Genital Psoriasis and Intimacy

Psoriasis can happen virtually anywhere on the body, but genital psoriasis presents its own set of obstacles. Those who’ve had to deal with it often report the same itching and stinging that come with psoriasis elsewhere on the body.

“I think the hardest part is just the feeling -- I don’t feel this way anymore -- but in the beginning, it was just, like, ‘Oh, I’ve done something. I’m not taking care of my body correctly. What if I just change my diet, what if I just use this medication, what if I just go to yoga and de-stress?’ ” says J.M., from Michigan, who was diagnosed with genital psoriasis as an adult.

“You can say all those things and you might still have psoriasis. What works for one person doesn’t work for everybody across the board. That’s the difficult part.”

More than that, though, many struggle with sexual intimacy. That’s understandable, given the body parts that genital psoriasis affects. Many folks also say their condition affects their quality of life.

Simply talking about genital psoriasis can be tricky, even with the ones closest to you.

“It’s just an odd little conversation to have,” J.M. says.

As with the physical aspects of the disease, though, the mental challenges of living with genital psoriasis can be controlled.

How do you start?

See a Doctor

Some who have genital psoriasis show up to the doctor having no idea what’s going on. They often have dry, red lesions in the groin.

“If somebody has psoriasis just in the genital area, most of the time they don’t know what it is. If somebody comes in and they already have an established diagnosis of psoriasis, the awareness tends to be higher,” says dermatologist Bruce Brod, the co-director of the Occupational and Contact Dermatitis Program at Penn Medicine in Philadelphia.

“Most have a lot of fear and trepidation,” he says. “I see [mostly] younger men. Of course they’re fearful that it’s a sexually transmissible disease. It’s embarrassing for them. It interferes with many aspects of their life.”

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Getting the proper diagnosis and setting up a treatment plan are critical. Walking into that doctor’s office for the first time is the right start.

“It was very difficult to me to bring up with my doctor. It did take me a while. It was very much a couple of years of, ‘Well, we’re going to try this medicine, we’re going to try that medicine.’ It was not good for me to do that,” J.M. says.

Don’t do the treatment thing on your own. You need a professional to guide you. The skin in the genital area is thinner and more sensitive than elsewhere on the body. So a topical ointment that is used on, say, your scalp -- even an over-the-counter ointment like salicylic acid or coal tar -- should be cleared with your doctor before you start spreading it on your genital area.

The only way to know for sure what treatment tack to take is to talk openly and honestly to your doctor.

“I guess that would be my one point of advice. Take a deep breath. Swallow your pride. And just tell your doctor,” J.M. says. “You don’t want to put the wrong medicine down in that area.”

Perhaps as important as talking is the timing. Don’t delay. Do it now.

“I think the most important message is to treat it, and treat it as soon as you can, to prevent it from becoming more painful and worse,” says Lawrence J. Green, a dermatologist in Rockville, MD. “It’s an area that’s very uncomfortable and, of course, the more you have, the more you need to treat -- the sooner the better.”

Talk With Your Partner(s)

Once you talk to your doctor, and a psoriasis diagnosis is confirmed and a treatment plan is sketched out, having a heart-to-heart with any potential sexual partners -- if you haven’t done so already -- is in order.

That, again, will not be the best sit-down you’ve ever had. But it has to be done. Experts suggest that you should reinforce the fact that psoriasis is not contagious and that it usually doesn’t affect normal sexual function.

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That might seem like a little too much information for something so intimate. But it’s best to be honest about genital psoriasis. And some say all that talking and sharing can make your relationship stronger.

“If your significant other isn’t accepting of the psoriasis, if they’re not helpful to you, if they’re not supportive,” J.M. says, “then that’s probably really not something you want to get into anyway.”

If you’re having trouble getting the conversation started with a potential sexual partner, your doctor may have some ideas. In fact, many doctors are willing to talk to your partner with you, or for you, to help educate and squelch any fears. Ask about it.

“It’s important to find out the impact it’s having on [your] sex life -- in terms of embarrassment, pain and discomfort, bleeding -- and to talk … about that in ways to reduce those symptoms and make sure there aren’t unanswered questions,” Brod says. “[It’s] difficult, it’s embarrassing, but … there are terrific treatment options for psoriasis that are available these days.”

Still need to talk? The National Psoriasis Foundation’s patient navigation center offers free, personalized attention that lets you call, text, chat online, or email any questions.

Understand What You Can and Can’t Do

Those with genital psoriasis have good days and bad days. It’s a chronic condition. Triggers -- things like stress, medicines, and even slight injuries to the skin -- can cause an itchy, painful flare-up.

Sexual activity can cause a flare-up, too. To help cut down on the friction in the genital area that can aggravate the skin and cause a possible flare, you should:

  • Try lubricated condoms or other lubricants; check with your doctor.
  • Keep the area clean.
  • Clean your genitals and reapply any topical medicine after sex, but use it only as directed.
  • If the area is sore or the skin is inflamed, cracked, or bleeding, try again when it feels a little better.

In the end, being sexually active with genital psoriasis is a very personal decision.

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“You really have to weigh for yourself, just as if you were taking medication, the side effects vs. the benefits,” J.M. says. “What one decision is for one person may not be the same for another. 

“How important is this aspect of your relationship vs. knowing that you could be in a flare afterward? Are you at a point in your relationship where you want to make that leap? If you are, hopefully you can be honest enough with your partner where you can explain everything.”

If you are ready for intimacy, if all parties agree to go ahead, Green, also a member of the National Psoriasis Foundation’s medical board, has one more bit of advice.

Just do it.

“Don’t worry. At all,” he says. “If it doesn’t hurt you, then go ahead and do it. It won’t affect the other person whatsoever. As long as it doesn’t hurt, please feel free to enjoy.”

WebMD Feature Reviewed by Stephanie S. Gardner, MD on July 12, 2018

Sources

SOURCES:

World Health Organization: “Global Report on Psoriasis.”

National Psoriasis Foundation: “About Psoriasis.”

National Psoriasis Foundation: “Your path to clear skin starts now.”

Acta Dermato-Venereologica: “Genital psoriasis awareness program: physical and psychological care for patients with genital psoriasis.”

Dermatology and Therapy: “Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study.”

J.M. (identity protected by request), Detroit metro area. Via contacts at the National Psoriasis Foundation.

National Psoriasis Foundation: “Genital Psoriasis.”

Bruce Brod, MD, co-director, Occupational and Contact Dermatitis Program, Penn Medicine, Philadelphia; Clinical professor of dermatology, Penn Medicine.

National Psoriasis Foundation: “Over the counter, not over your head.”

Lawrence J. Green, MD, associate clinical professor of dermatology, George Washington University School of Medicine, Washington, D.C.; member, Privia Medical Group, Rockville, MD; Medical Board member, National Psoriasis Foundation.

National Psoriasis Foundation: “Psoriasis and intimacy.”

The Psoriasis and Psoriatic Arthritis Alliance: “Genital Psoriasis.”

National Psoriasis Foundation: “Causes and triggers.”

American Academy of Dermatology: “Psoriasis.”

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