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Genital Psoriasis

Updated on February 19, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Laurie Berger

Genital psoriasis is one of the most uncomfortable and embarrassing symptoms of psoriasis. Besides itching and pain, having raw, irritated skin “down there” can take a toll on intimacy, sexual activity, and quality of life.

Up to two-thirds of people with psoriasis also develop lesions in the genital area, according to the National Psoriasis Foundation (NPF). Although genital psoriasis is very treatable, more than 40 percent of people with this symptom are too embarrassed to discuss it with their doctors.

Finding others who share the same issue has been a relief for members of MyPsoriasisTeam. “Oh, my goodness, I’m not alone!” one member exclaimed after sharing her secret with the community. “I’ve been too embarrassed to talk about it to anyone. … Just alone and in pain,“ said another. “It’s painful, itchy, and shame-inducing,” shared one member.

What Does Genital Psoriasis Feel Like?

Genital psoriasis is more painful than psoriasis elsewhere on the body. That’s because skin on the pubis, vulva, buttocks, and penis is thinner and more sensitive to scratching, rubbing, or friction — with or without sex. Here’s how members of MyPsoriasisTeam describe the feeling:

  • “Pure torture.”
  • “Drives me mad.”
  • “Feels like I’m on fire.”
  • “Legs rubbing make the area very sore.”
  • “Scratch until I bleed.”
  • “Man, I’m in itch hell.”
  • “Intimacy is uncomfortable because the area is so inflamed.”

How Does Genital Psoriasis Affect Members’ Lives?

Members of MyPsoriasisTeam share the ways genital psoriasis has affected their health and overall well-being.

Top Symptoms

Between 82 percent and 100 percent of people with genital psoriasis suffer from maddening itching, according to a 2018 literature analysis. “Itching at night is by far the worst symptom I have,” said one MyPsoriasisTeam member. “When I scratch, I break open and bleed like a sieve. All over my clothes, the floor, my bedsheets. It's alarming how much blood can come from a little scratch,” explained another member.

Stinging and burning are also common complaints, experienced by 40 percent of people with genital psoriasis. About 20 percent reported pain as their worst symptom, which can result from cracked, bleeding, or torn skin. “I feel shocking pain that’s caused, I believe, from fissures that form in the creases of my ‘downstairs’," explained one member.

Sexual Activity

While 72 percent of people with psoriasis have reported feeling reluctance about dating, those with genital lesions can be even more likely to avoid relationships and sex. Studies have shown that people with genital psoriasis have less frequent intercourse, reduced sexual desire, and fewer sexual relationships. “I haven't been intimate with my husband in more than a year because I don't feel sexy at all!” admitted one member.

Not only that, sex can hurt. Members of MyPsoriasisTeam experience pain, stinging, and burning during and after sexual activity. “Intimacy is uncomfortable because the area is so inflamed,” explained one member.

Small skin tears or traumas can trigger flares (known as the Koebner phenomenon) after sexual intercourse. “It has made sex very painful. I bleed because the skin on the head [of my penis] tears. I need lube or it hurts too much,” said one member.

Quality of Life

The stress and stigma of genital psoriasis also affects mental well-being. According to the National Psoriasis Foundation, people with the condition report lower self-esteem than those with psoriasis on other body parts.

Studies also demonstrate that people with genital lesions are often more depressed than those without. Women tend to be more sexually distressed than men. “I’ve lost relationships because of genital psoriasis; it really knocked out my confidence,” shared one member of MyPsoriasisTeam.

What Does Genital Psoriasis Look Like?

Psoriasis often hits below the belt at some point in people’s lives. “As a teenager I had it on my face. Now in my 50s, my face isn't bad, but it went south about 10 years ago. Not a happy camper,” shared one member. Two different types of psoriasis typically occur in the genital area, inverse psoriasis and plaque psoriasis.

Inverse Psoriasis

The most common type, inverse psoriasis typically presents as smooth, red, tight-looking patches in the folds of skin between the upper thigh and the genitals. Inverse psoriasis is more painful than other types and can be made worse by sweat or friction. People with inverse psoriasis on other parts of their bodies have almost an 80 percent risk of developing it in the genital area.

Plaque Psoriasis

Plaque psoriasis is characterized by thick, red patches and silvery or white scales that can crack and bleed. It typically appears on the pubis or upper thighs.

Either type of psoriasis can appear on the vulva, penis, scrotum, or the crease between the buttocks. In women, psoriasis on the vulva can look like silvery patches or grayish or red plaques outside the vagina or in skin folds. In men, small red patches most often occur on the glans (tip of penis) or shaft.

What Causes Genital Psoriasis?

The exact cause of genital psoriasis is unknown. However, scratching or consistent rubbing and pressure can create soreness, cracking, and bleeding that may lead to infections.

Genital psoriasis is often mistaken for other conditions, such as a sexually transmitted disease, allergic reaction, or yeast infection. Because doctors often fail to ask about or examine these areas, people with genital psoriasis may be undertreated or suffering unnecessarily.

“I was too embarrassed to talk to any doctors about it,” a MyPsoriasisTeam member said. “When I did, they brushed it off as a yeast infection, even though I didn’t have any of those symptoms. Finally, last year I was diagnosed with genital psoriasis, told it was a ‘life sentence,’ and prescribed a topical cream that did nothing. Haven’t been back to the doctor since, but I’ve been suffering.”

It’s important to undergo a clinical exam by a licensed dermatologist to get proper diagnosis and treatment.

Treatments for Genital Psoriasis

There’s no known cure for genital psoriasis, but it can be managed with medications, topical treatment, and some natural remedies. Sensitive genital skin requires different treatment than psoriasis on other parts of your body. A dermatologist can recommend the best options for you.

Topical Medications

Topicals applied to the skin help moisturize dry patches, reduce pain and itch, and slow down inflammation. Low-strength topical corticosteroids are typically the first-line treatment for mild-to-moderate genital psoriasis. Side effects include skin thinning, which is why steroids are only used for two to four weeks.

Non-steroidal creams and ointments for eczema, such as Protopic (Tacrolimus) and Elidel (Pimecrolimus), are effective second-line treatments for genital psoriasis. Prescribed off-label, these topical calcineurin inhibitors (TCIs) act on the immune system to reduce skin inflammation. Common side effects include local burning or irritation.

Vitamin D analogues, such as Dovonex (Calcipotriene) cream, are second-line treatments often prescribed in combination with topical corticosteroids and TCIs. Side effects include irritation in skin folds. Other second-line treatments include emollients, coal tar-based products, and antimicrobial agents that prevent infection in skin folds.

Doctors often prescribe systemic treatments when symptoms become resistant to topicals. These might include oral Methotrexate or Otezla (Apremilast), or biologics such as Humira (Adalimumab), Enbrel (Etanercept), and Cosentyx (Secukinumab). Taltz (Ixekizumab), an FDA-approved IL-17A inhibitor for treatment of genital psoriasis, has been shown to clear skin in people with moderate-to-severe genital psoriasis.

“I’ve been clear of genital psoriasis for over a year now by taking Methotrexate! Most all other plaque breakouts have disappeared over 90 percent!” shared one member of MyPsoriasisTeam. “I’ve been using Cosentyx and now Taltz. I’m 90 percent psoriasis-free for the past six years,” said another.

Some members reported their lesions returned once medication was stopped. “Clobetasol clears it right up, but it comes back in a few weeks,” said one. “Taltz totally cleared my psoriasis with one exception — my genital area! I'm going to have to go back to steroid ointments.”

Although phototherapy and coal-tar therapy are sometimes used to treat genital psoriasis, the American Academy of Dermatology cautions that both options have increased risk of genital cancer.

Nonmedicinal Treatments

Various natural and home remedies can help relieve symptoms of genital psoriasis, protect your skin, and ease the pain of sexual activity. Try the following to remedy itching:

  • Cold packs or compresses
  • Moisturizers chilled in the refrigerator
  • Aloe vera juice
  • An apple cider vinegar soak (one part vinegar to four parts water)
  • Calamine lotion
  • Colloidal oatmeal baths and creams

Skin Care Tips

Cleansing — Wash frequently with mild cleansers. Avoid irritating antibacterial soaps or body washes. One member makes her own: “I shower with coconut oil and jojoba oil, mixed to a whipped-cream-like texture. I’ve not used soap in 10 years.”

Warm Baths — Bathe in lukewarm or cool water and moisturize immediately after.

Daily Moisturizing — Use fragrance-free moisturizer daily, after bathing or whenever the affected area feels dry.

Quality Toilet Paper — Use soft paper to avoid irritation, and wipe well. Urine and feces can irritate genital lesions and trigger flares.

Loose Clothing — Choose breathable cotton undergarments and pants that don’t rub or irritate skin. “My dermatologist suggested men's boxer shorts and skirts in cotton, linen, rayon or bamboo — and no polyester or synthetic fabrics,” shared one member. Another added, “No underwear when I’m at home.”

Intimacy Do’s and Don’ts

Cleanse Before Sex — Use mild, fragrance-free cleansers to remove psoriasis medication that could affect your partner.

Use Lubes — Lubricants and lubed condoms can reduce friction during intercourse.

Modify Your Position — Communicate with your partner to find a position that minimizes rubbing on any irritated areas during sexual activity.

Know When to Avoid Sex — If skin on or around the genitals is raw, cracked, or bleeding, abstain from sexual activity to avoid further irritation and pain.

You Are Not Alone: Finding Support for Genital Psoriasis

By joining MyPsoriasisTeam, the social network and online support group for those living with psoriasis, you gain a support group more than 80,000 members strong. Genital psoriasis is one of the most-discussed topics.

How does genital psoriasis affect your intimate relationships? Has your doctor prescribed treatments to manage your symptoms? What helps you successfully get through each day? Share your tips and experiences in a comment below or on MyPsoriasisTeam. You'll be surprised how many other members have similar stories.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Laurie Berger has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

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