Living With Psoriasis and Erectile Dysfunction: What’s the Connection?

Inflamed patches and dry, cracked skin are common symptoms of psoriasis, but this autoimmune condition can affect men’s health in a way that’s less discussed: erectile dysfunction (ED).

If you’re experiencing ED, it’s worth bringing it up with your dermatologist, who can consider whether psoriasis-related symptoms, comorbidities, lifestyle factors, or medications may be contributing and, if needed, refer you to another specialist, such as a urologist or therapist.

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.

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

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.

If ED is persistent, don’t shy away from telling your dermatologist, Jafferany says. “Feelings of embarrassment, stigma, and the misconception that sexual health is unrelated to dermatologic disease often prevent these conversations,” he says.

A simple statement, such as “My psoriasis is affecting my intimate life” is enough to start the conversation, he says. Your dermatologist may ask an open-ended question, too, such as, “Many men with psoriasis have problems with ED or sex; how is that for you?” O’Leary says.

After that, your dermatologist may look at your health comprehensively, including your psoriasis severity, comorbidities, mental health, relationship concerns, and a review of all medications that could contribute to ED, he says.

In cases where the dermatologist isn’t the most appropriate physician to manage the problem, they can refer you to a urologist, or mental health professional.

A urologist may perform a physical exam, review medications and medical history, check hormone levels, and consider whether cardiovascular disease, diabetes, psychological distress, or other factors could be contributing, Dubin says.

That could mean connecting you to a cardiologist, assessing diabetes risk, addressing a hormonal problem when appropriate, or recommending therapy or relationship counseling.

While the key step in treating ED is to address the underlying cause, lifestyle modifications can improve your physical health, mental health, and sex life. Here are a few strategies.

• Optimize your psoriasis treatment plan. Jafferany says people with psoriasis should follow their treatment plan, including taking medications and topicals as prescribed, to keep their condition under control.

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• Try a smoking cessation program. Smoking damages blood vessels and restricts blood flow to the penis, both of which can affect erections.

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   For some people, quitting can lead to improvements within months.

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• Prioritize exercise. “Exercise is incredibly powerful,” Dubin says, adding that moderate- to vigorous-intensity activity can improve cardiovascular and blood vessel health.

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   It’s also great for people with psoriasis, specifically because it reduces systemic inflammation and supports weight management.

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   Dubin recommends combining cardiovascular activity with resistance training.
• Address psychological symptoms. Consider individual or couple’s therapy, O’Leary says. “Psychological approaches that address stress, shame, body image, and communication can help men regain confidence, strengthen relationships, and start to feel more comfortable with relationships and intimacy,” she says.
• Eat a heart-healthy diet. Dubin recommends a Mediterranean-style eating pattern, which emphasizes foods like fruits, vegetables, whole grains, legumes, fish, and healthy fats.

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   This diet can support cardiovascular and metabolic health — factors that are closely tied to ED — and may help with weight management in the process.

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