What lies beneath – ‘hidden’ skin and sexual attractiveness

‘Hidden’ skin is not truly hidden. All those areas that are not visible to the outside world can be very visible to the individual. I often explain to my patients that the area affected, or the severity of a skin condition does not predict the psychological impact. For example, skin conditions that are ‘mild’ in severity can have a huge emotional effect, and skin conditions affecting areas that are not highly visible can still be as distressing as those that are easily seen. Similarly, the visual appearance of a ‘hidden’ area can be a source of concern for many people.

What is the vulva?

The vulva is a part of the female anatomy that is highly variable between individuals. Although the ‘parts’ are usually similar between women, they can look different. This can be due to skin colour, age, presence of skin conditions or trauma (e.g. childbirth, female genital mutilation). Like the face, the vulva is not entirely symmetrical, and one side may look slightly different to the other. With few ‘real’ images to compare themselves to it is no wonder many women will wonder if their female anatomy is ‘normal’, thus perpetuating self-doubt.

Do women care about what their vulva looks like?

As the female genitalia is an eroticised area it is subject to images of characteristics that are thought to be valued (e.g. certain shape, size, colour), but are far from what is seen in the general female population. This type of narrow or unrealistic imagery can lead some women to developing negative feelings about their female anatomy. Couple this with the lack of representation of vulval skin conditions, and you can see how a female with a vulval condition can start to feel that their genital appearance is unappealing (to them, and to their potential/current partner). As expected, this will lead to loss of appearance-related confidence.  Exposing women to images of ‘normal’/natural vulvas has a positive effect on genital self-image, unfortunately these images are not the ones that are largely deemed desirable. 

What are the possible psychological impacts?

Dissatisfaction with genital appearance is associated with higher levels of self-consciousness during intimacy (‘I hope my partner doesn’t notice that one side of my labia is longer than the other/I have genital psoriasis/my episiotomy scar’), this can lead to lower sexual self-esteem (how you feel about yourself as a sexual being) and sexual satisfaction. Worryingly, women who experience these feelings may also be more likely to engage in risky sexual behaviour (maybe because of how they feel about themselves). Women who feel uncomfortable about their vulval appearance also have higher rates of sexual dysfunction; this may lead them to seek cosmetic procedures to ‘correct’ their appearance concerns. Appropriate screening for women wanting to undergo female genital cosmetic procedures is therefore extremely important to protect vulnerable individuals who may be seeking these for the wrong reasons.

What about people who have skin conditions (genital and non-genital)?

People with skin conditions are not often asked about how their skin makes them feel in terms of sexual attractiveness or well-being. We know that having skin conditions like acne, eczema or psoriasis can affect a person’s ability to view themselves as sexually attractive and their self-confidence, and even the capacity to be intimate. Feeling sexy is not just related to the skin in the intimate area, if a skin condition affects another area, it can still affect sexual well-being. These feelings are due to a number of reasons, they can directly relate to how the skin feels or looks (i.e. the texture of the skin), or the associated psychological distress (e.g. embarrassment, feeling low or anxious, developing body image issues, feeling socially isolated). There are also social and cultural considerations, for example, the incorrect belief that a skin condition can be catching or due to poor hygiene. These factors in combination, that are experienced by people with skin conditions often, can result in some vulnerable individuals being unable to view themselves as ‘sexy’ or express their sexual feelings. 

I can relate to these feelings, should I see someone?

I advise any person with a skin-related concern that is impacting their quality of life and well-being to discuss this with a healthcare professional. In psychodermatology we aim to discuss these types of feelings in detail and use a combined approach to work towards managing physical and psychological symptoms of skin-related issues.

If you are suffering from persistent negative thoughts, or feel like you need to talk to someone straight away about the way that you are feeling, then you might like to get in contact with MindSamaritans or Changing Faces, who may be able to help.


For better mental health

0300 123 3393


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Support Information & Advice

0300 012 0275


  1. Laan E, Martoredjo DK, Hesselink S, Snijders N, van Lunsen RHW. Young women’s genital self-image and effects of exposure to pictures of natural vulvas. J Psychosom Obstet Gynaecol. 2017 Dec;38(4):249-255.
  2. Veale D, Eshkevari E, Ellison N, Costa A, Robinson D, Kavouni A, Cardozo L. Psychological characteristics and motivation of women seeking labiaplasty. Psychol Med. 2014 Feb;44(3):555-66.

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