"Sometimes youre in an intimate situation, and it's going through your mind that you must look horrible," says Anne Krolikowski, 35, of Milwaukee, Wis., who was diagnosed with psoriasis when she was a child.
Fighting the anxiety requires taking control, says Allan F. Chino, PhD, a psychologist in private practice with Functional Pain Solutions in Tigard, Ore., and an assistant clinical professor of medicine at Oregon Health & Science University in Portland. "If the reason for not being into sex is because youre self-conscious about your condition, the condition has power over you," he says. "Its about taking power back. If theyre not feeling attractive and their partner is saying 'I disagree,' they have an opportunity to turn their feelings around."
Chino recommends telling your partner about the disease or flare-up before you get intimate. "Most people fear that the disease will take someone by surprise. By putting it out there, youre taking control. You might say, 'I'm having an outbreak' with great confidence, or if you have the courage, show it to someone. The anxiety and stress around the disease will ease up."
2. Focus on the pleasure
"Anytime you have distractions or competing thoughts, it's going to take away from your enjoyment of sex," Chino says. "Its a matter of tuning into the situation, focusing on your partner and the joy you are creating together, and allowing any self-conscious thoughts to disappear." He says relaxation techniquesor just taking a deep breath when self-conscious thoughts arisecan be a reminder to stay focused.
Recognize the difference between anxiety holding you back and just not being in the mood. Chino recommends following your "primary feelings" (sexual attraction or arousal) and not your "conditioned feelings" (guilt, shame, or self-consciousness) when it comes to intimacy. "If you feel sexual and the conditions are right, go for it. But if you dont feel like having sex, or its painful, dont do it."
John, 56, who has lived with psoriasis since the seventh grade, has found that his skin-care routine has even served as foreplay. "Asking her to smear a lotion or ointment on my body sometimes leads to sex," he says. Not only can this strategy increase the intimacy between two people, but it can also help your partner better understand the disease.
Sometimes you're anxious about having sex, because you're in pain and worry it will hurt. On occasion, John's plaques are sensitive to the toucheven intimate touches. "If that area is encountered, youll react," he says. "And your partner will know to leave that area alone."
Getting over it with communication and ground rules
If sex is painful, then there needs to be some understanding and communication, says Rebecca Ross, PhD, a psychiatric mental health nurse practitioner at Oregon Health & Science University in Portland. "Opening the dialogue gives partners the opportunity to problem-solve which behaviors are mutually pleasurable," she says. "If someone is still self-conscious, there are ways of making love without increasing the vulnerability."
If you've experienced pain or rejection during intimacy, you might decide to avoid the situation altogether, and that can become a vicious cycle. The more you abstain, the harder it is to get back in the saddle. If you find yourself avoiding sex for an extended period of time or feel unable to talk with your partner about it, consider seeking help from a friend, doctor, therapist, or support group.