Why This Conversation Matters
Buchi Neita, PA-C, and her co-host PA Jenny Laminack open the episode by naming the elephant in the exam room: sexual health remains taboo, both in the general population and for patients. As Laminack points out, patients often consider these concerns private and don't volunteer them. Neita agrees, noting that so much of what dermatology treats involves intimate areas — and if clinicians don't ask, patients frequently won't tell.
Neita shares that she'd seen roughly three patients that same day who saved an intimate-area concern until she was about to walk out the door. Her takeaway: patients are often embarrassed, so it falls to the clinician to offer the conversation and give patients an open door to share. Both hosts frame dermatology APPs as uniquely positioned for this because, as Neita puts it, they see more of the patient's body than nearly any other specialty.
The Conditions With the Biggest Impact
Laminack names hidradenitis suppurativa as top of mind — a long-overlooked condition she believes has one of the highest impacts on sexual quality of life. The lesions land in sensitive areas (groin, vulva, buttocks, under the breast), and it's not just the pain: it's the drainage, the odor, and the embarrassment. Neita adds that scarring and pigmentation, plus the challenge of explaining it to a new partner, drive some HS patients to avoid intimate relationships entirely, worsening loneliness, anxiety, and depression. Both note new treatments are finally coming to market.
Psoriasis is another daily encounter. Neita explains that inverse psoriasis favors the axillae, under the breast, groin, buttocks, and even the vulva and mons pubis. Even a low body-surface-area presentation confined to genitals or buttocks is a high-impact area with major quality-of-life consequences — and she now consistently asks about it, both to nail uncertain diagnoses and because effective non-steroidal options now exist. Laminack notes these patients are frequently misdiagnosed for years with 'jock itch' or yeast infections and mistreated as a result.
The hosts also cover lichen sclerosus (watch for extragenital involvement as a clue, counsel on the risk of squamous cell carcinoma and malignant transformation, and involve gynecology), atopic dermatitis in the areolae and groin, lichen planus of the vulva and under the breast, and vitiligo of the genitals. On lichen sclerosus, Neita stresses keeping patients on topical therapy even during asymptomatic periods to control chronic inflammation.
Reassurance, Gentle Care, and When to Escalate
A recurring theme is that the mental burden often exceeds the visual one. Neita recounts a young man with itchy genital vitiligo who, distressed and in a new relationship, had been taking his mother's Xanax to cope and was relieved to learn it was neither an STD nor contagious. Laminak's rule: educate patients that it's not their fault and that these conditions are common and normal.
For contact and atopic dermatitis of the vulva and scrotum, Neita warns against the 'poly-pharmacy' spiral — aggressive scrubbing, strong soaps, and washcloths that can drive lichen simplex chronicus. She counsels babying the area with gentle treatment, while noting the vulva is resilient and high-potency topical steroids are sometimes appropriate for thickened, itchy disease. For refractory lichen planus, she describes a patient doing well on methotrexate after topicals failed. Both hosts emphasize referral to local vulvar dermatoses experts and gynecology when appropriate.
Sexually Transmitted Conditions and Counseling
On genital warts (condylomas from HPV), Laminack stresses educating patients — especially women — about cervical exams and offering treatment options from destruction to topicals. Neita reassures patients that most sexually active people have been exposed, and encourages HPV vaccination, now approved up to age 45, citing its clear link to reduced cervical cancer. Both note patients tend to be less resistant to this vaccine than others.
For herpes simplex, the hosts focus on the chronicity being the hardest part for patients. Neita points out that buttock lesions are commonly missed as herpes, and recommends breaking down the diagnosis, helping patients manage flares, and offering long-term prophylactic therapy when needed. Laminak notes many patients opt for prophylaxis to avoid the worry of flares.
How to Ask the Question
To make patients comfortable, Laminak suggests softening the language — instead of 'Are you sexually active?', ask whether symptoms are impacting their intimacy or relationships, so it doesn't feel accusatory. Neita favors open-ended questions during the full-body skin exam: Is anything in the groin, genital, or buttock area bothersome? Is there pain or discomfort with intimacy? Any concerns about sexual health? Even when it's outside her scope, that opening lets her refer to the right provider.
The closing message: normalize these as common medical conditions that deserve care without shame, and use dermatology’s unique access to the whole body to open doors patients won’t open themselves.