Psoriasis is an autoimmune skin disease that causes inflammation of the skin resulting in red, scaly patches on the skin. Visible skin lesions can affect self-esteem and how people feel about their bodies. The lesions can also cause discomfort during sex, reduce desire, and lead to sexual problems.

The act of intercourse can cause discomfort due to friction which irritates the skin or worsens the symptoms. This is especially true for people whose psoriasis affects their genitals and other intimate areas of skin.

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

Psoriasis doesn’t have to put a damper on your intimacy. This article will discuss psoriasis related sexual problems, sexual symptoms, and managing sexual problems and symptoms.


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What is the connection between sexual problems and psoriasis?

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

Sexual dysfunction refers to problems that prevent a person from wanting or enjoying sexual activity. This includes issues such as low libido (reduced libido), erectile dysfunction, pain or discomfort during sex, and difficulty reaching orgasm.

What is psoriatic arthritis?

Psoriatic arthritis is a chronic inflammatory disease of the joints and entheses, the areas where tendons and ligaments connect to bones. It affects 30% of people with psoriasis.

At the 2021 American College of Rheumatology conference, a study found that 83% of patients with psoriasis and 76% of patients with PA reported sexual dysfunction, compared to 45% of participants in the control group. Researchers also reported higher rates of erectile dysfunction in people with psoriatic disease than in the control group.

What is psoriatic disease?

The term psoriatic disease refers to both psoriatic arthritis and psoriasis, individually and together.

A 2019 JAMA Dermatology One review found that people with psoriasis were 5.5 times more likely to suffer from sexual dysfunction than people without the condition. This higher risk was common among people with anxiety, depression, PA, and genital psoriasis.

Symptoms and Gender Differences

Psoriasis can affect genders differently when it comes to their health and sexual experiences.

Men

Men with psoriasis are more likely to suffer from erectile dysfunction than unaffected men. They are more likely to have sexual difficulties if they suffer from depression or other health conditions, such as high blood pressure and diabetes.

Psoriasis symptoms that can cause sexual problems in men could include:

  • Genital skin lesions
  • Depression
  • Anxiety
  • Discomfort about psoriasis plaques (raised lesions with a visible boundary)

The effects of psoriasis on male sexual health may include:

  • Decreased desire and concentration
  • Pain from genital lesions
  • Dyserection

A 2018 International Journal of Impotence Research A study found that male patients with psoriasis are at an increased risk of sexual difficulties if they are depressed or have other health issues like high blood pressure, increased blood sugar, and impaired psychological status.

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

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

Women

Women with psoriasis may find sex painful or experience mood disturbances that affect libido (desire to have sex). Sexual health issues can lead to personal distress and reduced quality of life.

Genital psoriasis studies have found that itching, burning, pain, redness, and scaling affect women’s sexual health, and may be more intense in women than in men. Additional studies have linked sexual problems to other health problems that coexist with psoriasis, including high blood pressure and diabetes.

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

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

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 Psoriasis Medications Cause Sexual Problems?

Rheumatrex (methotrexate) is a powerful 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 libido, erectile dysfunction, and gynecomastia (enlargement of breast tissue) in men after starting the drug.

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

Medications used to treat conditions that are comorbid with psoriasis can also affect sexual health. These can include antidepressants, muscle relaxants, nonsteroidal anti-inflammatory drugs, H1 antagonists, proton pump inhibitors, and certain blood pressure medications.

How are psoriasis-related sexual problems treated?

People with psoriasis can have a healthy sex life. Disease control in psoriasis can restore sexual function. Biological treatments, for example, have been shown to improve symptoms of psoriasis, and people using these treatments have reported a significant reduction in sexual difficulties and increased satisfaction and arousal.

For people with genital psoriasis, skin lesions tend to respond better to topical treatments because the skin is thinner in the intimate areas. If topical treatments are helpful, your doctor may prescribe stronger oral medications, 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 the thin skin affected by genital psoriasis. If skin in intimate areas is inflamed, avoid tight clothing, rubbing skin on skin, exercise, and sex.

It is essential to take care of the skin affected by genital psoriasis. Here are some ways to do it:

  • Use gentle, fragrance-free cleansers
  • Apply a fragrance-free moisturizer after bathing while skin is still damp
  • Use good quality toilet paper
  • Avoiding urine or feces on skin lesions
  • Get fiber in your diet to make bowel movements easier
  • Take long hot baths
  • Apply cold compresses to itchy areas of skin

How are sexual problems treated with methotrexate?

It is possible to minimize the side effects, including sexual disorders, associated with methotrexate. Taking folic acid on methotrexate-free days can help reduce the side effects of methotrexate.

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

If other medications you take are affecting your sexual health, your doctor may recommend alternative therapies that do not cause these effects. They may reduce doses if your treatment options are limited.

Summary

Having a healthy sex life with psoriasis can be hampered by managing the effects of the disease. It is not uncommon for people with the disease to feel embarrassed, have low self-esteem and feel stigmatized. All of this 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 medication changes or dose adjustments. Contact your doctor if psoriasis affects your sexual health and leads to sexual dysfunctions.

A word from Verywell

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

Counseling can help you build your self-esteem and confidence and better cope with the effects of psoriasis. A therapist can also help you learn how to address sexual issues with your partner.