How to Have a Happy Sex Life When You Have Psoriasis

Even if you’re in a happy relationship, psoriasis can be a sex-life killer. For most of us, sex drive ebbs and flows, but a psoriasis flare-up can dampen your desire further by ruining your self-confidence—and by making sex painful. Here's how to push past the roadblocks psoriasis throws up.

The first roadblock: Feeling unattractive
"Sometimes you’re 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.

In those moments, even if your partner understands your condition, thoughts like that can still intrude. "Being intimate can be hard," explains Victoria Gardner Nye, 35, from Cambridge, Mass., who has had psoriasis since she was a teenager. "Especially if they’re kissing you near your psoriasis. I know that my husband doesn’t care. But I worry he’s going to get a flake in his mouth."

Five steps to overcome it
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 you’re self-conscious about your condition, the condition has power over you," he says. "It’s about taking power back. If they’re not feeling attractive and their partner is saying 'I disagree,' they have an opportunity to turn their feelings around."

1. Talk about it up front
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, you’re 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. "It’s 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 techniques—or just taking a deep breath when self-conscious thoughts arise—can be a reminder to stay focused.

Krolikowski agrees: "If you let your fear or anxiety take over, it could certainly shut you down. But when you’re in the moment, you just go with it. Once you get through that initial burst of anxiety, you’re fine."

3. Don't force yourself
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 don’t feel like having sex, or it’s painful, don’t do it."

4. Find what works for you
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.

The second roadblock: Pain
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 touch—even intimate touches. "If that area is encountered, you’ll react," he says. "And your partner will know to leave that area alone."

Psoriasis can also appear in intimate areas of your body, making sex uncomfortable. "Psoriasis in the vaginal area can be uncomfortable and bleed slightly," says Gardner Nye.

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."

Ross recommends laying ground rules about what your partner should or should not do before becoming intimate—especially if certain activities or areas of your body make you feel uncomfortable.

When to get help
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.

"The red flag should go up, and you should start thinking about taking action," says Chino. "There is a potential for things to get worse and the avoidance could turn into a phobia. If it goes on long enough, it can become a part of your sense of self."

Talking to someone who understands your situation can help to validate your feelings. "People not only feel better when they have a therapist, close friend, or confidant they can open up to, but opening up to another person whom you trust and who cares about you has remarkable emotional and physical healing effects," says Chino.

If you don’t have health insurance or can’t afford a therapist, Chino recommends joining a support group or even writing your feelings down in a journal.