It’s the most common autoimmune disease in the United States, but unlike some of the others, psoriasis can cause severe embarrassment, self-consciousness, and anxiety. Sex is rarely talked about in conjunction with psoriasis, as the two aren’t directly tied. But for people who have the skin condition, the relationship between the two is obvious.

What Is Psoriasis?

Psoriasis is a chronic autoimmune disease that causes the immune system to attack healthy skin cells as if they were invaders. This leads to the creation of skin and blood cells as visible lesions or patches on the body.

These raised and often painful patches of skin can cause extreme mental and emotional stress for people with psoriasis.

Almost a quarter of the 7.5 million Americans with psoriasis have what is considered moderate to severe cases — meaning more than 3 percent of the body is affected — according to the National Psoriasis Foundation.

How Psoriasis Impacts Your Sex Life

Although there’s no evidence to suggest that psoriasis interferes with sex drive, it can have an impact on your sex life.

“This is one of the biggest issues in patients with psoriasis,” says Dr. Tien Nguyen, a dermatologist with Orange Coast Medical Center in Fountain Valley, California. Nguyen says that relationships can be significantly affected because of the embarrassment of the disease. This embarrassment can even lead to depression and “suicidal ideation at times.”

Research shows that between 30-70 percent of people with psoriasis say the condition affects their sex life. Depression, alcohol use, and other potential psychological effects of psoriasis could exacerbate these problems.

Learn More: Psoriasis Facts and Stats

In addition, there’s a physical component. Both men and women may suffer from psoriasis patches on their genitals, not only making them self-conscious about their appearance, but also potentially making sex physically uncomfortable.

Tips for Comfortable Sex

“Condoms can help reduce friction to these areas and prevent skin irritation,” says Dr. Tsippora Shainhouse, dermatologist and clinical instructor at the University of Southern California.

Shainhouse also suggests women with irritation around their vulva apply “a barrier grease like coconut oil, Vaseline, or Aquaphor to reduce friction.”

However, she also cautions that these topical greases should not be placed on the condom, as they may reduce its effectiveness as a contraceptive.

How to Handle Psoriasis Questions Before Sex

For some with psoriasis, the anticipation of sex is the hardest. Getting naked in front of someone for the first time can be very uncomfortable if you’re embarrassed about the condition of your skin.

Shainhouse recommends being up front, and broaching the topic yourself if your partner hasn’t asked about visible skin patches yet. Explain that it’s an autoimmune disease and is not contagious.

Just because your doctor or dermatologist may not always address the challenges of sex and psoriasis, that doesn’t make these difficulties any less real. Keep in mind, your medical team has heard it all; so don’t be afraid to bring up the topic if they don’t.