The effect of vitiligo on sexual relationships

Judith R. Porter, PhD,a Ann Hill Beuf, PhD,b Aaron B. Lerner, MD,e and
James J. Nordlund, MDd Bryn Mawr, Pennsylvania, New Haven, Connecticut,
Allentown, Pennsylvania, and Cincinnati, Ohio

To study the effect of vitiligo on interference with sexual relationships, we surveyed 158 pa-
tients by questionnaire. Although a majority of patients reported a negative impact on sexual
relationships, most patients felt embarrassment when showing their body or meeting strang-
ers. The majority of patients who reported a negative impact on sexual relationships attrib-
uted the problems to their embarrassment. Those who were particularly affected were those
with low self-esteem, men, those to whom appearance is important, and single persons. Der-
matologists should be especially alert to the effects of disfigurement and should attempt to
assist patients with this problem. (1 AM ACAD DERMATOL 1990;22:221-2.)

In a study of vitiligo patients, 57% said people PATIENTS AND METHODS

stared at them, 20% have been the victims of rude The sample consisted of all patients who received
remarks, and 8% encountered job discrimination as treatment at the vitiligo clinics of two major East Coast
a result of their disease. I Thus vitiligo may be asso- university hospitals during a I-year period. Patients were
ciated with a variety of negative psychologic effects, asked during their clinic visit to complete a questionnaire.
such as self-consciousness and feelings of inferiority. The response rate was 65% at one clinic and 70% at the
Negative psychologic responses, however, are not other. Only those respondents 16 years of age and older
were included in the analysis, which was based on
inevitable. Studies have shown that the poorest
responses from 158 patients. Data were analyzed with
overall adjustment to vitiligo is found among women, chi-square and regression techniques.
persons with severe and visible conditions, teenagers
and young adults, single persons, those of lower RESULTS
socioeconomic class, blacks, those to whom appear- The 158 respondents to the questionnaire ranged
ance is important, those reporting repeated discrim- in age from 16 to 79 years, with a median age of 38
ination, and those with low self-esteem. 2 years. The sample was predominantly female (71 %),
We investigated the extent to which patients with more than half were married, and most were middle
vitiligo believe that the disorder affects their sexual class. The sample was approximately 60% white
adjustment. In particular we explored the patients' (n = 93) and 40% black (n = 63). Three fourths of
perceptions of the degree to which vitiligo interfered the respondents reported that their disease is visible
with their sex lives, the source of their problems, and to some degree. Of these patients 28% rated their
the types of patients that are most likely to undergo vitiligo as mild, 41 % as moderate, and 31 % as severe;
stress during sexual activity. 41 % of the overall sample reported vitiligo in the
pubic area.
Data in Table I indicate that approximately one
From the Department of Sociology, Bryn Mawr College," the Depart-
ment ofSociology, Cedar Crest College, Allentown, b the Department
fourth of the sample believe that vitiligo has inter-
of Dermatology, Yale University School of Medicine, New Haven,c fered with their sexual relationships. Overall, 10% to
and the Department of Dermatology, University of Cincinnati 15% responded that vitiligo has limited either socia-
School of Medieine. d bility with the opposite sex or the number, location,
Funding for this project was provided by U.S. National Institutes of
Health grant No. IP50-AM25252.
and frequency of potential or actual sexual relation-
Accepted for publication April 3, 1989.
ships. One fourth to one half of the sample reported
Reprint requests: Judith Parler, PhD, Department of Sociology, Bryn stress in situations that involve meeting strangers,
Mawr College, Bryn Mawr, PA 19010. general contact with the opposite sex, and wearing
16/1/13214 clothing that exposes the body. These findings indi-

221
 Journal of the
American Academy of
222 Porter et al Dermatology

Table I SItuatIOns 10 whIch stress 10 sexual DISCUSSION

relationships occurs (n = 158) Although vltIhgo causes dIsfigurement, the ma-
1Pa............. (%)
Jonty of our sample reported that they are not
affected either 10 sexual encounters or 10 more gen-
Yes I No
eral Situations that may have ImphcatIons for sexual
Has vltlhgo mterfered With 23 77 contact When problems do occur, they are more
sexual relationships? lIkely to oceur With regard to general embarrass-
Has VltllIgo affected sociability 15 85 ment (strangers, contact With the opposite sex,
with the opposite sex? exposmg clothmg) than they are 10 more mtImate
Has vltllIgo mterfered With 10 90
number of dates? encounters Casual contact With strangers is the
Has vitilIgo affected where you 10 90 most stressful SituatIOn for these persons These
go on dates? types of stress may hInder the development of
Has VItilIgo affected frequency 10 90 potential sexual relationships, especially for s10gle
of sexual relatlOnslups? persons
Are you embarrassed In 55 45
situations requmng clothmg that Although dlscnmmatIon by others was perceived
exposes the body? as causmg problems, many patients attnbuted stress
Are you embarrassed m 35 65 ill sexual encounters to their own anXiety Self-
SituatIOns where you meet new esteem is the best predIctor ofsexual problems, those
people? With low self-esteem are particularly liable to man-
Are you embarrassed In 24 76
Ifest low self-confidence 10 their ability to 10teract
situations where you are In
contact With the opposite sex? With others 10 sexual encounters, and the presence of
a sk10 disfigurement probably heIghtens thIS stress
Persons to whom appearance IS Important also are
slgmficantly more hkely to feel embarrassment In
situations such as sexual contact, 10 which appear-
cate that more of the subjects felt general embar- ance norms are sahent
rassment m nonsexual 1Oterpersonal encounters than Skm dISfigurement IS especially hkely to lead to
10 more IntImate sexual/social relatIOnshIps stress for smgle persons, for whom appearance IS an
PatIents who said that their sexual relatIOnshIps Important resource In therr ablhty to InItiate sexual
were negatIvely affected then were asked for the relatIOnships Although studies report that women
cause of these problems About half (19/37) re- have more overall adjustment problems than men to
ported that the change was due to their own embar- skIn disorders, 1,2 In the sexual realm men report
rassment only, 13% (n = 5) responded that It was more difficulty than women ThiS find10g may be
solely due to their partner's embarrassment, and related partly to the greater hkehhood of men 1OitI-
37% (n = 13) attnbuted to change to both atlng sexual contacts, thiS also is partly due to the
Multiple regressIOn was used to reveal whose sex- greater hesitancy of men to use cosmetics (p = 0 01)
ual relatIOnshIps were particularly affected by vItlh- to hide the disorder from others
go There are four vanables that have sIgmficant ef- These findIngs suggest that sexual counsehng per
fects on adjustment to vitilIgo Persons who manIfest se IS less Important than the development of overall
low self-esteem (as measured by the CoopersmIth self-esteem, espeCially In s10gle patIents and In men,
Self-Esteem Inventory3), those who rate appearance who are at partIcular fisk of havmg problems In sex-
as lIDportant to them, men, and unmarned persons ual relatIOnship as a result of Vitiligo
are sIgmficantly more hkely to report that VltllIgo has
REFERENCES
10terfered WIth theIr sexual relatIOnships Of these
1 Porter J, Beuf A, Lerner A, et al Response to cosmetic diS-
factors, self-esteem has by far the strongest effect figurement patients With VitilIgo CutiS 1987,39
Age, vlslblhty and seventy of dIsease, race, SOCia- 493-4
economic class, and perceived discnm1Oatlon are not 2 Porter.T, Beuf A Response of older people to ImpaIred ap-
pearance the effect of age on disturbance by VItIligo J Ag-
slgmficant Of particular 10terest is the find10g that Ing Stud 1988216781
Vltlhgo of the pubiC area does not have a slgmficant 3 Coopersmith S The antecedent~ of self esteem San Fran-
effect on sexual adjustment CISCO, CalIf Freeman, 1967