How Psoriasis Can Affect Sexual Health

Psoriasis is an autoimmune skin disease that causes skin inflammation that leads to red, scaly patches on the skin. Visible skin lesions can affect self-esteem and how people feel about their bodies. Lesions can also cause discomfort during sex, reducing desire and leading to sexual problems.

The act of sex might cause discomfort from friction that irritates the skin or worsens symptoms. This is especially true for people whose psoriasis affects their genitals and other intimate skin areas.

A 2018 study in the journal Psoriasis finds up to 63% of adults with psoriasis experience psoriatic lesions on their genital area, but few are comfortable sharing this information with their doctors. They cite embarrassment, stigmatization, or shyness as reasons for not speaking up.

Psoriasis does not have to put a damper on your intimacy. This article will discuss sexual problems linked to psoriasis, sexual symptoms, and management of sexual issues and symptoms.

What Is the Connection Between Sexual Problems and Psoriasis?  

Research shows people with psoriasis and psoriatic arthritis (PsA) are at a higher risk for sexual dysfunction and depression.

Sexual dysfunction refers to problems that prevent a person from wanting or enjoying sexual activity. It includes problems like reduced libido (reduced sex drive), erectile dysfunction, pain or discomfort during sex, and difficulty achieving orgasm. 

At the 2021 American College of Rheumatology conference, one study found 83% of psoriasis patients and 76% of PsA patients reported sexual dysfunction, compared to 45% of the control group participants. The researchers also reported higher rates of erectile dysfunction in those with psoriatic disease than in the control group. 

A 2019 JAMA Dermatology review found people with psoriasis were 5.5 times more likely to experience sexual dysfunction than people without the condition. This higher risk was common in people with anxiety, depression, PsA, and genital psoriasis. 

Symptoms and Gender Differences

Psoriasis can affect the genders differently regarding their sexual health and experiences.

Men

Men with psoriasis are more likely to experience erectile dysfunction than males without the condition. They are more likely to have sexual difficulties if they experience depression or have other health issues, such as high blood pressure and diabetes. 

Symptoms of psoriasis that can cause sexual problems in men might include:

• Genital skin lesions
• Depression
• Anxiety
• Embarrassment about psoriasis plaques (elevated lesions with a visible boundary) 

The effects of psoriasis on male sexual health might include:

• Reduced desire and concentration
• Pain from genital lesions
• Erectile dysfunction

One 2018 International Journal of Impotence Research study found that male psoriasis patients have an increased risk for sexual difficulties if they are depressed or have other health problems like high blood pressure, increased glucose blood levels, and impaired psychological state.

The study found 53% of the men with psoriasis reported erectile dysfunction compared to 40% in the control group. Within the psoriasis group, 20% said their erectile dysfunction was mild, while 6% reported it as severe.

This study also found men who suffered from severe depression were more susceptible to erectile dysfunction. The authors note that because psoriasis can develop on the penis and cause pain and discomfort, it can lead to body image concerns that negatively affect sexual performance and reduce sexual desire.

Women

Women with psoriasis might find sex painful or experience mood disorders that affect libido (desire to have sex). Sexual health problems might lead to personal distress and decreased quality of life.

Studies on genital psoriasis find itch, burning, pain, redness, and scaling affect female sexual health, and the intensity of these might be higher for women than men. Additional studies have linked sexual problems to other health conditions that coexist with psoriasis, including high blood pressure and diabetes. 

A 2018 systemic review in the journal Psoriasis found women experience painful intercourse and can be more distressed by the effects of genital psoriasis on their sexual function than men. The report's authors note distress can improve with treatments that target genital lesions. 

A 2021 Italian Journal of Dermatology and Venereology study aimed to determine the frequency of sexual dysfunction in females with psoriasis and the possible correlation of sexual problems with disease severity, genital symptoms, age, and comorbidities (other conditions the person has).

The prevalence of sexual dysfunction was higher in women with moderate to severe psoriasis. Diabetes and high blood pressure were also significantly linked to sexual problems in psoriasis.

Do Medications for Psoriasis Cause Sexual Problems?

Rheumatrex (methotrexate) is a potent treatment, often prescribed to treat moderate to severe psoriasis. It works by suppressing the overactive immune system that leads to psoriasis. Methotrexate treats other types of psoriatic disease, including erythrodermic psoriasis, PsA, nail psoriasis, and palmoplantar psoriasis. 

Methotrexate is generally well-tolerated. Still, there have been reports of decreased sexual drive, erectile dysfunction, and gynecomastia (enlargement of the breast tissue) in men after starting the drug.

Soriatane (acitretin), a retinoid used to treat severe psoriasis, has also been linked to sexual problems.

Drugs used to treat conditions that are comorbidities of psoriasis can also affect sexual health. These might include antidepressants, muscle relaxants, non-steroidal anti-inflammatory drugs, H1 antagonists, proton pump inhibitors, and some blood pressure medications.

How Are Sexual Problems With Condition Psoriasis Treated?

People with psoriasis can have healthy sex lives. Disease control in psoriasis can restore sexual function. Biologic treatments, for example, have been found to improve psoriasis symptoms, and people using these treatments have reported a significant reduction in sexual difficulties and enhanced satisfaction and arousal.

For people with genital psoriasis, skin lesions tend to respond better to topical treatments because the skin is thinner in intimate areas. If topical treatments are helpful, your doctor might prescribe more potent oral medicines, including cyclosporine, retinoids, or methotrexate. Ultraviolet light treatments can also treat genital psoriasis. 

In addition to treatment options, it is crucial to take care of thin skin affected by genital psoriasis. If the skin in intimate areas is inflamed, avoid tight clothing, skin rubbing on skin, exercise, and sex.

It is essential to care for skin affected by genital psoriasis. Some ways to do this are: 

• Using mild, fragrance-free cleansers
• Applying fragrance-free moisturizer after bathing while skin is still damp
• Using good quality toilet paper
• Avoiding urine or feces on skin lesions
• Getting fiber in your diet to ease bowel movements
• Taking long, warm baths
• Applying cold compresses to itchy skin areas

How Are Sexual Problems With Methotrexate Treated?

It is possible to minimize side effects, including sexual dysfunction, related to methotrexate. Taking folic acid on non-methotrexate days can help to reduce methotrexate side effects.

Another way to reduce the side effects of methotrexate is to cut down the dosage. The typical methotrexate dose is 10 to 25 milligrams (mg). If you are only taking 10 milligrams, your doctor can reduce the dosage to 7.5 milligrams.

If other medicines you take affect your sexual health, your doctor can recommend alternative therapies that do not cause these effects. They can reduce dosages if your treatment options are limited. 

Summary

Having a healthy sex life with psoriasis can be hindered by dealing with the disease's effects. It is not unusual for people with the condition to feel embarrassed, experience low self-esteem, and feel stigmatized. All of these can affect intimate relationships.

Genital psoriasis can also cause physical limitations to sex, and some psoriasis treatments can cause sexual dysfunction.  

Psoriasis-related sexual problems are manageable with treatments that keep skin symptoms at bay and changes to medications or adjusting doses. Reach out to your doctor if psoriasis affects your sexual health and leads to sexual dysfunction conditions.

A Word From Verywell

If you have experienced symptoms of psoriasis that have caused you to avoid sex and feel unable to talk to your partner, consider talking to a friend, your doctor, or a therapist. Talking to someone who understands your situation might help to validate your feelings. 

Counseling can help you build self-esteem and confidence and better cope with the effects of psoriasis. A therapist can also help you learn to bring up issues about sex with your partner.