An erection depends on several different physical and psychological processes working together: blood flow to the penis, nerves, testosterone, arousal, and a good state of mind, says Justin Dubin, MD, a Miami, Florida–based urologist and the director of men’s sexual health at Baptist Health Medical Group, where he treats conditions such as ED.
You don’t need problems in all five areas for ED to occur — one can be enough, and several factors linked to psoriasis can interfere with these processes, Dr. Dubin says. “It really does make a lot of sense how having skin health issues, specifically a disease like psoriasis, can impact multiple aspects of your overall health, including sexual function,” he says.
Chronic Inflammation and Metabolic Conditions
Psoriasis-related inflammation can weaken the function of blood vessels, while chronic conditions that are more common in people with psoriasis can also damage blood vessels and nerves involved in erections, according to Mohammad Jafferany, MD, a professor of psychodermatology, psychiatry, and behavioral sciences at Central Michigan University College of Medicine in Saginaw and the president of the Association for Psychoneurocutaneous Medicine of North America.
Dubin says men sometimes come to his office for ED and end up being diagnosed with conditions like high blood pressure, diabetes, or sleep apnea. ED can act as a “canary in a coal mine,” he says because problems with erections may be an early sign of underlying cardiovascular disease.
He also points to American Academy of Dermatology guidelines that recognize sexual dysfunction as a psoriasis comorbidity, with the cardiovascular — and psychological — effects of psoriasis contributing to it.
Anxiety, Depression, and Body Image
“When someone is feeling low, exhausted, or hopeless, sex may simply feel less important, or they may have less interest in intimacy,” Dr. O’Leary says. The unpredictability of flare-ups can also increase anxiety around sex.
“How you feel about yourself is an important part of intimacy and in the case of people with psoriasis, it can mean they find it hard to relax when being touched, worrying about how the other person will perceive their skin, rather than experiencing the pleasurable sensations,” Dr. O’Leary says.
It’s a bit of a vicious cycle: the more self-conscious someone feels about their body, the more difficult it may be to become sexually aroused, which then increases anxiety and self-doubt the next time they’re intimate. “Over time, people can withdraw and isolate themselves,” she says.
Genital Psoriasis and Psoriatic Arthritis
“When you feel bad about the way you look, worry about leaving flakes of skin everywhere, and you’re experiencing discomfort and pain, it can easily impact your comfort with being intimate,” O’Leary says.
Medication Side Effects
Antidepressants and certain medications used for high blood pressure can cause sexual side effects in some people, and methotrexate has also been linked to sexual side effects, Dubin says.
That doesn’t mean you should stop any medication on your own. And effective psoriasis treatment may actually help, Jafferany says. “Most modern psoriasis treatments, especially biologic therapies, may actually improve sexual function by reducing inflammation and improving disease control,” he says.
Research suggests people with psoriasis may have lower levels of testosterone, but Dubin says it usually isn’t the primary driver of ED. “Addressing your testosterone is probably the least likely thing” to substantially improve erections on its own, he says.
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