The presence of lesions, whether genital or located in visible areas, can lead to embarrassment, low self-esteem, and fear of rejection. In addition, discomfort and pain may impair the patient's ability to fully enjoy intimate relationships. Some patients also fear that psoriasis may be mistaken for a contagious disease.

The main difficulties reported include reduced sexual activity, changes in usual sexual practices, and, in some cases, complete absence of sexual activity.9–12

Although lesions in the genital area, visible regions such as the face or hands, or severe psoriasis may have a greater impact on sexual function, psychological factors play a critical role. A negative self-image during psoriasis flares contributes to reduced sexual desire and avoidance of intimacy,15–18 even when lesions are minimal.

Comorbid anxiety and depression significantly affect the sexual health of patients with psoriasis. These conditions can decrease libido, promote insecurity, and intensify fear of rejection, all of which negatively affect sexual relationships.10,19–22 They may also impair treatment response and worsen self-perception, further exacerbating the impact of psoriasis on sexual health.

Underdiagnosis is often due to factors such as limited consultation time, the taboo surrounding sexuality, insufficient examination or inquiry about the genital area, lack of direct discussion during clinical encounters, and limited awareness of tools such as validated questionnaires that can help identify sexual health problems.

Cultural factors, including religion, beliefs, and educational level, play an important role in how patients perceive psoriasis, its impact on sexuality, and their willingness to address sexual health concerns during consultations. Additionally, social and relational factors, such as poor communication, relationship conflict, and cultural beliefs, may influence how dermatologic conditions affect sexual well-being.5,6,23

Sexual health problems in women with psoriasis, reported in up to 79% of cases, are often associated with a higher prevalence of psychological comorbidities and reduced quality of life.10,19,24–27 In women of reproductive age, the impact may also include issues related to contraception and pregnancy.28,29 Although sexual health impairment may occur regardless of sex or age,25,29 these issues frequently go unnoticed, particularly in older women.

Sexual impairment can occur at any age and should not be underestimated (prevalence of 58.6% among individuals aged 18–69 years).25,29 It should not be assumed that patients, particularly older adults, lack concerns related to sexuality. This topic should be addressed respectfully with patients of all ages using a proactive approach that does not presume the absence of sexual health concerns.

Early detection can help prevent the worsening of sexual health problems caused by the physical and psychological impact of psoriasis.30,31 It is important to ask direct questions about sexual health because many patients do not spontaneously report problems in this area. This approach is essential for providing comprehensive care and identifying issues that might otherwise remain undiagnosed.

Validated questionnaires allow an objective assessment of the impact of psoriasis on sexual life and facilitate structured follow-up. However, their use should take into consideration the clinical context, available consultation time, and the patient's willingness to complete them. For example, they may be reserved for cases in which a significant impact on sexual life is evident or when systemic treatment is being considered.

Appendices B and C summarize the main validated questionnaires identified for evaluating sexual health and psychological impact in patients with psoriasis.

A specific assessment of genital involvement is essential for appropriate management of psoriasis, as many patients (up to 45.8%) do not spontaneously report symptoms in this area.32,33 A proactive and sensitive approach should therefore be adopted to facilitate detection of genital involvement, improve quality of life, and guide more precise treatment while minimizing patient discomfort.

Effective and early treatment improves cutaneous symptoms of psoriasis21,24,34–41 and provides psychological and emotional benefits that directly influence sexual health by enhancing self-esteem, reducing anxiety, and decreasing stigma related to visible lesions.42

Early treatment does not necessarily imply the use of systemic therapies. It is also important to consider the potential adverse effects of certain dermatologic treatments on sexual function, as they may contribute to the onset or worsening of sexual dysfunction, including erectile dysfunction.16,17,43–46

Management of genital lesions requires a sensitive approach due to the delicate nature of the area and the significant impact such lesions may have on the patient's quality of life, including self-perception and intimate relationships. Periodic genital examination should be performed to ensure appropriate disease control and to guide the selection and adjustment of the most suitable therapeutic options.

A multidisciplinary approach is essential when sexual dysfunction persists after improvement or resolution of skin lesions, or when no dermatologic cause is identified. In such cases, referral to the appropriate specialist—such as a sexologist, psychologist, urologist, or gynecologist—should be considered depending on the clinical scenario and the resources available at the healthcare facility.

Dermatologists may identify these issues but are generally not trained to address them comprehensively. Therefore, referral to a psychologist or sexologist is recommended to prevent the development of conditions such as anxiety and depression,47 particularly when dermatologic treatment alone does not resolve the identified concerns.

Dermatologists are the appropriate specialists to manage psoriasis, and treatment of genital lesions often resolves many related problems. However, complex cases may require referral to medical sexology, urology, or gynecology, particularly when the physical consequences of the disease are significant. An individualized approach should be adopted, considering both the severity of symptoms and the availability of relevant specialists within the healthcare center.

Up to 41.1% of partners of individuals with psoriasis report experiencing some form of sexual dysfunction.10 Therefore, this potential impact should be considered. However, the dermatologist's role is not to directly assess the partner but rather to focus on managing the patient's condition.

Referrals should be evaluated on a case-by-case basis when the impact of psoriasis on the partner or the relationship is evident. This should not be a general recommendation, as the dermatologist's primary role is to treat psoriasis and avoid intervening in areas that exceed their professional scope.

Follow-up should be incorporated into routine clinical visits to ensure that treatments are effective across all aspects of the patient's well-being, including sexual function. Tools such as the DLQI48 and ASEX49 may assist in the periodic evaluation of sexual function. In addition, coordinated care with sexual health professionals or primary care providers, once the primary psoriasis-related concerns have been addressed, may support long-term follow-up.

The impact of psoriasis on sexual function is multidimensional and should be assessed holistically, considering all aspects of the disease that may influence this domain. A multidisciplinary approach is recommended, involving collaboration with other healthcare professionals to effectively address the different dimensions of sexual health impairment.12,18,22

The organic basis of female sexual dysfunction remains understudied. However, its high prevalence—reaching up to 79% of affected patients—highlights the importance of increasing dermatologists’ awareness of its possible etiologic factors.19,25,26

Although dermatologists are not expected to directly manage these dysfunctions, they should be able to recognize potential organic causes and refer patients to appropriate specialists when necessary.

Identification of sexual dysfunction in patients with psoriasis should form part of a comprehensive clinical assessment. Management of these conditions typically falls outside the scope of dermatology and should be undertaken by specialists such as urologists, gynecologists, or sexologists. These dysfunctions may arise from factors beyond psoriasis severity, including chronic inflammation, psychological factors, and cardiovascular comorbidities commonly associated with the disease.16–18,50

Genital psoriasis is associated with a significant deterioration in sexual health and emotional well-being.32,34,51–57 Although examination of the genital area may cause discomfort for some patients, it remains essential for a comprehensive evaluation of the disease and its impact on sexual health.

The psychological burden of genital involvement is considerable because of its impact on sexual life, body image, and self-esteem. Over time, this may lead to symptoms of anxiety, depression, or body image disturbance.32,54,55 However, psychological morbidity should be broadly assessed in all patients with psoriasis, regardless of lesion location, to ensure comprehensive care.

These tools enable an objective and quantifiable assessment of the problem, facilitate monitoring of changes over time, and support individualized management. They may also provide a more discreet and reliable way for patients to express concerns about sexuality and genital involvement, thereby improving communication between physicians and patients.32,33,56

Beyond skin symptoms, joint pain, fatigue, and physical limitations related to psoriatic arthritis negatively affect sexual quality of life.58–60 Coordination with other specialists, particularly rheumatologists, is essential, as they manage functional impairments caused by pain and joint stiffness that may interfere with sexual activity.

Instruments such as the DLQI48 and the Psoriatic Arthritis Impact of Disease (PsAID)61 questionnaire can help quantify disease burden, tailor treatments, and guide structured follow-up. Their use may be particularly beneficial during joint consultations with rheumatologists, who have a more targeted approach to evaluating arthritis-related effects.

The final recommendations agreed upon by the expert panel are presented in Table 3.

Limitations reported by dermatologists indicate that time constraints, insufficient training in specific topics, and structural barriers within the healthcare system hinder the appropriate assessment of sexual health in patients with psoriasis. This highlights the need to enhance professional education, increase available resources, and promote a more individualized approach to achieve comprehensive patient care.