An Overview of Genital Psoriasis

Why It Happens and How to Maintain a Healthy Sex Life

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Table of Contents

Genital psoriasis can affect both men and women, interfering with sexual enjoyment and the quality of life. Psoriasis on the genitals is often associated with severe symptoms since the skin is so delicate and rich in nerve endings. Abrasions, cracks, and bleeding can often lead to secondary infections of the penis, vulva, or rectum.

To complicate matters even further, some of the topical medications used to treat psoriasis on other parts of the body may cause pain or discomfort when applied to the genitals.

According to a 2018 study in the Journal of Dermatological Treatment, 33 percent to 63 percent of people with psoriasis have genital psoriasis. There is no clear explanation as to why some develop genital psoriasis and others don't.

Genital psoriasis cannot be transmitted through sexual contact and has no impact on pregnancy, sexual function, or menopause.

Symptoms

The signs and symptoms of genital psoriasis are similar to those of psoriasis on any other part of the body. The autoimmune disease is characterized by inflammation and the rapid build-up of skin cells on the outermost layer of skin called the epidermis.

Because the cells are being produced faster than they can be shed, the affected skin will develop red, inflamed patches (called plaques) covered with white to silvery scales. Itching and dandruff-like flaking are common. When scratched, the plaques will easily bleed and worsen. Over time, the plaques can consolidate and create large areas of dry, cracked skin.

Genital psoriasis generally affects the skin of the penis, vulva, or rectum. The mucus lining inside the vagina or rectum is typically unaffected.

The symptoms can vary based on the type of psoriasis you have:

  • Plaque psoriasis is the most common form, accounting for roughly 80 percent of cases.
  • Pustular psoriasis causes the eruption of pus-filled blisters on the affected skin.
  • Inverse psoriasis tends to develop in folds of skin (such as the groin) and is more common in overweight people.

Sexual Problems

Genital psoriasis can interfere with your sexual life due not only to the physical symptoms but the embarrassment of having to explain the condition to a sexual partner. Weeping and inflamed skin can often be misread as a sexually transmitted infection such as herpes or genital warts. Rather than face rejection, some people will simply avoid sex, leading to isolation and depression.

Even if your psoriasis is under control, the friction induced by intercourse can inadvertently trigger an outbreak of symptoms, called a flare. Certain lubricants, particularly spermicidal ones, may be irritating to the skin and trigger a flare.

According to a 2015 study in the Journal of the American Academy of Dermatology, no less than 42 percent of people with genital psoriasis report decreased sexual intercourse as a result of their physical and emotional symptoms.

Causes

As an autoimmune disorder, psoriasis is characterized by an immune system gone awry. For reasons poorly understood, the immune system will suddenly attack normal cells and tissues. With psoriasis, the assault will be primarily focused on keratinocytes, a type of skin cells that makes up 90 percent of the epidermis.

When this happens, the ensuing inflammation will cause the hyperproliferation (overproduction) of keratinocytes, leading to the formation of plaques.

Scientists believe that psoriasis is caused by a combination of genetic and environmental factors. Several genetic mutations have already been identified that appear to predispose an individual to the disease. However, the actual expression of the disease may require an environmental trigger, such as an infection, for symptoms to manifest.

It is unclear why some people experience psoriasis of the genitals. It has been proposed that past infections or skin traumas may cause increase the density keratinocytes in tissues, providing more "targets" for the autoimmune assault. Further research is needed to support this hypothesis.

Diagnosis

Genital psoriasis is diagnosed based on a review of your symptoms and medical history. The medical history may reveal conditions that place you at an increased risk for psoriasis (as family history and other autoimmune disorders) or reveal alternate explanations for your condition (such as contact dermatitis).

If your symptoms are atypical or you are resistance to treatment, your dermatologist may obtain a tissue sample by scraping or biopsying the skin. Under the microscope, psoriatic tissue will have dense, compacted cells. This can help differentiate psoriasis from other likely causes, such as eczema or cancer.

Unlike some autoimmune disorders, there are no blood tests or imaging studies that can definitively diagnose psoriasis.

Psoriasis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Treatment

Mild genital psoriasis is typically treated with topical therapies rather than systemic pills or injections. An over-the-counter 1.0% hydrocortisone ointment is usually recommended for short-term treatment. Long-term therapy may involve calcipotriene cream (a vitamin D derivative), which is considered safe and effective.

Protopic (tacrolimus) and Elidel (pimecrolimus) are potent topical immunosuppressants that are reserved for people who fail to respond to hydrocortisone or calcipotriene. If the skin becomes infected, topical antibiotics may be prescribed. Your doctor may also recommend lubricants or emollients to relieve or prevent skin dryness and cracking.

If these options don't work, prescription topical steroids may be used but only under the supervision of a dermatologist. The overuse of steroids can cause the irreversible thinning of the skin (atrophy) and other side effects.

If your symptoms are severe or the entire genital area is involved, systemic treatment may be required. Options include:

  • Methotrexate, a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and other autoimmune disorders
  • Acitretin, an oral retinoid drug that can reduce inflammation
  • Biologic drugs, such as Humira (adalimumab), Orencia (abatacept), Enbrel (etanercept), and Rituxan (rituximab), which interrupt immune signals that trigger autoimmune symptoms

Coping

In addition to treatment, there are strategies that can help you cope and/or prevent the recurrence of genital psoriasis. Among some of the more useful self-help tips:

  • Identify your triggers. These differ from one person to the next and may include infections, stress, medications, allergies, skin trauma, or cold, dry temperature. By keeping a psoriasis diary, you may be able to identify your specific triggers and avoid them in the future.
  • Reduce stress. Stress may not be a direct trigger but can impact your immune function and increase your vulnerability to a flare. If you battle with stress, try mind-body therapies such as yoga, tai chi, meditation, guided imagery, mindful breathing, biofeedback, or progressive muscle relaxation (PMR).
  • Communicate with your partner. Because people can mistake a psoriasis outbreak for a sexually transmitted infection, advise your partner about your condition before having sex. Having a brochure on hand can sometimes help.
  • Use condoms. Using a condom may help reduce some of the friction that can induce a flare. Use plenty of a hypoallergenic, water-based lubricant. Water-based lubricants are less likely to damage latex condoms and cause them to burst.
  • Explore other forms of sex. Sexual intercourse is only one of the many varieties of sex you can enjoy. If your genital are too sore of penetration, explore mutual masturbation with light touching. There are also sex toys that can provide pleasure without causing too much friction. Role-playing can also do wonders for your sex life and compel you to interact on a more intimate level.

A Word From Verywell

Genital psoriasis, like psoriasis on other parts of the body, is something you will need to manage over the long term. If you begin to notice lesions in your genital area, it is important to speak with your doctor or dermatologist as soon as possible. By acting early, you may be able to control the condition and reduce the severity or frequency of flares.

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