Another important area in a couple's relationship is that of sexual intimacy. The association between body image and sexual functioning is a good illustration of the reciprocal nature of interpersonal influences in skin disease (Weiderman, 2002). Common sense dictates that good sex is about confidence, feeling good about yourself and your body. Yet, many dermatology patients struggle with physical intimacy and often have sex lives that are fraught with difficulties.
Avoidant Attachment Style: 'I'm a 23 year-old male and I have psoriasis on my chest, back, butt, arms and legs. Fortunately it is not on my hands, face, in my hair or on my privates. People don't know I have it because I keep all the evidence covered. I've been dating a girl for 6-months and we were getting serious but I still hadn't told her about my psoriasis. I didn't know how to do it. Then I read this forum and got some courage. I think she had been waiting for me to take the plunge about sex for a long time, so finally____I suggested it and just said, "But there's something you have to know." She knew nothing about psoriasis and cooled right away I got as far as showing her one arm and that was the end of it. Now I feel so low, I don't know whether to dump her because she's so closed-minded or to just give up.'
A negative body image can damage the perception of self as a sexual being and thus disrupt intimacy in a relationship. Gupta and Gupta (1997) investigated the impact of psoriasis on the sexual activities of 120 sufferers and found that 40% experienced a decline in sexual activity and had higher scores on depression than non-affected patients. Embarrassment over unsightly or painful lesions was most apparent during intercourse; which also confirms past research that sexual functioning is disrupted in dermatology patients if genital areas are affected (Buckwalter, 1982; Medansky, 1986). It appears that negative body image perpetuates sexual difficulties because anxiety or low self-esteem can decrease a patients' interest in initiating or being receptive to sexual activity (Weiderman, 2002). Furthermore, feelings of shame and depression are often exacerbated if affected individuals interpret sexual difficulties as reflecting their undesirability to their partner (Tantleff-Dunn & Gokee, 2002).
In 2003, a US marketing firm surveyed 502 patients with psoriasis on their attitudes towards relationships; 38% reported difficulties with sex and intimacy. It was evident that problems were more prevalent in young single adults as 53% reported difficulties in their sex life, in contrast to 30% of married subjects. Furthermore, 49% of adults aged 18-24 and 36% of adults aged 25-35 experienced angst in intimate situations. Dermatological shame was also prevalent since 52% turned off the lights when intimate with their partner and 48% worried that their partner was embarrassed by their psoriasis. On the issue of relationship functioning, 26% said psoriasis interfered with their ability in getting emotionally close with their partner. Interestingly, a different study of vitiligo patients and their beliefs on intimate relationships revealed that most patients felt more embarrassed in non-sexual interpersonal relationships than in intimate sexual relationships (Porter et al., 1990). Both these studies and the excerpt provided at the start of this chapter (from the partner of a patient with psoriasis), illustrate that couple relationships can have a protective effect but that good communication is critical to ensuring sexual confidence.
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