Impotence ​& Genital​ Psoriasis

Valentines is a funny day. I’m not sure what it is all about- the rest of the World seems to have an idea though. In the U.K February 14th marks National Impotence Day; In the U.S its National Condom Day and in Canada the 14th is Sexual and Reproductive Health Day.

Whichever way you look at it, it’s a day that people are thinking about sex.

I have personal experience with erectile dysfunction (ED), although you may have noticed I am not in possession of a penis. I did briefly date a guy who I had been friends with for years. He struggled with erections, and sadly he refused to seek help. Take it from me- ED needlessly interferes with a relationship when the issues are not tackled head-on. There are a lot of interventions available, and with 1 in 10 men affected at some point in their life, there is nothing to be embarrassed about.

I also don’t think we talk about this enough- it’s a genuine concern, and I imagine its widely under-reported too.

It is, for this reason, I decided to write this article, and chat with my good friend, and fellow psoriasis sufferer Russ about genital psoriasis and erectile dysfunction.

Genital Psoriasis

If you asked me the most annoying place to have psoriasis- its hard to choose between my inner ear, my eyelids and in and around my genitals.

The things about genital psoriasis is that I will openly chat to my Dr about my annoying eye issues and we will joke about the state of my inner ear (ok he is telling me off for using earbuds to scrape out the scaling, but that makes me laugh). I do not tell him about the patch of psoriasis that is in my genital area. It definitely seems less funny. Because it is.

This is why I love talking to Russ, he is so open and honest about everything

“I have had genital psoriasis in my groin and scaling around the testicles, but not on the dangly bit.”

Russ Cowper

Can you imagine announcing that in the pub!? So here we are talking openly and honestly about living with genital psoriasis and later on in this article we will chat in depth about the challenges of living with psoriasis on our sex lives. (Hint: Its not always positive *surprise*).

Genital Psoriasis Top Tips:

Here are the top strategies we cover in the episode:

1. Cut (but dont shave) Pubic hair

If I shaved off my pubic hair, the regrowth made the psoriasis itchier

Gemma Boak

Trimming pubic hair can make psoriasis less itchy, if hair is moving across the surface then it can stimulate the nerve ending and make us more aware of the itch. I find the regrowth from shaving makes me itch more as the regrowth stubble catches the fabric on my underwear and again, increases friction on the skin surface. There’s an optimum length, you need to find it.

2. Experiment with fabric types (and nakedness)

Cycling shorts help with itching a lot, it reduces friction, which can cause genital psoriasis to get sore

Russ Cowper

Russ finds the smooth elastic and seamless nature of the fabric in cycling shorts great for wearing for a couple of hours when he needs to go out. Im not convinced as I like air flow and so tend to lean towards cotton full briefs… needless to say G strings are not an option with genital psoriasis.

We are both huge proponents of a ‘full airing’ where you try to find opportunities to allow as much air to the area as possible. This could be full nakedness, but as that is not acceptable for most people, no underwear while wearing baggy tracksuit bottoms is a great compromise.

3. Avoid Fragrance and harsh detergents

There is no need to fragrance your genitals, you just need to keep them clean. Fragrances will irritate the skin unnecessarily. The skin is moist and delicate- using abrasive cleaners risks disrupting the skin barrier and also disrupts the microbiome that keeps the genitals healthy. This is particularly important if you have broken skin, to reduce the risk of infection. Mild cleaning products are effective, speak to your doctor for specific recomendations.

Genital Psoriasis & Impotence

The psychological aspect in intimate relationships is significant, it really does affect your sex drive.

Gemma Boak

What is Impotence?

Impotence is another way of referring to Erectile Dysfunction, a situation where an erection cant be maintained for the duration of sex or sexual activity (regardless of whether ejaculation takes place or not).

Why Impotence and Psoriasis?

According to a bunch of studies, men with psoriasis are more at risk of erectile dysfunction (1). The thing is, according to the data they are right – – but things are not as they seem.

Impotence can be caused by both physical and psychological reasons. Psoriasis can affect both, and it’s likely that impotence is a side effect of something else.

Pre Sex Psoriasis Stuff

I don’t know about you, but when I’m in a flare the word Sexy is not a word I would use to describe how I feel about myself; therefore sex is rarely above chocolate or sleep on my agenda. This is where the male of the species is at a disadvantage.

Women have got the advantage in a flare. I’ve taken part in an intimate relationship (read- sex), and because my skin has been awful I haven’t been in the mood, but have warmed into it as things have got going. Whereas for a man, they need to be warmed into it from the start.

I think the psychological aspect of psoriasis in a sexual relationship is quite significant. It really does affect your sex drive.

Gemma Boak

So lets look at just a few of the psychological challenges a person faces when they have psoriasis and are in an environment where they may have sex.

So what happens? Your body goes into fight or flight like response. Adrenaline peaks as your anxiety levels rise, you may be afraid and blood is rerouted from the penis to the brain and heart- so its ready fight off that lion(ess).

Your penis needs a good blood supply for good erections. Fact.

How do you know if its an anxiety/ stress/ psychological problem? Check out your/ your lovers penis first thing in a morning. If he is standing firm and erect, then biologically in a low-stress situation, theoretically, thing are looking up… (but you should still double check with a doctor).

If you are reading this because you have erection stress then have a candid conversation with your partner. Having a partner who understands, can help alleviate some of the psychological stress.

In this situation, you just need to own it. I dated a guy who had a erectile dysfunction, and we never talked about it. …..For me, it was very difficult to have a relationship with him, because he wouldn’t talk to me about it. ….I think you just need to say “the reason is I’m not feeling very self confident”, or “I’m not feeling this”, or “you can’t touch this part of me”. Its not a blame thing, its an openness thing. Normally it’s a team effort.

Gemma Boak

Obesity and Cardiovascular disease

Problems with erections can be due to reduced blood flow.

Several co-morbidities of psoriasis are linked to reduced blood flow including diabetes, hypertension and problems with the heart. Reduced blood flow is also seen in people with large amounts of excess weight.

In these instances, Impotence can be a side effect of a bigger problem. Treat the cause, and the blood flow challenge should be improved. So – yep- you need to go speak to your doctor. I have read of instances where diabetes has been diagnosed as a result of someone coming in with E.D. Those stories may be exaggerated, but your doctor wants to see you, so go.

Depression and anxiety

In the few studies available, E.D is strongly associated with depression and anxiety and living with psoriasis we are much more likely to experience both of these challenges.

What can you do?

Go and see your doctor.

They can prescribe you things to help with psoriasis, which may alleviate both the physical and psychological causes of the symptoms. In some cases, Biologic therapy of psoriasis patients has led to an improvement in ED (2)

Your doctor will also be able to investigate the possibility of other causes, such as undiagnosed diabetes or cardiovascular conditions that you cannot do yourself.

They will also be able to advise on lifestyle changes and give E.D specific interventions for you to try at home.

If you do not have a good doctor, or you struggle to get what you need then you need to listen to this interview with Dr Dan Maggs on how to get the most from your G.P.

Speak to your partner

It’s easy to hide from this problem, but your sexual partner cares about you and wants to be involved. If you are both working on the same page, then it can take a lot of the anxiety out of the situation and make your intimate time together more fun for everyone.

About Russ

Russ is the co-host of The Psoriasis Geek Podcast. He has experienced psoriasis and psoriatic arthritis since his teens and is currently taking biologic medication.

Russ writes poetry about psoriasis and dedicates his time into supporting other people living with psoriasis in his role as a Psoriasis Shout Out Ambassador and with his work with Associations such as BAD and BADBIR.

References

  1. Wu T, Duan X, Chen S, Chen X, Yu R, Yu X.(2018) Association Between Psoriasis and Erectile Dysfunction: A Meta-Analysis. J Sex Med. 15(6):839-847. https://www.ncbi.nlm.nih.gov/pubmed/29735408
  2. Molina-Leyva A, Salvador-Rodriguez L, Martinez-Lopez A, Ruiz-Carrascosa JC, Arias-Santiago (2018) JAMA Dermatol. Association Between Psoriasis and Sexual and Erectile Dysfunction in Epidemiologic Studies: A Systematic Review.https://www.ncbi.nlm.nih.gov/pubmed/30304327
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