Hidradenitis suppurativa (HS) is a disease that predominantly affects axillary and genital areas of young adults and can have a profound impact on sexual health. According to a recent poster study, presented at the 2019 American Academy of Dermatology Annual Meeting, dermatologists are in unique position to help patients discuss the ways this disease impacts their quality of life. Findings from the study showed that patients with HS are comfortable discussing sexual health concerns with a dermatologist. “This is particularly important because dermatologists may hesitate to initiate the conversation,” said corresponding author Andrea Murina, MD, in an interview with The Dermatologist.1
“HS is most commonly seen in the emergency department when patients are evaluated for recurrent boils. However, dermatologists have the ability to diagnose HS and initiate a relationship that continues over time,” she said. During the course of treatment, it is important for dermatologists to assess the impact of HS on patients’ quality of life, particularly their sexual health. But prior to having this conversation it is important to make the patient as comfortable as possible so that we can examine the extent of the disease, particularly in the genital areas, she added.
Patients with HS at a tertiary care dermatology clinic in New Orleans, LA, completed an anonymous survey. The surveys assessed demographics, disease characteristics, and comfort level discussing sexual concerns with providers.
“Dermatologists are the primary providers of care for patients with HS,” said Dr Murina. “These patients present in their teens and early twenties and can be uncomfortable both discussing and showing their HS lesions to physicians. I try to examine patients fully at every visit, but some patients are hesitant to get undressed. We performed this survey to determine how patients felt about the skin examination and explore ways that we can make them more comfortable.”
Overall, 27 surveys showed that 88.9% of responders were comfortable showing their HS lesions to a dermatologist. In contrast, 33% of responders would show their HS to other doctors or nurses. “This indicates that for some patients, we are the only people that see these areas and the only ones who know the extent of their disease,” said Dr Murina. In addition, only 7.4% of responders showed their HS-affected areas to a family member and/or spouse.
Although only 40.7% of responders reported being sexually active, 64% said they wanted to discuss sexual concerns with a dermatologist. Patient comfort in talking about their HS in general positively correlated with comfort in discussing sexual health, while age or disease duration was not correlated with comfort level. “Overall this data is encouraging that many patients are concerned about how HS will impact their sexual health and are willing to discuss these matters with their dermatologists,” she said.
Comfort Level During Exams
Dr Murina and her colleagues also assessed ways dermatologists could improve patients’ comfort during clinical examinations. “We realized that some patients are not accustomed to axillary and genital examinations so we asked patients how dermatologists can increase comfort during examination of their HS areas,” she said.
Responses varied; however, they highlighted a few ways dermatologists could increase patient comfort. Suggestions included:
- Providing cloth gowns (although paper was a close second [7 vs 5 responders])
- Giving patients a handheld mirror
- Offering self-hygiene products before exam
- Locking the door during exams
- Allowing a family member to be present in the exam room
These “may help alleviate some of the stresses of an examination,” said Dr Murina.
“Its important not to make assumptions about a patient’s sexual behaviors based on the severity of their disease. The best thing dermatologists can do is ask a patient if they are experiencing negative effects in their sexual health due to their HS and open up the conversation,” she added.
Dr Murina and her colleagues intend to expand the sample size of this study to increase the accuracy of these results. “We are continuing to collect patient survey responses and we hope to integrate more comfort measures into our clinical practice. We hope that by making some small changes we can provide more support for patients with HS,” she said.
1. Accetta J, Majidian M, Foutouhi S, McKay C, Murina A. Hidradenitis and sexual health: How should health providers ask about genital disease and impact on sexual health? Presented at: 2019 American Academy of Dermatology Annual Meeting; Washington, DC; March 1-5, 2019.