How to Stop Genital Psoriasis From Damaging Your Sex Life

Sensitivity of tissues can make treatment difficult

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It is one thing to experience the discomfort and scaly appearance of psoriasis; it is another when it occurs on or around the genitals and interferes with your sex life.

Genital psoriasis can affect both men and women and is arguably worse than other forms of the disorder given the delicate nature of the tissues. The condition is further complicated by skin folds and creases that can make treatment difficult, while localized ruptures can lead to secondary infections or the vulva, penis, or rectum.

Understanding Psoriasis

Psoriasis is a common autoimmune disorder characterized by the abnormal accumulation of cells on the surface of the skin. The rapid buildup of cells results in the formation of thick, silvery scales and patches of dry, itchy skin.

Psoriasis is a persistent disorder that can alternately improve or worsen. Most types will go through cycles, flaring up for a few weeks or months before gradually subsiding or going into complete remission.

There is no explanation as to why psoriasis develops in the genital area of some people. It cannot be transmitted through sexual contact and has no correlation to pregnancy, sexual activity, or menopause.

Signs and Symptoms

Symptoms of psoriasis of the genitals are not unlike those in other parts of the body. The characteristics and severity can vary from person to person and may include:

  • Raised, red patches of skin covered with silvery scales (plaques)
  • Dry, cracked skin that can bleed, especially when scratched
  • Inflammation accompanied by itching, burning, or pain
  • Weeping in areas of tissue contraction (such as the rectum or penis)
  • Secondary bacterial or fungal infections of affected skin
  • Swollen and stiff joints

Psoriatic patches can range from scattered flecks of dandruff-like scaling to major eruptions that cover large portions of the body.

By and large, mucosal tissues inside the vagina or rectum are not affected.

Psoriasis and Sex

One of the major frustrations of genital psoriasis is that the risk of flare-ups is directly linked to sexual intercourse. While a condom may help reduce the some of the friction that can induce a flare-up, it is hard to avoid the abrasiveness of skin against skin, particularly if the skin is hairy or the area of involvement is large.

Genital psoriasis can interfere with sex by causing both physical and emotional discomfort. The physical appearance of the skin can often undermine a person's self-confidence while weeping skin can be misread by an uninformed partner as a sexually transmitted infection.

Treatment can be equally problematic. Topical steroids commonly used on other parts of the body may cause the thinning of the skin (atrophy) around the genitals, further enhancing symptoms of pain and irritation during intercourse.

Treatment

While stronger topical steroids are typically avoided when treating genital psoriasis, an over-the-counter 1.0% hydrocortisone preparation or prescription-strength hydrocortisone with iodoquinol cream will usually offer relief. Non-steroidal Protopic (tacrolimus) and Elidel (pimecrolimus) may also help.

If these options don't work, stronger steroids should be used sparingly and only for short periods under the supervision of a dermatologist.

If 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 rheumatoid diseases
  • 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
    View Article Sources
    • Ryan, C.; Sadlier, M.; De Voi, E. et al. "Genital psoriasis is associated with significant impairment in quality of life and sexual functioning." J Amer Acad Derm. 2015; 72(6):978-83. DOI: 10.1016/j.jaad.2015.02.1127.
    • Guglielmetti, A.; Conlledo, R.; Bedoya, A. et al. "Inverse Psoriasis Involving Genital Skin Folds: Successful Therapy with Dapsone." Dermatol Ther. 2012; 2(1):15. DOI: 10.1007/s13555-012-0015-5.