When skin disease affects intimacy: The ethical duty for dermatologists to screen for sexual dysfunction.

Sexual health is central to quality of life; yet, its relationship to dermatologic disease remains insufficiently studied. Skin conditions can directly contribute to sexual dysfunction through pruritus, scarring, pain, and body-image distress, and genital involvement is common but often overlooked. We present two cases to examine the ethical implications for dermatologic practice. In the first, a patient with vulvar lichen sclerosus reports avoiding intimacy, but the dermatologist does not explore the concern further. In the second, a patient with well-controlled plaque psoriasis never discusses the effects of genital involvement because the dermatologist does not initiate the conversation. These cases show how silence may perpetuate unrecognized suffering and restrict meaningful patient autonomy. Ethical dermatologic care for sexual manifestations of skin disease requires sensitivity; permission-based, trauma-informed inquiry that prioritizes the patient's control, safety, and agency by asking for consent before discussing sensitive topics; equitable screening; treatment of modifiable cutaneous contributors; and appropriate referral when concerns extend beyond dermatologic management.