Health and wellness touch everyone’s life differently. This is one person’s story.

This might be hard to believe, but I once had sex with a man who had never seen my skin — and wouldn’t have the opportunity to see it — until almost 10 years later.

Now, you might be thinking to yourself, “How is that even possible?”

Well, I have psoriasis. I’ve dealt with flaky, dry, inflamed, cracked, bleeding, purple to dark brown plaques of dead skin for most of my life. When it’s at its worst, it’s visible, hard to hide, and unattractive. And with it comes a load of stigma, misconceptions, and questions.

When someone is living with insecurities from a skin condition, they may go to great lengths to not be seen — which can include hiding, lying, or avoiding. I went to great lengths to conceal my psoriasis, even if it meant… having sex with my clothes on.

As I reread that last statement, I don’t just cringe. My eyes swell with tears. The now 30-year-old me can still feel the pain caused by the insecurities of the 20-something woman who could never physically give herself, fully. I look at myself in the mirror and remind the inner me of 10 years ago, “You are beautiful.”

My psoriasis is currently suppressed due to an effective treatment, but those feelings of not feeling good enough and those fears of not being desirable due to my skin still erode my soul, as if I was currently 90 percent covered with plaques. It’s a feeling that never goes away. It sticks with you forever, no matter how clear your skin may currently be.

Unfortunately, I’ve conversed with many men and women living with psoriasis who feel the same way, never revealing to their partners how psoriasis truly affects their soul and well-being. Some hide their insecurities behind anger or avoidance. Some avoid sex, relationships, touch, and intimacy altogether, due to fears of rejection or inadequacy.

Some of us living with psoriasis feel seen, but for the wrong reasons. We feel seen for the imperfections of our skin. Societal standards of beauty and the misunderstandings associated with visible diseases like psoriasis can make you feel as though people see your condition before they actually see you.

At times, interacting with certain individuals only contributes to negative feelings. Two of my friends, for instance, have had their psoriasis used against them in their romantic relationships.

Recently, I was interacting with a young, married woman on Twitter. She told me about the insecurities she felt from living with psoriasis: not feeling good enough for her husband, not feeling attractive, feeling like an emotional burden to her family, and self-sabotaging to escape social gatherings due to embarrassment.

I asked her if she had shared these sentiments with her husband. She said that she had, but that they only worked to frustrate him. He called her insecure.

People who don’t live with chronic illnesses, especially one as visible as psoriasis, cannot begin to understand the mental and emotional struggles of living with psoriasis. We tend to hide many of the internal challenges we face with the condition as much as the psoriasis itself.

When it comes to intimacy, there are things that we want you to know — and things that we want to hear and feel — that we may not always feel comfortable actually telling you. These are just a few suggestions for how you, as a partner, can help a person living with psoriasis feel positive, comfortable, and open in a relationship.

1. Let us know you’re attracted to us

Studies show that psoriasis can have a severe impact on one’s mental health and self-esteem. Like any partner, we want to know you find us attractive. Tell your partner that you find them handsome or beautiful. Do it often. We need all the positive affirmations we can get, especially from those closest to us.

2. Acknowledge our feelings, even if you don’t fully understand

Remember the young woman from Twitter I mentioned above? When her husband called her insecure, it was coming from a place of love — he said that he doesn’t notice her psoriasis and isn’t bothered by it, so she should stop worrying about it so much. But now she’s too scared to share her feelings with him. Be kind to us, be gentle. Acknowledge what we say and how we feel. Don’t belittle one’s feelings just because you don’t understand them.

3. Don’t use our disease to insult us

Often, people go below the belt when having an argument with their partners. The worst thing you can do is say something hurtful regarding our disease out of anger. I spent 7 1/2 years with my ex-husband. He never once said anything about my psoriasis, no matter how bad we fought. Your spouse will never trust you the same if you insult them about their disease. It will affect their self-esteem in the future.

4. We might do unconventional things in the bedroom — be patient

I used to wear clothes with the first guy I gave myself to. He didn’t actually see my skin until 10 years later, when I posted a picture on Facebook. I would wear thigh-highs and typically a button down long sleeve shirt, so he couldn’t see my legs, arms, or back. The lights ALWAYS had to be off, no exceptions. If you have a partner who seems to be doing strange things in the bedroom, communicate with them in a loving way to get to the source of the problem.

Living with psoriasis isn’t easy, and being a partner to someone with the condition can present challenges, too. But when it comes to being intimate, the key is to remember that these feelings and even insecurities are coming from a real place. Acknowledge them, and work through them together — you never know how much stronger your relationship could grow.

Alisha Bridges has battled with severe psoriasis for over 20 years and is the face behind Being Me in My Own, a blog that highlights her life with psoriasis. Her goals are to create empathy and compassion for those who are least understood, through transparency of self, patient advocacy, and healthcare. Her passions include dermatology, skin care, as well as sexual and mental health. You can find Alisha on Twitter and Instagram.

Read this article in Spanish.