There are many chronic health conditions that have a significant impact on people and their daily lives, yet they can be difficult to spot. The stranger on the bus who suffers from high blood pressure, or the soccer coach who deals with diabetes would not be assigned a “label” associated with their condition from a bystander or even a close friend. In contrast, psoriasis and other skin conditions are visible to others with significant impact on self-esteem, work, school, social interactions, and relationships. Valentine’s day is quickly approaching and while some are excitedly planning ways to celebrate with their partners, others are dealing with the emotional pressures, self-image, and fear due to their psoriasis. If you are feeling this way, you are not alone. We hope that this article can serve as reassurance for you and your partner to enjoy Valentine’s day for what it signifies: celebration of unconditional love.
The physical effects of psoriasis on relationships
Psoriasis is a common inflammatory skin condition that manifests as a raised, scaly rash that can happen anywhere on the body.1–3 It can be painful and itchy and sometimes cover a significant portion of the skin including genitals. People have reported avoidance and feelings of unattractiveness due to their psoriasis, especially among those in new relationships.5 The feeling of unattractiveness, stigmatization, and stress together can make some people completely shy away from relationships.
This is especially true in people with genital psoriasis. This population have been shown to experience impairments in sexual function and consequently engage in intercourse less frequently, avoid sexual relationships, and have decreased sexual desire.6–9 People may experience pain and symptom exacerbation during or after intercourse, and because of this, avoid sex. Genital psoriasis has been shown to remain untreated in up to two-thirds of psoriasis cases due to the stigmatization, shyness, and fear of judgement from a physician.6,10 Don’t be afraid to have a conversation with your doctors and ask for treatments that are targeted towards genital psoriasis.10 If your doctors don’t explicitly ask about how psoriasis is affecting your sex life, please tell them! This information is important to your care and treatment plan, and your doctor may be more conscious to ask you – or others – in the future.
Decreased intimacy with a partner is one of the most important physical impacts of psoriasis. A study conducted at the University of Western Ontario showed that 60% of patients with psoriasis who experienced decline in sexual activity attributed this to appearance, while only about 15% attributed the decline to decreased interest from their partner.11 This really highlights the importance of body positivity, and how poor self-image can impact relationships.
The emotional effects of psoriasis on relationships
We are often our own harshest critics and those with psoriasis are no exception. Psoriasis is associated with higher rates of mental health issues like anxiety and depression. Changes in mood, anxiety due to changing symptoms, and shame are just a few of the impacts that psoriasis can induce.2 It is not hard to imagine how these effects could permeate into all aspects of life, including relationships. With that said, a change in mindset from that of resentment and shame to control and understanding can have a significant influence on quality of life. Try checking in with yourself often so you can learn to recognize your personal clues about when psoriasis starts to impact your mood and your relationship. Be aware that a strong, healthy relationship starts with yourself. The best ways to gain control of psoriasis include appropriate medical care, stress relief, exercise, and a healthy diet. Never be afraid to seek help from medical professionals when your psoriasis is not being controlled or your psoriasis is significantly impacting your mood.
Talking to your partner about your psoriasis
Honesty and openness are key when discussing psoriasis with a partner. First, broaching topics we are self-conscious about in the context of a new relationship may be less difficult when you are confident and willing to answer questions. Humor can help, too, but try not to put yourself down – you are worthy of love!
Many people aren’t familiar with psoriasis and they may falsely assume it’s contagious. It is important to address this common concern with your partner. Beauty standards are shifting, and more and more celebrities and influencers are being candid about their skin conditions. For example, Kim Kardashian, an American media personality, has just recently begun to open up about her psoriasis and psoriatic arthritis. Cara Delavigne – a model, actress, and singer – also recently discussed her experience with psoriasis and how lack of knowledge led to people she worked with being afraid to touch her, fearing her condition was contagious. Though challenging, you can make a big impact by educating those around you, including your partner, about your experience with psoriasis.
Don’t let the elephant linger in the room! If it is on your mind, put it out there and talk about it.
The dating world can certainly be intimidating. With the advent of online dating (especially during the pandemic), vanity is often the difference between a swipe right or left. Online dating certainly has its challenges but being honest early about your psoriasis and its impacts on your life may help the development of a relationship. You could use those initial discussions and stages of getting to know each other to bring it up with positive language. Approaching a conversation with a positive attitude can create the opportunity for questions and a positive conversation. You have faced challenges dealing with your psoriasis and you should be proud of how you have managed them.
Unfortunately, we are not immune to stigma and criticism. If you receive negative reactions to your psoriasis, try not to be frustrated and know that it is not your fault. Likely that individual is not well-informed about psoriasis. Facing stigmatization is emotionally draining and it is very difficult to react in the moment. If you find that you have it in you, perhaps encourage that person to do some research for themselves. If that is too much in the moment, take a step back, gather some space, and know that you are not responsible for other people’s reactions.
Factors to consider during intimacy
When it comes to intimacy, make sure that you are as comfortable as possible. Some people may have difficulty exposing their skin to their new partners, so take it one step at a time. Showing pictures of psoriasis to your partner can be the first step. If you are progressing towards intimacy in a new relationship, perhaps have a conversation in advance. Put it out there – your fears, what you are excited about, and anything else that may creep up and distract you in the moment.
Don’t be afraid of psoriasis standing in your way when you choose what to wear – find something that makes you feel sexy and confident. Choose fabrics that do not irritate your skin such as silk or cotton and ensure that your skin is well moisturized to minimize the scaly appearance of psoriasis. Know that you can communicate with your partner if things get uncomfortable or painful. Lubricants can help to reduce friction and subsequent pain and discomfort. Opt for lubricants that are unscented, as fragrance can irritate the skin or even cause allergic reactions. After intimacy, gently cleanse the skin and apply non-scented moisturizer to help keep your skin healthy and avoid irritation.
We do not get to choose the skin we have, but we can control how we treat ourselves and have the right mentality. It’s no doubt that psoriasis can be very challenging to live with. Be kind to yourself and realize that your body is incredibly capable and powerful. Showing our skin love and understanding encourages others to do the same whether they are a partner, family member, friend, or even a complete stranger.
- Lahousen T, Kupfer J, Gieler U, Hofer A, Linder MD, Schut C. Differences between psoriasis patients and skin-healthy controls concerning appraisal of touching, shame and disgust. Acta Derm Venereol. 2016;96. doi:10.2340/00015555-2373
- Sumpton D, Kelly A, Tunnicliffe DJ, et al. Patients’ Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies. Arthritis Care Res. 2020;72(5). doi:10.1002/acr.23896
- Feldman SR, Malakouti M, Koo JYM. Social impact of the burden of psoriasis: Effects on patients and practice. Dermatol Online J. 2014;20(8).
- Young M. The psychological and social burdens of psoriasis. Dermatol Nurs. 2005;17(1).
- Magin P, Heading G, Adams J, Pond D. Sex and the skin: A qualitative study of patients with acne, psoriasis and atopic eczema. Psychol Heal Med. 2010;15(4). doi:10.1080/13548506.2010.484463
- Yang E, Beck K, Sanchez I, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. Psoriasis Targets Ther. 2018;Volume 8. doi:10.2147/ptt.s169389
- Meeuwis KAP, Van De Kerkhof PCM, Massuger LFAG, De Hullu JA, Van Rossum MM. Patients’ experience of psoriasis in the genital area. Dermatology. 2012;224(3). doi:10.1159/000338858
- Cather JC, Ryan C, Meeuwis K, et al. Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study. Dermatol Ther (Heidelb). 2017;7(4). doi:10.1007/s13555-017-0204-3
- Ryan C, Sadlier M, De Vol E, et al. Genital psoriasis is associated with significant impairment in quality of life and sexual functioning. J Am Acad Dermatol. 2015;72(6). doi:10.1016/j.jaad.2015.02.1127
- Meeuwis KAP, De Hullu JA, Inthout J, et al. Genital psoriasis awareness program: Physical and psychological care for patients with genital psoriasis. Acta Derm Venereol. 2015;95(2). doi:10.2340/00015555-1885
- Gupta MA, Gupta AK. Psoriasis and sex: A study of moderately to severely affected patients. Int J Dermatol. 1997;36(4). doi:10.1046/j.1365-4362.1997.00032.x