Women's Health - Psoriasis must be Part of the Reproductive Health Conversation

PsorAfrica is calling for greater recognition of the reproductive-health burden carried by many women living with psoriasis, from intimacy and family planning to pregnancy and postpartum care.

Psoriasis is a chronic, immune-mediated inflammatory disease, and for many women it develops during the critical years when they may be making decisions about relationships, contraception, pregnancy and starting a family.

A recent clinical review on the management of women of childbearing age with psoriasis has highlighted that women frequently have questions about fertility, pregnancy and breastfeeding, yet many report limited access to reliable information and often have to initiate family-planning conversations with healthcare providers themselves.

For advocacy group PsorAfrica, this makes reproductive health an important part of the psoriasis conversation.

“Women of childbearing age living with psoriasis deserve treatment and care that considers their lived experiences, including their reproductive health, relationships, pregnancy and plans for motherhood,” says Hellen Wangui, Secretary of the Psoriasis Association of Kenya.

“Too often, women are left to navigate these decisions with limited information and support. We must ensure that every woman with psoriatic disease can make informed choices about her health and her future, with the right evidence, counselling and support at every stage of her reproductive journey.”

PsorAfrica President Pierre-Célestin Habiyaremye says women should not have to navigate these important decisions on their own.

“Psoriasis has been associated with depression and some psoriasis treatments could be harmful to the developing foetus. This is why it is critical for women to have proper pre-conception planning and management,” he says.

Habiyaremye says we also need to move beyond seeing psoriasis only as patches that appear on the skin.

“It can affect confidence, intimacy and relationships. The psychological impact, including body-image concerns and fear of rejection, can be as significant as the physical symptoms. These are deeply personal issues, and stigma can mean women suffer silently instead of raising them during medical consultations.”

Pregnancy requires informed, individualised care

Pregnancy does not affect every woman with psoriasis in the same way.

While some experience an improvement in symptoms during pregnancy, others experience worsening symptoms. Flares are also frequently reported after childbirth.

A survey on women aged 18-45 across 11 countries found that 69% of those surveyed did not feel that they were given enough information regarding post-pregnancy disease management. Many women said their diagnosis led to them having a smaller family and reported a low or moderate level of support from healthcare providers while pregnant or attempting to conceive.

For Wangui, the principle is simple: “Reproductive health must be part of psoriasis care, not an afterthought. It must include women living with chronic diseases.”

The organisation is calling for reproductive health services across Africa to recognise that women living with chronic inflammatory diseases have needs that extend beyond contraception and pregnancy.

Women with psoriasis need:

• access to accurate pre-conception and pregnancy counselling;
• conversations about sexual health and intimacy without embarrassment or judgement;
• appropriate review of medication when pregnancy is being considered;
• coordinated dermatological and maternal healthcare during pregnancy where needed;
• support for postpartum psoriasis flares and breastfeeding-related treatment decisions; and
• greater awareness among healthcare workers that psoriasis can affect physical, emotional, sexual and reproductive wellbeing.

“Reproductive health is about giving women the knowledge, healthcare and freedom to make informed decisions,” says Habiyaremye. “A woman living with psoriasis should be able to plan a family, seek treatment and speak openly about reproductive health without stigma. That is the kind of patient-centred healthcare we want to see across Africa.”