An Overview of Genital Psoriasis

Symptoms, Treatment, and Your Sex Life

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Genital psoriasis can affect both men and women, interfering with sexual enjoyment and quality of life. Psoriasis on the genitals is often associated with worse symptoms than other forms of the disorder because the skin in this region is so delicate. Skin abrasions, inflammation, and blisters can lead to secondary infections of the penis, vulva, or rectum, and some of the usual psoriasis treatments can increase pain and unpleasant sensations, especially during sex.

That is why genital psoriasis requires special attention and treatment to reduce symptoms, maintain comfort, and prevent impairment of your sex life.

Understanding Psoriasis

Psoriasis is a common autoimmune disorder characterized by a scaly appearance of the skin. It is a persistent condition that can improve or worsen, often flaring up for a few weeks or months before gradually subsiding or going into complete remission.

It is caused by an 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 which most often appear on the scalp, knees, and elbows, but can appear elsewhere—including the genitals.

About 33 percent to 63 percent of those with psoriasis have genital psoriasis. There is no explanation for why some people who have psoriasis develop it in this area. It cannot be transmitted through sexual contact and has no impact on pregnancy, sexual function, or menopause.

Signs and Symptoms

Signs and symptoms of genital psoriasis are similar to those of psoriasis in any other part of the body. Genital psoriasis affects the outside of the penis, vulva, or rectum. The mucus lining inside the vagina and rectum are not typically affected.

The characteristics and severity can vary from person to person and may include:

  • Scattered flecks of dandruff-like scaling
  • Plaques, or psoriatic patches, which are raised, red patches of skin covered with silvery scales
  • Dry, cracked skin that can bleed, especially when scratched
  • Inflammation accompanied by itching, burning, or pain
  • Weeping (oozing) of pus-filled blisters
  • Major eruptions that cover large portions of the skin
  • Secondary bacterial or fungal infections of the affected skin
  • Swollen and stiff joints

Psoriasis and Sex

Genital psoriasis interferes with quality of life, with as many as 42 percent of those affected reporting decreased sexual intercourse due to physical and emotional discomfort. There are a number of factors that can play into this, including:

  • The risk of flare-ups is directly linked to sexual intercourse.
  • The physical appearance of the skin can often undermine a person's self-confidence.
  • Weeping skin can be misread by a partner as a sexually transmitted infection, discouraging intercourse.
  • Treatment is a challenge and symptoms may persist.
  • Folds of the skin on the penis and rectum can make it difficult to apply topical creams.
  • Topical steroids commonly used on other parts of the body for psoriasis treatment may cause atrophy (thinning of the skin) around the genitals, increasing symptoms of pain and irritation during intercourse.

Diagnosis

Psoriasis of the penis, like psoriasis that affects any other area of the skin, is usually a clinical diagnosis based on your symptoms and the appearance of your skin. If there is any uncertainty about your diagnosis, your doctor may do some tests, such as collecting a scraping of your skin to test for a sexually transmitted disease, an infection, an inflammatory condition, or cancer.

Often, if you have similar psoriasis lesions elsewhere on your body, this suggests that the lesions on your penis are also psoriasis.

Treatment

Over-the-counter 1.0% hydrocortisone is usually recommended for short-term treatment of genital psoriasis. Long-term therapy with calcipotriene (a vitamin D cream) is also often recommended and considered safe.

If the area becomes infected, topical antibiotics may be prescribed. Your doctor may also recommend lubricants or emollients on a regular basis for relief and prevention of dryness and abrasion, which can cause bleeding and blisters.

Protopic (tacrolimus) and Elidel (pimecrolimus), which are potent, non-steroidal topical immunosuppressants are also used to treat genital psoriasis.

Laser therapy, which can target the affected area, may cause skin irritation but can be effective after the irritation subsides.

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

If the entire genital area is involved or if local treatments don't work, 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

Coping

In addition to treatment, there are some strategies you can use to help you cope and to prevent psoriasis from interfering with your sex life.

  • Understand your medical condition: Psoriasis is a bothersome condition, and some people have uncomfortable or unattractive outbreaks. But it isn't dangerous, and it does not interfere with sexual function, the ability to get pregnant (or to get someone pregnant) and is not contagious. Knowing what to expect can help ease some of your anxiety about your genital psoriasis.
  • Communicate with your partner: Because people can mistake a psoriasis outbreak for a sexually transmitted infection, you should explain your condition to your partner, preferably before you become intimate with one another.
  • Use condoms: Using a condom may help reduce the some of the friction that can induce a flare-up.
  • Try a lubricant: Some lubricants can alleviate the friction and discomfort of a psoriasis lesion. Be sure to talk with your doctor or pharmacist about which lubricants are safe, especially if you have open lesions or weeping.

A Word From Verywell

Genital psoriasis, like psoriasis in other parts of the body, is something you will have to manage for years. If you begin to notice lesions in your genital area, you should discuss it with your doctor.

Over time, you may have some improvement and worsening of these lesions, and you will start to notice what tends to exacerbate or help your outbreaks so that you can develop a routine to prevent them.

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