When she's not treated, psoriasis covers up to 90 percent of Alison Cooper's body. (Alison Cooper is not her real name). “I never thought I would feel comfortable enough to be intimate with someone,” she says. “Sex gave me lots of anxiety, and I feared my partner would be disgusted or would judge me after seeing my skin.”
Despite her fears, she says she manages expectations by being forthright about her condition with her sexual partners as well as taking time to develop relationships before becoming intimate. “My ex-husband did a great job of assuring me that my psoriasis didn’t matter,” she says, “and my current boyfriend is as loving and reassuring.”
Even when people with psoriatic disease are in committed relationships like Cooper's, the impact that these two conditions have on the sex lives of patients is notable and widespread.
According to recent a study in JAMA Dermatology, men and women with psoriasis are five times more likely to experience sexual dysfunction (SD) compared to those without the condition, and men are four times more likely to have erectile dysfunction (ED). There was also a strong link between SD/ED and psoriatic arthritis.
Sexual dysfunction, which affects 43 percent of women and 31 percent of men, prevents sexual satisfaction and can arise during any phase of the sexual response cycle. Sexual dysfunction is defined as any problem that impacts your relation to sexuality and prevents you from experiencing satisfaction from sexual activity. Erectile dysfunction is also common, affecting the sex lives of up to 30 million American men. Erectile dysfunction occurs when the penis is not firm enough for vaginal penetration or when it loses firmness following penetration.
Another study, soon to be published in Arthritis Care and Research, also found that men and women living with inflammatory arthritis, including psoriatic arthritis, are more likely to experience sexual and erectile dysfunction. Dr. Andrew Briggs, lead author of the study and a professor of health science at Curtin University in Perth, Australia, says, “We know that there is an association between inflammatory joint disease and sexual function and intimacy." While researchers are not sure why inflammatory disease has such an impact on sexual health, the hypothesis is that negative body image, lower mood, and genital lesions may all contribute.
Theresa Johnson (not her real name) lives with psoriasis and psoriatic arthritis. She’s not surprised that psoriatic arthritis and sexual health are connected. “When I’m living with pain,” she says, "I’m completely focused on getting out of pain and then accomplishing what I need to do to keep my job and be a good mother. If I’m in the middle of a flare up, sex is one of the furthest things from my mind.”
If you are living with sexual dysfunction and psoriatic disease, share what you are experiencing with your doctor, says Dr. Briggs.
If you are living with sexual dysfunction, one of the first steps is to talk to a healthcare provider you trust, who will then be able to refer you to the appropriate specialist. "For example, if you feel skin flares are the main reason for lack of intimacy, your doctor may contact your dermatologist to determine if a more effective treatment is available," says Dr. Briggs. "Involving your partner in your care by having him or her attend your doctor appointments can also make you feel like a united team in and out of the bedroom."