitis and acquired phimosis are commonly associated with BXO and are often the presenting complaints. Perianal involvement of BXO is not typically observed. Patients may report itching and burning, but in the early stages, BXO can be asymptomatic. Painful erections, narrowing of the urinary stream, and diminished force during urination may also occur (the latter 2 symptoms may be secondary to urethral stricture formation).

BXO is less commonly associated with genital squamous cell carcinoma (SCC) than the lesions of vulvar lichen sclerosus. However, it is noted that 25% of penile SCC is associated with lichen sclerosus. Penile melanoma in the setting of lichen sclerosus is rare but has been observed, with penile melanoma accounting for less than 1% of penile cancers.