How to Have a Healthy Sex Life With Psoriasis
Getting naked in front of someone is a vulnerable experience. Psoriasis can make it even more uncomfortable in the bedroom, as sufferers often have visible symptoms in the form of scales, redness and plaques.
With two-thirds of individuals with psoriasis experiencing genital psoriasis and flare-ups, communicating with your partner(s) about your skin before, during and after intimacy can increase comfort and confidence.
What is psoriasis?
Psoriasis is a chronic inflammatory skin condition that causes plaques, which range from small specks to large lesions. This skin condition is an autoimmune disease that causes skin to regenerate faster and thus attack healthy skin cells. Signs and symptoms can vary with different subtypes.
Unlike other subtypes of psoriasis, genital psoriasis develops around the genital area, specifically on or around the vulva or the penis. Plaques can also appear on the thighs, between the buttocks and in the vagina. Symptoms include red patches covered in silver scales and dry, cracked skin that may burn, itch or feel sore.
Sex with psoriasis can be painful, the intimacy leading to psoriasis triggers due to friction, injury to the skin, stress and anxiety. This discomfort can lead to individuals decreasing the frequency of intercourse, a limited sexual desire or avoiding relationships altogether.
Psoriasis is a lifelong condition. However, many treatments can limit the symptoms of psoriasis, including biologics, topical medications, creams and ointments, and UV light.
How does psoriasis affect intimacy?
Psoriasis symptoms often start between ages 15 and 25, the same time period in which many people are at their most sexually adventurous.
Kristina Collins, M.D., a board-certified dermatologist and dermatologic surgeon, discussed the effects psoriasis can have on confidence, specifically before and during intimacy:
"When psoriasis affects areas visible in everyday clothing, individuals may lose confidence in approaching people or dating. During sex, those with psoriasis feel especially self-conscious when the disease involves the hands, genital regions, groin or buttocks. Individuals may also struggle with how and when to bring up the topic with their sexual partner before becoming intimate."
Additionally, genital psoriasis can be misidentified as an STI or other infectious disease due to misinformation.
"There is a false assumption that skin diseases like psoriasis are contagious or are due to a lack of hygiene," Collins continued. "It is vital to educate the public about psoriasis and other skin diseases. Affected individuals should not be discriminated against or made to feel self-conscious. We would never treat someone with asthma or high blood pressure differently, so why do we do this with skin disease?"
Communication before intimacy
Having better sexual communication is associated with greater sexual satisfaction in relationships when establishing sexual desires, preferences, fears and fantasies. However, disclosing personal information can be difficult, especially about body areas that require specialized care, such as the vulva, penis and scrotum.
"If you find it difficult to talk to your partner about psoriasis, it can be helpful to discuss how psoriasis has affected you in the past, and provide information on what psoriasis is and what your partner can do to help you have a more enjoyable sexual experience in the future," said relationship therapist Becky Crepsley-Fox.
Psoriasis can also affect your confidence during intimacy, although sharing your concerns can help your partner(s) determine what is pleasurable for you.
"To increase confidence, it's important to communicate what you want in bed," Crepsley-Fox said. "Are there certain parts of your body that feel good while being touched? Any areas that feel painful? Find where the discomfort is coming from and experiment with sensations you get pleasure from."
Crepsley-Fox also emphasized that communication should continue after intimacy. Individuals who reported communication following sexual activity had higher levels of trust, relational closeness and relationship satisfaction.
"A great tip is to continuously communicate during sex on what you enjoyed or found helpful. After a sexual experience, you can say, 'I loved the way you did…' That way, your partner is more likely to remember for future sexual experiences," Crepsley-Fox said. "You could also sit down with your partner(s) outside of the bedroom and discuss what you might want to try and what you might need in those situations for increased pleasure and decreased discomfort."
What works for you
Lubricants, condoms and clothing that don't irritate your skin and worsen flare-ups are essential.
"Find brands that don't contain any skin irritants and parabens, which many lubricants, unfortunately, do. Many individuals prefer oil-based lubricants over water-based lubricants to avoid flare-ups," Crepsley-Fox said. "However, if you're using condoms, oil-based lubricant is not compatible. Experiment with which lubricant feels right for you."
Specific ingredients you should avoid in lubricants include parabens, glycerin, petroleum jelly and nonoxynol-9.
"Irritation or trauma of the skin is a known trigger of psoriasis flare-ups," Collins said. "Individuals may benefit from wearing 100 percent cotton undergarments and may prefer gentle or cooling lubricants over warming lubricants to prevent inflammation. It may also help to rinse the skin after sex and apply emollients or medicinal creams immediately, as recommended by your doctor."
Taking care of your skin
It's important to consult your dermatologist before trying any new lotions and creams for your psoriasis. Many anti-itch lotions and creams contain fragrances, oils, chemicals and dyes that can irritate your skin, especially after the buildup of sweat during sex.
According to the National Psoriasis Foundation, moisturizing and protecting the skin barrier can help stem the recurrence of psoriasis.
Using lotions containing antioxidant and anti-inflammatory compounds will help eliminate itching and scales and reduce redness. Talk to your doctor or dermatologist if psoriasis is affecting your physical and mental health, and ask for a list of recommended lotions and ointments.