People with psoriasis may be at increased risk of sexual dysfunction, particularly when they also suffer from mood disorders or arthritis, a research review suggests.
Researchers examined data from 28 studies with more than 52,000 psoriasis patients and more than 1.8 million people without psoriasis. Those with psoriasis - an autoimmune disorder that causes red, scaly skin patches - had a 5.5-fold higher risk of sexual dysfunction than people without the condition, the analysis found.
Psoriatic arthritis, or swollen and inflamed joints that sometimes accompany the skin disorder, was associated with a higher risk of sexual dysfunction among people with psoriasis, the study also found. So were depression, anxiety and psoriasis flare-ups of itchy, dry skin on the genitals.
"Sexual dysfunction may arise more commonly in those with psoriasis for a number of reasons," said Dr. Jon Goulding of University Hospitals Birmingham NHS Foundation Trust in the UK.
"The presence of visible and symptomatic skin lesions, particularly on the genitals, may understandably adversely affect sexual function, through negative effects on self-confidence and self-esteem," Goulding, who wasn't involved in the study, said by email. "Anxiety and depression often develop in patients with psoriasis for similar reasons, and sexual dysfunction may be a manifestation of profound psychological distress."
Men with psoriasis had a 37 per cent to almost four-fold higher risk of erectile dysfunction than men without psoriasis in the eight studies that looked at this specific question.
Often, men with psoriasis are obese or have other cardiovascular risk factors that may restrict blood flood in the body, including in the penis. Psoriasis that develops on the penis can also contribute to pain and discomfort during sex or contribute to psychological issues that impair sexual performance, some previous research suggests.
Women, too, may find sex painful with psoriasis or experience mood disorders related to the condition that impact their sexual function, previous research has found.
Raised patches of dry, scaly, itchy skin are a hallmark of psoriasis. The inflammatory skin condition can be made worse by exposure to stress, cold and infections. Symptoms may be eased by topical ointments and medications, but there is no cure.
The current analysis didn't include controlled experiments designed to prove whether or how psoriasis might directly or indirectly cause sexual dysfunction.
But it's possible that systemic inflammation impacts sex hormones in a way that impairs sexual function, Dr. Alejandro Molina-Leyva and colleagues write in JAMA Dermatology. Molina-Leyva didn't respond to requests for comment.
Even when psoriasis doesn't stop people from having sex, it may make them feel worse afterward, noted Dr. Alexander Egeberg of Gentofte Hospital in Denmark, who wasn't involved in the study.
"Genital psoriasis lesions may not only be embarrassing for patients, which can cause patients to be psychologically affected, but it can also be painful during intercourse, and genital psoriasis may actually worsen following sexual activity due to friction and skin irritation," Egeberg said in an email. "Moreover, psoriasis is associated with cardiovascular disease and cardiovascular risk factors such as hypertension and diabetes, which may also cause male erectile dysfunction."
Egeberg has received research funding from drug companies that make sexual dysfunction and psoriasis treatments, including Pfizer and Eli Lilly.