Sexual Health Implications of COVID-19 Pandemic

Effects of the COVID-19 pandemic on sexual functioning and activity: a systematic review and meta-analysis

BACKGROUND

Since December 2019, when it was first reported in Wuhan, province of Hubei, China, the new virus SARS-CoV-2 has spread rapidly around the world and has become a global pandemic. During the COVID-19 pandemic, due to the public health measures implemented, people's sexual activity has also been affected. Restrictions on people's activities, reduced sports activities, economic issues, increased psychological stress, and reduced entertainment have, indeed, dramatically impacted sexual activity and functioning. The purpose of this study was tosystematically identify, collect and summarize the existing body of evidence from published studies on the effects of COVID-19 pandemic on sexual activity and functioning.

METHODS

Several scholarly databases, namely MEDLINE (via PubMed interface), Web of Science (WOS), Embase, CINAHL, the Cochrane Library, Scopus, and PsycINFO databases, were mined from December 2019 to the end of January 2021. We utilized a random-effect meta-analytical model to analyze all the data. More in detail, the Standardized Mean Difference (SMD) was used in order to estimate and evaluate the effects of the COVID-19 pandemic on sexual activity and functioning.

RESULTS

Twenty-one studies were included in the present study. In total, 2454 women and 3765 men were evaluated. In the present meta-analysis, sexual functioning and activity were assessed by means of two standardized and reliable tools, namely the "Female Sexual Function Index" (FSFI) and the "International Index of Erectile Function-5 items" (IIEF-5). A total of 5 studies reported the FSFI score before and after the COVID-19 pandemic in female participants. Based on the random-effect model, the SMD was computed to be - 4.26 [95% confidence interval or CI: - 7.26, - 1.25], being statistically significant. A total of 3 studies reported the IIEF-5 score before and after the COVID-19 pandemic in male participants. Based on the random-effect model, the SMD was computed to be - 0.66 [CI 95%: - 0.99, - 0.33], being statistically significant. In the majority of these studies, participants reported a reduction in the number of sexual relations and an increase in the frequency of solo sex activity, especially masturbation, compared to the time prior to the COVID-19 pandemic.

CONCLUSION

The results of the present study showed that COVID-19 related restrictions were correlated with higher rates of sexual dysfunction and reduced sexual activity; however, results of the current meta-analytical study show that this change in sexual functioning was greater in women compared to men. Sex is one of the dimensions of every person's life; therefore, researchers should identify the factors that lead to sexual dysfunction due to COVID-19 pandemic in their community. In this regard, sexologists should design and implement effective programs to reduce the heterogeneous causes affecting sexual functioning, given the psychological strain that the COVID-19 pandemic puts on individuals.

Incidence of common infectious diseases in Japan during the COVID-19 pandemic

Recent reports indicate that respiratory infectious diseases were suppressed during the novel coronavirus disease-2019 (COVID-19) pandemic. COVID-19 led to behavioral changes aimed to control droplet transmission or contact transmission. In this study, we examined the incidence of common infectious diseases in Japan during the COVID-19 pandemic. COVID-19 data were extracted from the national data based on the National Epidemiological Surveillance of Infectious Diseases (NESID). Common infectious diseases were selected from notifiable infectious diseases under the NESID. The epidemic activity of the diseases during 2015-2020 was evaluated based on the Infectious Disease Weekly Reports published by the National Institute of Infectious Diseases. Each disease was then categorized according to the route of transmission. Many Japanese people had adopted hygienic activities, such as wearing masks and hand washing, even before the COVID-19 pandemic. We examined the correlation between the time-series of disease counts of common infectious diseases and COVID-19 over time using cross-correlation analysis. The weekly number of cases of measles, rotavirus, and several infections transmitted by droplet spread, was negatively correlated with the weekly number of cases of COVID-19 for up to 20 weeks in the past. According to the difference-in-differences analysis, the activity of influenza and rubella was significantly lower starting from the second week in 2020 than that in 2015-2019. Only legionellosis was more frequent throughout the year than in 2015-2019. Lower activity was also observed in some contact transmitted, airborne-transmitted, and fecal-oral transmitted diseases. However, carbapenem-resistant Enterobacteriaceae, exanthema subitum, showed the same trend as that over the previous 5 years. In conclusion, our study shows that public health interventions for the COVID-19 pandemic may have effectively prevented the transmission of most droplet-transmitted diseases and those transmitted through other routes.

Sexual and Reproductive Health during the COVID-19 Pandemic: Results from a Cross-Sectional Online Survey in Germany

The accumulated evidence maps the COVID-19 pandemic's diverse impacts on sexual and reproductive health (SRH); however, the precise changes in sexual behaviours and the underlying causes producing these changes are rarely considered. This study is aimed at assessing the changes in sexual behaviours during the COVID-19 pandemic in Germany, using quantitative methods, and it is also aimed at identifying the underlying reasons, using qualitative methods. It is a part of the broader I-SHARE project, which administered a cross-sectional online survey in 33 countries to describe the effects of the COVID-19 restrictions on different aspects of SRH. In the current study, a total of 611 adults from Germany are included. The findings demonstrate a decline in sexual satisfaction, as well as increases in sexual problems and partnership conflicts. Furthermore, the findings indicate an increase in pornography consumption and masturbation. Psychological stress, due to the pandemic, seemed to be the main reason for the changes in the participants' sexual behaviours, followed by a decrease in social contacts, and an increase in time resources. Thus, it is important to provide accessible clinical and psychosocial (online) interventions and services in order to maintain good sexual health in times of pandemic.

Quality of Life, Sexual Health, and Associated Factors Among the Sexually Active Adults in a Metro City of India: An Inquiry During the COVID-19 Pandemic-Related Lockdown

BACKGROUND

Sexual dysfunction (SD) and its effect on our life is an important but less studied topic especially during post-COVID era. This study examines the extent of SD and other mental health predictors and their effect on quality of life.

METHODS

A cross-sectional survey of sexually active adults was conducted in an Indian metro-city. Along with sociodemographic data, sexual dysfunction, depression, anxiety, stress, and quality of life were assessed by Arizona Sexual Experience Scale (ASEX), Depression Anxiety and Stress Scale (DASS), and WHOQOL-BREF, respectively. Structural equations modeling was used to understand their relationship.

RESULTS

Out of the total 1,376 respondents, 80.52% were male, 65.98% were married, and 48.54% were graduates. The mean age of the participants was 34.42 (±9.34) years. Of the participants, 27.18% had sexual dysfunction. Majority of the respondents did not have depression (59.30%), anxiety (52.33%), or stress (44.48%). Mild and moderate levels were the commonest findings among those who had depression, anxiety, or stress. Among the respondents, 27.18% had sexual dysfunction as per the ASEX instrument. Increase in age and female gender were associated with sexual dysfunction overall and also all its components. Presence of depression adversely affected ease of achieving orgasm and satisfaction from orgasm and was associated with sexual dysfunction overall. The respondents had a mean score of 73.57 (±13.50) as per the WHO-QOL. Depression and stress emerged as statistically significant factors for poor quality of life, while sexual dysfunction was not associated statistically.

CONCLUSION

More than one-fourth of the study population reported sexual dysfunction during the first wave of the pandemic in India. The study findings highlight the role of poor mental health issues in this regard. In fact, issues like depression and stress were associated with poor quality of life as well. The current findings unequivocally warrant specific interventions to improve mental health of the respondents.

Exploring the adult sexual wellbeing and behavior during the COVID-19 pandemic. A systematic review and meta-analysis

Implemented social distancing measures may have forestalled the spread of COVID-19, yet they suppressed the natural human need for contact. The aim of this systematic review was to explore the impact of the COVID-19 pandemic on adult sexual wellbeing and sexual behavior. An extensive search in Pubmed, Scopus, and PsycInfo databases based on PRISMA guidelines was conducted. After applying specific eligibility criteria, screening resulted in 38 studies. Results were drawn from 31,911 subjects and outlined the negative effect of the pandemic in sexual frequency, function, satisfaction, and the behavioral changes regarding masturbation and internet-based practices. Meta-analyses of the drawn data on 1,343 female, and 1,372 male subjects quantified the degree of sexual function change during the COVID-19 pandemic vs. prior the pandemic. A random effects model revealed the significant negative impact of the pandemic on female sexual function (SMD: 0.76, 95% CI:0.74 to 1.59), while no significant change was found for the males (SMD: 0.25, 95% Cl: -0.03 to 0.52). Significant heterogeneity was identified across included studies (p < 0.00001, I² = 97%, I² = 90% for females and males, respectively). As part of the global health, sexual wellbeing should be on the focus of clinicians and researchers.

The Impact of COVID-19 on Female Sexual Function: A Systematic Review and Meta-Analysis

Coronavirus disease 2019 (COVID-19) not only has put populations at risk for mental and sexual health risks. This systematic review and meta-analysis was performed on published articles reporting female sexual function before and during COVID-19 pandemic in PubMed, Web of Science, Scopus, Google Scholar, Magiran and SID databases till August 2021. From the initial 3198 articles, 8 articles were included in the review. Meta-analysis showed no significant difference in total FSFI score and its domains during the COVID-19 pandemic and the pre-pandemic period. Further studies should separately evaluate the effect of lockdown on female sexual function.

Obstetric challenges during COVID-19 pandemic: A narrative review

The severe acute respiratory coronavirus 2 (COVID-19) pandemic impacts the health of women at reproductive age in different ways, starting from pregnancy planning to post-delivery. This narrative review summarises the challenges to obstetric practice posed by the severe acute respiratory coronavirus 2 (COVID-19) pandemic. In this paper, we highlight the impacts of COVID-19 to obstetric practice globally and the efforts taken to address these challenges. Further study is critical to investigate the effects of COVID-19 on pregnancy, the outcome of COVID-19 positive pregnant women, and the safety of vaccination during pregnancy and breastfeeding.

"Making Peace" with Bodies and Sexual Selves: Changes during COVID-19 among Adults in the United States

The COVID-19 pandemic has negatively impacted the physical and mental health of many and has necessitated widespread societal shifts, including changes to work and family activities. These changes have impacted individuals’ identity, including their sexual self-image and body image, yet research on perceptions of these changes is missing. This study reports on quantitative and qualitative data from an electronic survey with adults in the United States (N = 326) to examine these perceptions. Body appreciation did not significantly differ between demographic groups. Themes emerging from the qualitative results included changes in general self-image (becoming more restricted or disempowered), changes in sexual self-image (deepening, becoming more sexy/sexual, or less sexy/sexual), and changes in body image (positive, negative, and neutral). Our findings point to positive, negative, and neutral effects on sexual self-image and body image, implying that nuanced approaches are needed to understand how identity has transformed as a result of the COVID-19 pandemic.

Comparison of Sexual Function Before and After COVID-19 Infection in Female Patients

Introduction Ample data regarding the impact of coronavirus disease-2019 (COVID-19) on the pulmonary, nervous, and gastrointestinal systems are available. However, its impact on sexual performance is understudied. In this study, we will determine the impact of COVID-19 on the sexual performance of females.  Methods This longitudinal study was conducted in the COVID-19 unit of a tertiary care hospital in Pakistan from June 2020 to March 2021. We enrolled 300 female patients admitted to the hospital due to severe COVID-19. Patients' female sexual function index (FSFI) scale was assessed at the time of discharge. Participants were asked to answer the question based on their sexual performance before they contracted COVID-19. They were asked to return after 60 days, where FSFI was assessed again. Results The mean FSFI score for participants before COVID-19 was significantly higher compared to the score 60 days after discharge (28.16 ± 1.9 vs. 24.43 ± 2.5; p-value: <0.0001). Participants who had FSFI score more than 26 were significantly higher before COVID-19 (72.5% vs. 51.0%; p-value: <0.0001). Conclusion There is a significant decline in sexual function of females, who had contracted COVID-19 infection. COVID-19 survivors should be counseled properly about the impact on the sexual function when discussing long-term complications of COVID-19.

Sexual activities during the COVID-19 pandemic in Indonesia

BACKGROUND

Corona Virus Disease 2019 (COVID-19) has spread globally starting from late 2019. The WHO declared it a global pandemic in March 2020, causing nations around the world to introduce various control measures to halt the rapid spread of the disease, such as quarantines, lockdowns, and work from home (WFH) policies. These policies often force people to spend more time at home with their cohabitants, or possibly sexual partners. Various negative feelings experienced during those policies are considered to affect the general mood and sexual life of the population. This study aimed to investigate the difference in mood and sexual activity before and during the COVID-19 pandemic.

METHODS

This research was a cross-sectional pilot study. Authors collected data from 131 randomly selected, sexually active volunteer subjects using a self-administered online questionnaire. Subjects' mood status, behavior, and frequency of sexual intercourse before and during COVID-19 pandemic in Indonesia were analyzed.

RESULTS

Subjects consisted of 67 (51.1%) men and 64 (48.9%) women. Our analysis shows that there was a decline in overall mood scale, and also sexual activity frequency, before and during the pandemic (4.63 vs. 4.03; 80.2% vs. 67.9%, respectively). The COVID-19 pandemic control measures may enable subjects to have more time with their sexual partners at home, but it does not increase the frequency of their sexual activities.

CONCLUSION

There was a slight decrease in overall mood scale and sexual activity frequency during the COVID-19 pandemic recorded among subjects. The authors suspect that depression symptoms, fear, anxiety, irritability, boredom, confusion, and feeling of being isolated experienced during strict pandemic control measures, caused by stressors such as job loss, decreased monthly income, and the current state of the pandemic are influencing these phenomena.

Male Sexual Health and Sexual Behaviors during the First National COVID-19 Lockdown in a Western Country: A Real-Life, Web-Based Study

Restriction measures enacted during the COVID-19 pandemic had severe effects on male sexual and reproductive health. We aimed to investigate the real-life impact and perception of sexual function in 2020 in Italy, as the first Western country experiencing a national lockdown by measuring relative search volume for keywords pertaining to sexual health and behaviors provided by Google Trends and sales data for pro-erectile treatments. No significant change was observed for erectile dysfunction and premature ejaculation. Interest towards most phosphodiesterase type 5 inhibitors decreased significantly during lockdown (e.g., sildenafil, p = 0.0002; tadalafil p = 0.0016), then reverted to pre-lockdown levels (e.g., sildenafil, p < 0.0001; tadalafil p < 0.0001), mirroring a concomitant sales decrement (p = 0.0292). A subsequent recovery to previous levels at the end of the social confinement was also found (e.g., after vs. before lockdown, sildenafil, p = 0.8459; tadalafil p = 0.1166). During lockdown, interest towards pornography significantly increased during restrictions (p = 0.0053) and remained high (after vs. before lockdown, p = 0.0004), whereas interest towards paid and casual sex declined (p = 0.0015 and p = 0.049, respectively), then reverted to previous levels (after vs. before lockdown, p = 0.3969 and 0.8373, respectively). During the first Italian lockdown, we observed a transient but measurable decrease of sexual health-seeking behaviors and changes in sexual behaviors, with unknown impact for sexual medicine and public health.

The Impact of the Coronavirus Disease-19 Pandemic on Sexual Behavior of Marriage People in Indonesia

BACKGROUND: The coronavirus disease (COVID-19) pandemic has been a global challenge since its first encounter. It has changed the daily lives of families including the sexual behavior of couples due to public health concerns and government policy to restrict people’s movement. It has changed both interpersonal and partner relationships; the time availability at home, the continued presence of children at home, the fear of infection, and the inability to physically interact with others have changed most people’s sexual behavior. AIM: This study aims to evaluate sexual behavior changes in marriage people of Indonesia during the COVID-19 pandemic. METHODS: A cross-sectional online study was conducted, using self-constructed questionnaires. The convenience sample was collected from married males and females for at least 10 months from November 2020 to January 2021. The participants were asked 19 and 20 questions for female and male, respectively, which was an adaptation of the previous questionnaires. Furthermore, a study was conducted to analyze descriptively the changes of sexuality among married people before and during the COVID-19 pandemic. RESULTS: About 201 participants who completed the survey, 110 males (54.7%) and 91 females (45.3%) were included in the analyses. The mean age of participants was 37 years old. Most of the participants have middle to high socio-economy classes and have children at home. Shifting in the work schedule is the main reason to change sexual behaviors. Participants experienced significant changes in sexual behaviors and some sexual responses before and during the restriction time. CONCLUSION: The pandemic has changed sexual behaviors due to social restrictions in Indonesia. These findings imply messages about the consequences of the pandemic on sexual behaviors that may affect the sexual relationship, marriage stability, and physical health itself to fight coronavirus.

COVID-19 and Male Sexual Functioning: A report of 3 Recovered Cases and Literature Review

COVID-19 is a new global pandemic. It can affect multiple body systems and functions. However, the relationship between COVID-19 and male sexual activity did not yet get much consideration. Herein, we report the impact of COVID-19 on sexual function in 3 men who recovered from the disease. Compared with their condition before catching the infection, the men showed, in different degrees, a decline in all aspects of sexual function as assessed by the international index of erectile function. They started to develop premature ejaculation or exacerbate an already existing condition according to the premature ejaculation diagnostic tool scoring. Beck’s depression inventory revealed deterioration of the men’s moods up to severe depression. The sex-related hormones (testosterone-total and free, luteinizing hormone, follicle-stimulating hormone, prolactin, and estradiol) of these men were within normal levels. To the best of our knowledge, this is the first case report documenting deleterious changes in mood and several aspects of sexual functioning in males after recovery from the COVID-19 using validated measurement tools. Follow-up and psychological support of the recovered men may help mend their moods and consequently upgrade their sexual functioning.

Positive Massage: An Intervention for Couples' Wellbeing in a Touch-Deprived Era

COVID-19 has brought not only fear and anxiety, but also legitimate restrictions of communication and consequential touch-deprivation in our daily lives. Couples' relational wellbeing continues to be impacted by these COVID-19 related stressors. Protecting both personal and relational wellbeing is therefore particularly important at this time. Using a preventative intervention approach, the current paper argues the theoretical benefit of the Positive Massage programme and reports a qualitative analysis of stressed but healthy couples' experience of engaging in the programme. Thirty-four participants completed 3 weekly classes and home-based practice of massage exchange. Data from an open text online questionnaire completed every week of the programme and again 3 weeks afterwards were analysed using thematic analysis. The identified themes included "holistic stress relief", "relationship-promotion", and "selves-care skill". Couples perceived Positive Massage as an effective mutual support skill to relax and help one another by de-stressing, both emotionally and physically through verbal and nonverbal communication, creating gratitude, deeper connection and self-efficacy via quality time together and pleasurable touch. Theoretically and experientially, Positive Massage can be an effective preventative selves-care skill. Promoting the concept of selves-care and its practical application through Positive Massage would be beneficial for couples' personal and relational wellbeing in a touch-deprived era.

Female Sexual Function During the COVID-19 Pandemic in the United States

Introduction

International studies have demonstrated increasing rates of sexual dysfunction amidst the coronavirus disease 2019 (COVID-19) pandemic; however, the impact of the pandemic on female sexual function in the United States is unknown.

Aim

To assess the impact of the COVID-19 pandemic on female sexual function and frequency in the United States.

Methods

A pre-pandemic survey containing the Female Sexual Function Index (FSFI) and demographic questions was completed by adult women in the United States from October 20, 2019 and March 1, 2020. The same women were sent a follow-up survey also containing the FSFI, as well as the Patient Health Questionnaire for Depression and Anxiety with 4 items (PHQ-4), and questions pertaining to mask wearing habits, job loss, and relationship changes. Risk for female sexual dysfunction (RFSD) was defined as FSFI < 26.55.

Main Outcome Measure

Differences in pre-pandemic and intra-pandemic female sexual function, measured by the FSFI, and sexual frequency.

Results

Ninety-one women were included in this study. Overall FSFI significantly decreased during the pandemic (27.2 vs 28.8, P = .002), with domain-specific decreases in arousal (4.41 vs 4.86, P = .0002), lubrication (4.90 vs 5.22, P = .004), and satisfaction (4.40 vs 4.70, P = .04). There was no change in sexual frequency. Contingency table analysis of RFSD prior to and during the pandemic revealed significantly increased RFSD during the pandemic (P = .002). Women who developed RFSD during the pandemic had higher PHQ-4 anxiety subscale scores (3.74 vs 2.53, P = .01) and depression subscale scores (2.74 vs 1.43, P = .001) than those who did not. Development of FSD was not associated with age, home region, relationship status, mask wearing habits, knowing someone who tested positive for COVID-19, relationship change, or job loss and/or reduction during the pandemic.

Conclusion

In this population of female cannabis users, risk for sexual dysfunction increased amidst the COVID-19 pandemic and is associated with depression and anxiety symptoms. Bhambhvani HP, Chen T, Wilson-King AM, et al. Female Sexual Function During the COVID-19 Pandemic in the United States. Sex Med 2021;9:100355.

Effect of the COVID-19 pandemic and social distancing measures on the sexual functions of women treated for vaginismus (genitopelvic pain/penetration disorder)

Introduction and hypothesis

Female sexual function is influenced by the emotional and hormonal state. COVID-19 has been the major global health crisis of our time with high psychosocial impact. Vaginismus is a form of female sexual dysfunction and a subset of genitopelvic pain/penetration disorder in which any form of vaginal penetration is painful or impossible. Our aim was to evaluate the effect of the COVID-19 pandemic on sexual function of women treated for vaginismus.

Materials and methods

All women treated using dilators between 2018–2019 were included. Data obtained 3 months after comfortable penetration and during the pandemic via telephone interview were compared. The Female Sexual Function Index (FSFI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and Beck Depression Inventory (BDI) were used to evaluate sexual function and depression. Frequency of sexual intercourse and pain was compared using a visual analogue scale.

Results

Seventy-seven women were included. Mean duration of treatment and number of treatment sessions were 3.5 ± 2.6 months and 4.2 ± 2.6, respectively. There were significant improvements in the FSFI desire, arousal, orgasm, and pain subscales and total score and in the GRISS infrequency, noncommunication, avoidance, non-sensuality, and vaginismus subscales and total score during the pandemic. The GRISS dissatisfaction and anorgasmia subscales and BDI score significantly worsened. Mean frequency of sexual intercourse was 2.3 ± 1.8/week and did not change significantly. Pain scores decreased during the pandemic (2.7 ± 2.8) compared to post-treatment (6.2 ± 2.9).

Conclusion

Although frequency of sexual intercourse was not affected and pain scores and FSFI total and subscale scores improved, satisfaction and orgasm were adversely affected, which may be attributed to increased stress and anxiety during the pandemic.