What should I do if my vitiligo is starting to get in the way of my sex life?

Dear Reader,

Showing parts of your body to others can be nerve-racking for many people, and it can be especially difficult if the person doesn't respond in a positive way. As you've noted, vitiligo is a skin condition characterized by areas of the skin lacking pigment, and it affects roughly one to two percent of the world population. Though vitiligo is a common condition, many people aren’t all that educated on the specifics of it (and even those who have seen depictions of the condition in real life or the media might not be aware of how it can affect genital appearance), so a brief explanation may help reassure them that there’s nothing to worry about. You mentioned that your sexual partners’ reactions to your vitiligo “messes with your head,” and how you move forward from there may depend on why your partners are reacting in the way that they are.

Before diving into your predicament and address your concerns, getting the facts down about vitiligo for other curious readers may be a helpful place to start. There are various types of vitiligo depending on the location and pattern of skin depigmentation, including generalized, segmental, mucosal, focal, trichome, and universal. The most common type is generalized vitiligo, in which macules or patches are found in different areas of the body. Other kinds, such as mucosal vitiligo, occurs in areas of the body that have mucous membranes, such as the mouth or genitals. Larger areas of depigmentation are referred to as patches, while smaller areas are called macules. These patches or macules are caused by the loss of cells that produce melanin (melanocytes), which are responsible for providing skin pigment. Though there are many theories about how vitiligo develops, the exact cause is still unknown.

With a more clear understanding about vitiligo, it can aid in discussing how it may affect your sex life. If your partners seem surprised, is it because your condition might make your penis look different than they expected or different from other penises they’ve seen before? If they seem confused, is it because they might not know what vitiligo is or looks like? If they seem worried, is it because they’re afraid you might have a sexually transmitted infection (STI) or some other condition that could put them at risk? Depending on the source of their reaction, you might consider taking the time (before clothes start coming off!) to explain what vitiligo is and assure your partner that it’s not contagious or of risk. If you’ve explained what you can but they still seem apprehensive, you may consider asking them what their specific concerns are so you can address them accordingly.

Even if your partner is reassured by your explanation and wants to keep going, having to navigate these types of encounters in which another person, particularly in a sexual context, expresses any kind of apprehension towards your body can be discouraging and alienating, even if they may not have intended to offend you. You may find it helpful to consider why their reactions mess with your head. Does it make you feel insecure or self-conscious? Is it frustrating? Do you start to overthink or become hyperaware of your body in a negative way? Getting to the root of how and why may enable you to handle these encounters with more ease and confidence. Regardless of how these encounters make you feel, though, your feelings are valid. 

In fact, because of how vitiligo can alter one's appearance, many individuals feel that they're perceived and treated poorly by other people and society as a whole due to their condition. As a result, many people with vitiligo experience emotional and psychological effects on their overall quality of life, such as lower self-esteem, isolation, stigmatization, self-consciousness, and depression. In regards to individuals with vitiligo on their genitals, it's unfortunately not uncommon to encounter sexual partners who incorrectly assume that the marks of discoloration are a side effect of an STI. However, there’s some research to suggest that people with vitiligo experience relatively similar qualities of life regardless of whether their vitiligo impacts their genital appearance. That’s not to say that it can’t be a hard and difficult thing to experience, but you certainly aren’t doomed to a lifetime of bad sexual encounters because of your vitiligo!

It’s critical to keep in mind, though, that in any sexual encounter, your partner has the right to revoke their consent at any time. If their only concern is the appearance of your penis, you can offer education and reassurances, but if after all that they still decide they don’t want to go any further, it’s key to respect their decision. However, it’s equally critical to remember that there is nothing wrong with you or your body. and you should not be made to feel ashamed or self-conscious (but it’s still normal and okay if you do feel this way). Learning to appreciate and value your unique trademark may help you feel more comfortable in your skin, and the more comfortable you are, the more comfortable your partners will likely be as well.

At the same time, there’s nothing wrong with seeking out potential treatments if you think it might improve your self-esteem and quality of life. There are various medical treatments you might try whose purpose is to ultimately create a more uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation). While there are short-term treatments to camouflage vitiligo such as self-tanner and cosmetics, they’re typically meant for topical use (such as on your arms or face) and might not be safe or effective for genital use; instead, you may consider consulting a health care professional about getting a prescription for certain repigmentation treatments, such as topical creams and ointments such as corticosteroids and calcineurin inhibitors. You might also try light therapy, in which the areas of depigmentation are exposed to ultraviolet wavelengths during multiple treatment sessions. If your condition is causing you severe enough distress that it’s taking a toll in other areas of your life, it’s recommended to reach out to a mental health professional. There are also plenty of online resources you can consult, such as American Vitiligo Foundation and Vitiligo Friends, that may help you understand more about your condition and give you insight on how to cope with the more difficult parts of living with vitiligo.

Ultimately, your best bet is likely to simply acknowledge and explain why your penis looks different from others that your partners might have seen before. Your partners can then choose how they want to proceed, and they may very well be totally fine with it after they’ve learned why you look the way you do. Besides, what a boring world it would be if every penis looked exactly the same!