Is Psoriasis Causing My Sexual Dysfunction?

For many reasons, psoriasis might be affecting your sex life. Read on for essential risk factors and tips to help improve intimacy.

Psoriasis (PsO) is an autoimmune skin disease that causes inflammation that results in thick, scaly plaques. PsO plaques are more common on the elbows, knees, scalp, and genitals but can appear anywhere on the body.

Although they aren’t contagious, these skin lesions can affect your self-esteem and how you interact with others. This can also impact your intimacy and experience with sex.

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What does sexual dysfunction mean?

If you’re living with PsO and experiencing sexual dysfunction, you’re not alone. Sexual dysfunction includes all problems that prevent one from wanting, engaging, and finding pleasure in sexual activity. This includes:

• Reduced libido (low or no sex drive)
• Erectile dysfunction
• Pain or discomfort during sex
• Difficulty or inability to achieve orgasm

How is psoriasis connected to sexual dysfunction?

According to a 2022 study, 90% of people with psoriasis felt some level of unattractiveness because of their condition, 80% reported that their skin lesions at least sometimes interfered with their sex life, and 50% experienced avoiding sexual contact.

Psoriasis plaques primarily interfere with intimacy and sex in two ways:

• Physical discomfort
• Emotional discomfort

Physical discomfort

The physical discomfort of PsO is related to the potential dryness, cracking, bleeding, inflammation, and even infection associated with the condition. These symptoms may be exacerbated by the friction involved in intimacy or sexual intercourse.

This can be especially painful if you have PsO plaques on the genitals or near this sensitive area of the body.

Emotional discomfort

The emotional discomfort is associated with lowered self-esteem and confidence. According to a 2019 study of men with psoriasis, the majority of people experienced feelings of shame and embarrassment, which adversely affected their sex life.

Stigmatization is another psychological burden associated with psoriasis. Stigmatization refers to negative views that others hold about psoriasis and the potential feelings and experiences this can create for people living with it.

For example, some people might believe psoriasis is contagious and feel uncomfortable or avoid making contact. Feeling stigmatized and having impaired self-esteem can further complicate one’s sex life when living with PsO.

Other risk factors for sexual dysfunction

Scientific evidence shows that people with psoriasis are at higher risk of sexual dysfunction than the general population.

Additional factors associated with sexual dysfunction in people with psoriasis include:

• disease severity
• being female
• psoriatic arthritis
• genital psoriasis
• age
• anxiety
• depression

Does gender matter?

Women may be slightly more impacted by sexual dysfunction when living with psoriasis, but the reasons are not entirely clear. According to a 2018 study, sexual dysfunction may be present in 40.8% of people with PsO but as high as 68% in Brazilian women with PsO.

Men are still at risk of sexual dysfunction. According to an analysis of men with PsO from 2018, 43.8% had erectile dysfunction.

Do genital lesions explain sexual dysfunction?

Psoriasis lesions on the genitals do not necessarily explain the high prevalence of sexual dysfunction in people living with PsO.

Though genital lesions can contribute to physical discomfort and the avoidance of sex, a 2018 study reported that the moderate prevalence of psoriatic lesions in the genital area (35%-42%) does not explain the prevalence of sexual dysfunction in the larger psoriasis population.

Do PsO treatments help with sexual dysfunction?

Biologic drugs have improved sexual dysfunction in people living with psoriasis. Treating psoriasis with this form of medication may improve intimacy and sex.

Topical treatments are usually effective on genital plaques. Still, it’s essential to note that these treatments need to be removed before sexual intercourse or intimacy.

Methotrexate (MTX) is a common treatment for PsO. Though it’s typically well-tolerated, there have been some reports of decreased sexual drive, erectile dysfunction, and gynecomastia (enlargement of breast tissue) in men after starting this therapy.

Soriatane (acitretin), a retinoid prescription topical cream used to treat PsO, has also been linked to sexual problems.

Prescriptions to treat comorbid conditions, or conditions often found with PsO, can also affect sexual performance and drive.

These prescriptions may include neuropsychiatric medications (i.e., antidepressants, antianxiolytics), muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDS), gastroesophageal reflex disease (GERD) medications (i.e., H1 antagonists, proton pump inhibitors), and some blood pressure medications (i.e., beta-blockers). 

Consider asking your healthcare professional how your medications may be interacting with your sex life.

Tips if you’re living with PsO and sexual dysfunction

1. Treat your psoriasis: Whether you’ve been on your psoriasis journey for decades or are new to the experience, you need a good plan of care to manage your PsO. Clearer skin can lead to more confidence, and this might lead to improved sexual function.
2. Consider therapy: Talk therapy, or counseling, is vital for the management of the psychological effects of PsO. Cognitive behavioral therapy (CBT) and mindfulness-based therapies can be helpful when managing PsO, according to a 2019 study. 
3. Find a support group: Joining a support group can be a great way to find a community and others who relate to your experience. Check out this link from the National Psoriasis Foundation for group activities in your area.
4. Strive for openness with your partner: Honesty and communication can play a big part in sex. Your partner might not be aware of the ways your condition is affecting you emotionally or physically. Plus, open communication can often lead to solutions.
5. Use water-based lubricants: Water-based lubricants are helpful for avoiding and preventing friction during sex.
6. Be mindful of your skin products: Mild, fragrance-free, and moisturizing soaps and detergents can be beneficial for your skin. This directory from the National Psoriasis Foundation details products that are safe and sensitive to skin.

The takeaway

Psoriasis can impact many aspects of your life, but it specifically may affect intimacy and sex. It’s vital to treat your PsO and seek emotional support. Be sure to discuss sexual dysfunction with a medical professional to see what treatments may be right for you.