Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners

Abstract

Introduction Psoriasis is a chronic, multisystem, inflammatory, disfiguring disease with a high negative impact on quality of life due to comorbid psychological, organic, and sexual consequences. Aim To evaluate the psychopathological and sexual aspects of psoriasis vulgaris in patients and their partners compared to healthy controls. Methods In the current comparative cross-sectional study, the sample included 220 psoriasis vulgaris patients (110 males and 110 females), their consenting partners, and 220 age- and sex-matched healthy controls. All participants were evaluated for depression and anxiety using the Hospital Anxiety and Depression Scale and for low self-esteem using the Rosenberg's Self-Esteem Questionnaire. Sexual function was assessed in females using the Female Sexual Function Index questionnaire and in males using the International Index of Erectile Function and its abbreviated 5-item version. For male patients suffering from erectile dysfunction, hormonal assessment and penile duplex ultrasound were added. Main Outcome Measure The main outcome measures were frequency of depression, anxiety, low self-esteem, and sexual dysfunction in psoriasis vulgaris patients, partners, and controls; the domains of sexual function affected in the studied groups; and the etiology of erectile dysfunction in affected psoriatic males. Results Frequency of depression, anxiety, and low self-esteem were significantly higher in psoriasis patients of both sexes compared with controls. Sexual dysfunction followed the same trend of being significantly higher in cases when compared to controls. Females had a significantly higher frequency of sexual dysfunction than males. Sexual dysfunction in both sexes involved multiple domains of the sexual response cycle, with depression and genital affection by psoriasis being risk factors in both sexes and disease severity being an additional risk factor in females. Erectile dysfunction was mainly psychogenic in origin in male patients. Clinical Implications Assessment of psychopathological and sexual comorbidities in psoriasis patients and partners should be an integral part of the management plan and should be added to the guidelines of the disease. Strength & Limitations This study is of sufficient power to draw solid conclusions. Assessment of the partners and determination of the sexual domains affected by the disease and nature of erectile dysfunction in males are points of novelty. The cross-sectional design is a limitation of the study. Conclusion Psoriatic patients of both sexes and their partners suffer from a high burden of psychopathological and sexual consequences that are related to disease distribution and severity.

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Dermatological diseases, sexuality and intimate relationships: A qualitative meta‐synthesis

“…There is a growing body of evidence that many diseases-especially chronic disease-create physical and psychological issues that impact on patients' sexuality and intimate relationships (Alariny, Farid, Elweshahi, & Abbood, 2019;Corona et al, 2010;Cuenca-Barrales, Ruiz-Villaverde, & Molina-Leyva, 2019). In recent years, sexuality is more likely to be considered by HPs-but in many cases, although the issue is regarded as essential-practitioners can miss the specific sexuality-related problems that their patients may experience (Bauer, Haesler, & Fetherstonhaugh, 2016).…”

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“…The level of several biomarkers, such as: fibrogen, resistin (adipose tissue-specific secretory factor), Complement 3, lipocalin-2, sE-selectin, is higher compared to healthy controls [5,6]. Genetic and epigenetic changes, alteration of the immune system, secretion of pro-inflammatory cytokines, hyperactivity of the epidermal keratinocytes, and consequently the hyperproliferation, cause the psoriatic phenotype [2]. This destructive process is responsible for the main symptoms (including erythematous).…”