If you know anything about hidradenitis suppurativa, you can imagine how this chronic inflammatory skin condition can interfere not just with a person’s quality of life but also their sex life. Also known as HS or acne inversa, hidradenitis suppurativa causes symptoms that can be both painful and pretty awkward to talk to a partner about. What often begins with early stage bumps resembling pimples or blackheads progresses into painful abscesses, nodules, and cysts, which can break open and ooze unpleasant-smelling liquid, and also leave scarring. More serious cases can involve tunnels (sinus tracts) under the skin. Complicating matters further, HS symptoms frequently flare up in areas of skin associated with intimacy, like the breasts, groin area and genitals, inner thighs, buttocks, and anus; severe cases can even cause swelling of the genitals. Discomfort aside, these lesions can make a person feel self-conscious—especially without clothing. No surprise, more than half of women with HS experience some type of sexual disfunction, according to a 2019 study in the journal Dermatology. This is an aspect of the condition that both dermatologists and mental health professionals are increasingly focused on addressing.
The first thing to keep in mind if you have hidradenitis suppurativa on your groin—and still want to have sex—is that you’re far from the only woman facing this challenge. While its name may not yet be super familiar, HS actually isn’t a rare disease; it’s estimated to affect about 1 in 100 people, disproportionately women of childbearing age. And more and more research is revealing that these women’s stress about HS is interfering with their ability to form and enjoy intimate relationships. “Definitively, HS perpetrates a profoundly negative impact on females’ sexual life,” concluded a recent study published in the Journal of the American Academy of Dermatology (JAAD). That’s why if you have HS, it’s so important to address this issue of sex directly and proactively, and know how to cope with both the physical and emotional challenges involved—starting with the following.
Your choice of underwear really matters.
Beginning with something basic, if you have hidradenitis suppurativa on your groin, choosing the right underwear can greatly reduce flare-ups. Anything that pinches, rubs, rides up, or makes you sweaty down there should be avoided. For fabric, think soft, breathable, moisture-wicking. Some people prefer seamless bike-short styles, which eliminate excess friction in the entire groin area (men’s cotton boxer briefs can also do the trick). These days, there are even companies that design undergarments specifically for HS; they wick away moisture to prevent microbial colonization and absorb any fluid that leaks from burst lesions. Beyond underwear, sleeping in loose-fitting cotton pajamas and avoiding tight jeans can help prevent hidradenitis suppurativa groin flare-ups.
It’s best to be upfront about your bumps.
You probably shouldn’t mention your skin condition on a first date, but it’s best to raise the topic before you’re partially clothed and feeling ultra-vulnerable. This also gives your partner time to fully process the information. You can mention how, even though some hidradenitis suppurativa groin lesions might resemble STIs, this skin disease is not contagious, or caused by poor hygiene. Rather, it’s caused by an over-active immune system (and often ties to family history). You could share how long you’ve had it, how it’s impacted your life, how it’s being treated. If your partner reacts in a way that’s supportive, then you can ease into details of sex with HS: how you have sensitive areas of skin that require a gentle tough, and that certain sex positions—or intimate alternatives to intercourse—might help minimize your discomfort and create a more enjoyable experience. This conversation should be ongoing, as your needs and desires may change, and remember that giving consent to a sexual activity once doesn’t mean you’re consenting forever. If talking about HS and sex feels overwhelming, this conversation guide may help.
Friction is the enemy.
Now for some practical in-the-moment tips for having sex with HS. Many people like using lubricant to reduce friction, which can lead to flare-ups in your groin area. Just be aware of product ingredients; sensitive-skin products that are fragrance-free are usually safest, as they’re less likely to trigger irritation. Your healthcare professional may have a recommendation. Some people also find that using lubricated condoms helps reduce friction and discomfort during intercourse with HS. Just note that when you have active lesions that are red and painful, you might want to stick to intimate activities that avoid that area of skin until your flare-up is under control. That’s because sex has the potential to not only irritate your flare-up but lead to a secondary infection (bacterial infection) that requires treatment with antibiotics.
Post-sex hygiene is important.
Even though poor hygiene doesn’t cause HS, strategic hygiene can help reduce future flare-ups. That includes taking the time to gently wash your groin area after sex. This is a habit you could bring up when first talking to your partner about your skin condition, so it won’t feel abrupt when you duck out to shower. Clean your skin with a fragrance-free, gentle body wash, or an antiseptic skin cleanser (inexpensive and over-the-counter at the drugstore), which helps kill bacteria that can contribute to future flare-ups. Another option that dermatologists recommend: an anti-acne body wash that contains benzoyl peroxide or zinc pyrithione, both of which also fight bacteria on the skin. In addition to washing, you could use a cotton pad to apply apple-cider vinegar to the affected areas of your groin after sex; it has natural antibacterial and anti-inflammatory properties.
Simple methods can help ease pain.
If you have HS lesions on your groin, using a warm compress (like a warm washcloth) for ten minutes a few times a day can help reduce inflammation and speed healing. Some people find relief from applying a warm tea bag, briefly steeped, directly to a painful lesion. Zinc oxide creams (like many diaper creams) or aloe vera gel are a couple easy-to-find, effective topicals that also help calm inflamed skin. (Related useful tip: Antiperspirants with zinc oxide can be a great way to quiet HS in your armpits.)
Your mentality makes a huge difference.
It’s important to keep in mind that HS is more than a skin-deep health condition—it can have a real impact on your body image and mental health over time, especially if it’s affecting your sex life or even causing social isolation. Your dermatologist can likely refer you to a therapist who can help you address anxiety about sex with HS, as well as any challenges you might be having with establishing a stable intimate partnership due to self-esteem issues. Some therapists specialize in treating people living with chronic disease. Worth noting: Research shows that women with HS report fewer sexual challenges when they are in stable long-term relationships. If you want that but have struggled to find it, therapy can help. Seeing a sex therapist is another great way to discover new solutions whether you’re single or partnered, including getting to know types of touch or fantasy that will help you get aroused and overcome anxieties about getting intimate with HS.
Shaving can cause more harm than good.
Shaving the bikini area can trigger HS flare-ups for many people, so some women with HS on their groin decide to embrace their pubic hair and let it grow au natural. On the flip side—this one might sound surprising—many people find that laser hair removal puts mild to moderate (stage 1 and 2) HS into remission. Why it can work: HS involves inflammation of hair follicles, especially in areas like the groin that have sweat glands. Laser hair removal reduces the number of follicles and sweat glands, as well as kills skin bacteria, helping eliminate the roots of flare ups. The clinical evidence backs up laser hair removal as an HS treatment: One 2019 study published in the Journal of Cutaneous and Aesthetic Surgery reported that HS symptoms in participants improved by 73 percent after four months of treatment. Just be aware that laser hair removal is pricey and usually requires at least three sessions to get results, and you should first check with your healthcare provider to see if you’re a good candidate (people with dark skin have a higher risk of skin damage, and the lasers can be less effective on blond, red, or gray hair).
You can talk to your healthcare provider about this.
It might feel embarrassing at first, but we promise they’re not judging you. Your healthcare provider can discuss ways to make sex with HS more comfortable. They can also talk about the big picture—the best way to make sex more comfortable when you have hidradenitis suppurativa on your groin is to find the medical treatment options that reduce the frequency and severity of your flare-ups. That might include a combination of different HS treatment options, like topical clindamycin, retinoids, steroids, biologics (like infliximab, adalimumab, and secukinumab), and anti-inflammatory medications like acitretin. Surgical interventions can also help with more severe HS, eliminating recurring lesions on your groin. Establishing a weight loss strategy might be a part of the plan; obesity is a risk factor closely associated with HS, and losing weight helps many people go into remission.
Enlist some virtual support.
When it comes to talking about any sexual challenge, anonymity can be a wonderful thing. That’s where the Internet (and good-old Reddit) comes in so handy. There are lots of online HS support groups, where you can get advice from people facing similar challenges. As a first step, check out organizations like the HS Foundation and Hope for HS. You’ll read stories about people who have HS on their groin and also enjoy great relationships and sex, which will hopefully help you feel more confident that you can get there too.
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