How to Have Safer Sex with Hidradenitis Suppurativa

Hidradenitis suppurativa (HS), or acne inversa, can be challenging to manage, both on the body and in the psyche. It affects all aspects of a person's life, including sexual relationships. HS involves painful, sometimes open sores, boils, and cysts that can emit blood, pus or other discharge. It's not contagious.

However, safer sex when you have HS is important.

What is hidradenitis suppurativa?

Hidradenitis suppurativa is a chronic, inflammatory skin disease. It's caused by a blockage of hair follicles and sweat glands, causing inflammation and abscesses, or painful bumps that fill with pus.

Some people develop a pilonidal sinus, or small pitted areas or tunnels in the skin.

This skin condition occurs most often in areas where the skin rubs together, including:

• Armpits
• Groin
• Buttocks
• Beneath the breasts

The symptoms of hidradenitis suppurativa can be mild to severe. HS can significantly impact a person's comfort and self-esteem, particularly when it comes to sexual intimacy. But a fulfilling and safer sex life is possible with HS.

How does hidradenitis suppurativa affect sexual behavior?

Hidradenitis suppurativa can take a significant mental toll on people who have it, many of whom struggle to feel confident in their bodies. HS can cause feelings of self-consciousness and low self-esteem.

"HS can definitely have an effect on a person's self-esteem, and especially their sexual self-esteem when it appears in places like the chest, genitals, butt and thighs," said Elleri Scriver, C.S.E., an ASSECT-certified sexuality educator, founder of Pillowtalk Sex Ed, and sexual health program coordinator at the University of South Carolina in Columbia.

There is hope, though, for improving self-image with HS. In addition to therapy or treatments for hidradenitis suppurativa, Scriver suggests romanticizing your genitals by "masturbating and becoming familiar with your body [and] normalizing your body by increasing your positive exposure to bodies like yours."

Furthermore, Scriver suggests taking agency over the look of one's body. Do so by buying lingerie/underwear that you like, because it can help hide symptoms in the immediate situation. Also, try drawing your genitals [or] getting a piercing or tattoo. Embrace body neutrality.

Sometimes, the chronic pain and discomfort experienced by people with hidradenitis suppurativa can lead to mental health issues such as depression or anxiety. These mental health conditions can further affect a person's sexual health, leading to such problems as decreased sex drive or sexual dysfunction.

Engaging with an experienced mental health professional can be as important as seeing a specialist for the physical aspects of HS.

How do you talk to your partner about hidradenitis suppurativa?

People with HS may feel less attractive or desirable due to their condition. These feelings can be compounded when flare-ups occur. They may feel anxious about how a partner might react to their symptoms or worry that they will disrupt sexual activities.

This anxiety and worry can be a source of stress, potentially exacerbating hidradenitis suppurativa symptoms in a vicious cycle.

The best way to combat this and the first step to having safer sex with HS is open communication. Talk to your partner about your condition, where it's OK to touch and your fears. These conversations might feel uncomfortable, but they are important in establishing understanding and empathy within the relationship.

Hidradenitis suppurativa isn't a sexually transmitted infection (STI), but having proactive two-way communication can be helpful. Your partner may have concerns or questions about HS, so sharing credible resources or involving them in medical appointments may be beneficial.

What should you do before having sex with hidradenitis suppurativa?

You're free to have sex that's as consensually dirty as your bodies desire, but when you or your partner has HS, hygiene before and after sex is critical. It can help prevent HS flare-ups.

It can be tricky to ask your partner to have better sexual hygiene or to commit to getting clean before sex, but it's a meaningful conversation.

"Practicing good hygiene is important for managing HS and reducing the risk of infection," said Amber Shine, a certified sex therapist and dating coach. "[Make sure to] gently clean the affected areas with a mild, fragrance-free cleanser and avoid harsh soaps or scrubbing vigorously."

Make sex more comfortable when you have HS

Exploring and trying different positions to find the ones that put the slightest pressure and friction on any affected areas is critical, said Noor Hanif Said, M.B.B.S., a dermatologist at Renaissance Dermatology Specialist Clinic in Singapore. "This can help reduce pressure, friction and pain [during sex]."

It's important to be gentle and avoid rough or aggressive positions and activities to prevent irritating the skin, Said added. So while you might like a bit of rough play, it might be best to keep that to unaffected areas or to wait until you're not in an active flare-up.

Scriver added that if you are into rougher bedroom play, "be careful with the placement of rope or adhesives during sex if you're into bondage." If you like latex, rubber or leather, avoid wearing those things for long periods to reduce friction.

HS flare-ups can be painful and may necessitate taking a break from sex. If that's the case, there are many ways to express intimacy without physical contact: emotional connection, verbal communication or simply spending quality time together.

How can you keep your partner safe when you have HS?

HS can't be sexually transmitted, but open, draining wounds or boils can still put you and your partner at risk of other infections. The right protection can help you avoid further problems for anyone involved in your sexual rendezvous.

Put a bandage on open wounds during sexual activity to prevent bodily fluids from spreading, Scriver said. That will also avoid any risk of a partner passing on an STI through an open wound. They may not be the sexiest things to look at, but they could be an excellent opportunity to get out of your head and have a fun fantasy.

If you've wanted to roleplay a nurse-patient or doctor-patient scenario, why not teach your partner about wound care and let you both have fun? Ensure your partner wears gloves to help keep everything as sterile as possible. As much as sexual aftercare is important, precare is just as critical in intimacy when HS is involved.

"Utilizing condoms and dental dams may reduce the risk of transmitting infections," Said explained.

Having a barrier like a dental dam can also make oral sex or fingering a little more tolerable if some areas are hyper-sensitive.

The bottom line

Living with hidradenitis suppurativa is undoubtedly challenging, but it doesn't mean you can't have a fulfilling sex life. It is possible to navigate the challenges posed by HS and maintain a healthy, satisfying sexual relationship—together.

Remember, you are not alone; resources and supportive communities are ready to help. Speak with your physician if you need help navigating your HS.