Consensus on Recommendations for Safe Sexual Activity during the COVID-19 Coronavirus Pandemic

(Un)forgotten Sex Lives During the COVID-19 Pandemic: Coping Strategies That Work and the Role of Experience

Available literature points to a worsening trend in sexual functioning, desire, and satisfaction during the pandemic. Nevertheless, virtually no empirical research was conducted on the mechanisms of coping with the pandemic's impacts on sex life. Thus, the purpose of this exploratory study was to examine a variety of coping mechanisms and their perceived usefulness by people who have and have not tried these coping strategies to maintain and enhance their sex lives during the first year of the pandemic. The cross-sectional data were collected using an online survey methodology (N = 420; 66.9% women) and analyzed utilizing exploratory factor analysis, analysis of variance, and multiple regression. The results revealed nine factors/coping mechanisms (based on 59 items/strategies), including goal-setting strategies, risk and experimentation strategies, relational strategies, caution and logistical strategies, creativity and innovation strategies, substances and context-related strategies, online and technology strategies, diversion strategies, and educational strategies. Consistently, across all the specific coping strategies and overall coping mechanisms, people who tried them found them significantly more useful than those who had not tried these coping strategies. Moreover, a higher diversity of tried strategies per coping mechanism consistently and significantly predicted the perceived usefulness of that coping mechanism. These results emphasize the crucial role of experience with coping mechanisms and show that amidst COVID-related adversity and challenges, many people found ways to adapt their sex lives and enjoy silver-lining opportunities. This exploratory study offers promising evidence for potential sexual coping strategies during times of stress that could be informative for clinical practice and education.

Association between COVID-19 and sexual health: an umbrella review

PURPOSE

We conducted this umbrella review to review the current evidence on the relationship between COVID-19 and sexual health in both men and women.

METHODS

We conducted searches in Pubmed, Embase, and the Cochrane dataset for meta-analyses that met our pre-set inclusion criteria. We included studies with detailed information investigating the link between COVID-19 and sexual health in men/women. We did not limit the language.

RESULTS

The results of the included studies frequently relied on the Female Sexual Function Index to assess sexual health in women. For men, the International Index of Male Function and hospital diagnoses were commonly used to assess sexual health. Currently, there is conflicting evidence regarding the impact of COVID-19 on sexual health. However, since most studies were observational in nature, additional study designs are necessary to draw definitive conclusions across different contexts.

CONCLUSION

Our findings highlight the importance of sexual health among COVID-19 patients and people affected due to COVID-19. Further critical studies should investigate the mechanism underlying the association between COVID-19 and sexual health.

Evidence for Sex Differences in Depression, Sexual Attitudes, and Impulsivity as Predictors of Breaking Shelter-in-Place Orders During the COVID-19 Pandemic

Although the call to understand how sexual behaviors have been impacted by the COVID-19 pandemic has been established as an important area of study, research examining the extent to which gender, sexual attitudes, impulsivity, and psychological distress predicted breaking shelter-in-place (SIP) orders to engage in sexual behaviors with partners residing outside the home is undefined. Obtaining a deeper examination of the variables which predict risky sexual behaviors during SIP has important implications for future research at the intersection of public health, sexuality, and mental health. This study addressed the gap in the literature by considering how partnered sexual behaviors may be used during the COVID-19 pandemic to alleviate stress, as measured by breaking SIP orders for the pursuit of sexual intercourse. Participants consisted of 186 females and 76 males (N = 262) who predominately identified Caucasian/White (n = 149, 57.75%) and heterosexual/straight (n = 190, 73.64%) cultural identities with a mean age of 21.45 years (SD = 5.98, range = 18-65). A simultaneous logistic regression was conducted to examine whether mental health symptoms, sexual attitudes, and impulsivity predicted participants' decision to break SIP orders to engage in sexual intercourse. Based on our results, breaking SIP orders to pursue sexual activities with partners residing outside the home during the COVID-19 pandemic may be understood as an intentional strategy among men with less favorable birth control attitudes to mitigate the effects of depression. Implications for mental health professionals, study limitations, and future areas of research are additionally provided.

New Challenges in Sexuality and Sexual Dysfunction

Human sexuality constitutes not only a basic need but also a right that significantly enriches interpersonal relationships, providing mutual satisfaction and pleasure [...].

More than Two… but not Right Now: Interpretations and Responses to Covid-19 Measures on Reddit for Two Communities of Consensual Non-Monogamy

Using Owen's Thematic Analysis, we reviewed the Reddit posts of participants in two online communities regarding consensual non-monogamy (CNM) during the January 2021 peak of the Covid-19 pandemic. In 5,209 comments, 465 unique users in the /polyamory and /swinging forums on the social media platform Reddit referred to the pandemic with two themes emerging as most salient. In the first theme, participants described, interpreted, and responded to the social limitations of the Covid-19 era, with particular attention to limitations on CNM identity and behavior during the pandemic. In the second theme, participants articulated concerns about individual and social health. In addition to strictly personal concerns about physical and mental health, participants described challenges to the well-being of relationships and communities and ways to manage risk and mitigate social damage. We discuss the implication of these findings in light of the unique social structure of CNM communities.

Emotional health assessment related to COVID-19 in older people: A cross-sectional study

BACKGROUND

The aim of this study was to assess the presence of anxiety, fear and psychological distress in the population of people over 65 years of age and to study possible differences with a sample of subjects aged between 60 and 65 years.

METHODS

A descriptive and psychometric cross-sectional study. The total sample used consisted of 1112 subjects from university training programmes for the old people from all over Spain. Anxiety and fear of COVID-19 were measured using the AMICO scale and psychological distress using the GHQ-12 instrument.

RESULTS

Significant differences were found in the AMICO (p = 0.006) and GHQ-12 (p = 0.03) measures between age subgroups, with lower values in older age groups. Contrast statistics showed significant differences on both measures (AMICO and GHQ) in women, single or widowed subjects, and those who had not been infected by the SARS-CoV-2 virus.

LIMITATIONS

It would be desirable to increase the sample size, especially in the lower age group (<65). The establishment of the age limit between the two groups could be located at 60 years of age. The use of new technologies to get information should be considered.

CONCLUSIONS

Overall, moderate levels of fear and anxiety of COVID-19 were present. Women tended to have higher levels of both general psychological distress and fear and anxiety of COVID-19. Especially in those over 65, higher levels of distress and fear/anxiety of COVID-19 were associated with being widowed or single, and not having been infected before with SARS-CoV-2.

A Network Comparison of Motives behind Online Sexual Activities and Problematic Pornography Use during the COVID-19 Outbreak and the Post-Pandemic Period

Many researchers have considered whether online sexual activities (OSAs) increased over the course of the COVID-19 pandemic and whether these have led to an increase in problematic pornography use (PPU). This study investigated the impact of COVID-19 on PPU through pornography use motivations (PUMs) and OSAs to develop a better understanding of the mechanism and changes affecting PPU. Two groups of Chinese adults were recruited during the initial months of the pandemic (April 2020, n₁ = 496) and the post-pandemic period (October 2021, n₂ = 504). A network analysis was conducted to compare the structures of PPU symptoms among the two groups. The results showed that PUMs and OSAs were stronger predictors of PPU during the pandemic than post-pandemic (R²_pandemic = 57.6% vs. R²_{post-pandemic} = 28.7%). The motives of fantasy, sexual pleasure, stress reduction, and self-exploration were the prominent motivations during these two periods, but we found distinct PPU-related communities. PPU, sexual pleasure, and viewing sexually explicit materials (a type of OSAs) constituted a community during the pandemic but not in the post-pandemic’s network. The present study indicated that the pandemic may not have been the only factor impacting the higher rate of PPU. Instead, the higher frequency of OSAs during the pandemic may have been a strategy to cope with stress and to safely satisfy sexual desire.

The Impact of the SARS-CoV-2 Pandemic on Reproduction, Sexual Function and Behaviors: A Review of the Main Trends and Findings

Objective: This review sought to describe the main trends and findings on the SARS-CoV-2 and the pandemic's effect on reproduction (i.e., effects on fertility, reproductive tissue, pregnancy, vertical and sexual transmission) and sexual function and behaviors. Methods: A review was conducted on studies assessing these variables through the Scopus and PubMed databases between the years 2019-2021. Results: Results showed SARS-CoV-2 pandemic and social distancing measures have affected-and in some cases not-different aspects of people's reproductive function, sexual function and behaviors. Conclusions: Suggestions are offered for researchers and professionals focused on future research and clinical practice.

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.

Sex, Digital Devices, Social Media, and Social Isolation: A Study on Sexual Behavioral During COVID -19 Pandemic

Introduction:

Coronavirus (COVID-19) pandemic has caused social and economic damages. People have adapted to a new reality of physical distance.

Objective:

The study aimed to assess the use of digital devices and social media, focusing on psychosocial and demographic factors of people´s sexual behavior during the pandemic.

Methods:

A total of 1,357 Brazilian adults participated in a cross-sectional online survey. They were recruited through social media to obtain information regarding sexual behavior and the use of digital devices and social media.

Results:

Digital devices and social media were used by 38.8% of the participants. Among the group that used technological devices, most claimed to have changed their sexual behavior, with 76.9% consuming more sexual content through movies or series.

Conclusion:

In a smaller group, technological resources appeared as an alternative for safer sex, reducing the risks of COVID-19 transmission.

Impact of COVID-19 on pornography use: Evidence from big data analyses

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has led to radical changes in social distancing awareness and affected social relationships. Owing to large-scale lockdown, home quarantine and social distancing requirements, it was anticipated that sexual activities would be severely impacted. However, retrospective self-report studies showed that pornography use and autoerotism increased during the pandemic.

AIM

This study used big-data databases available on the Internet to investigate factors that modulated pornography use during the pandemic.

METHODS

Daily relative search volume (RSV) data from Google Trends for the period from 24 February 2020 to 13 July 2020 were extracted. Pornhub traffic data were extracted from the Pornhub Insights website, for the period from 24 February 2020 to 13 July 2020. The parameter was defined as 'percent change in traffic compared to an average day in 2019'. The number of daily new cases of COVID-19 was extracted from the database on Our World in Data.

OUTCOME MEASURES

The normality of the data was examined using the Shapiro-Wilk test. All variables included in this study were non-normally distributed. Therefore, non-parametric tests or parametric tests with bootstrapping were adopted where appropriate.

RESULTS

According to Google Trends, the RSV for 'pornography' increased after late March 2020, which is close to the date when the World Health Organization declared COVID-19 a global pandemic. The number of daily new cases of COVID-19 was positively correlated with the traffic of Pornhub, a popular pornography website, and the RSV for 'pornography'. Moderation analysis demonstrated a significant main effect of daily new cases of COVID-19 and the RSV for 'social distancing' in predicting Pornhub traffic/RSV for 'pornography'. Furthermore, the RSV for 'social distancing' significantly moderated the relationship between daily new cases and Pornhub traffic/RSV for 'pornography'. A stronger COVID-pornography use association was observed with increased social distancing awareness.

CONCLUSION

Increased pornography consumption during the pandemic was observed, and it was associated with the severity of the pandemic. Social distancing awareness could be a key factor influencing interest in and use of pornography. Further studies on the changes in sexual desire and birth-rate control are worthwhile because long-term public health may be affected by the changes in sexual behaviour during the pandemic.

Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: a scoping review

OBJECTIVES

The COVID-19 pandemic has exposed and exacerbated existing socioeconomic and health disparities, including disparities in sexual health and well-being. While there have been several reviews published on COVID-19 and population health disparities generally-including some with attention to HIV-none has focused on sexual health (ie, STI care, female sexual health, sexual behaviour). We have conducted a scoping review focused on sexual health (excluding reproductive health (RH), intimate partner violence (IPV) and gender-based violence (GBV)) in the COVID-19 era, examining sexual behaviours and sexual health outcomes.

METHODS

A scoping review, compiling both peer-reviewed and grey literature, focused on sexual health (excluding RH, IPV and GBV) and COVID-19 was conducted on 15 September 2020. Multiple bibliographical databases were searched. Study selection conformed to Joanna Briggs Institute (JBI) Reviewers' Manual 2015 Methodology for JBI Scoping Reviews. We only included English-language original studies.

RESULTS

We found that men who have sex with men may be moving back toward pre-pandemic levels of sexual activity, and that STI and HIV testing rates seem to have decreased. There was minimal focus on outcomes such as the economic impact on sexual health (excluding RH, IPV and GBV) and STI care, especially STI care of marginalised populations. In terms of population groups, there was limited focus on sex workers or on women, especially women's sexual behaviour and mental health. We noticed limited use of qualitative techniques. Very few studies were in low/middle-income countries (LMICs).

CONCLUSIONS

Sexual health research is critical during a global infectious disease pandemic and our review of studies suggested notable research gaps. Researchers can focus efforts on LMICs and under-researched topics within sexual health and explore the use of qualitative techniques and interventions where appropriate.

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.

COVID-19 Pandemic on Fire: Evolved Propensities for Nocturnal Activities as a Liability Against Epidemiological Control

Humans have been using fire for hundreds of millennia, creating an ancestral expansion toward the nocturnal niche. The new adaptive challenges faced at night were recurrent enough to amplify existing psychological variation in our species. Night-time is dangerous and mysterious, so it selects for individuals with higher tendencies for paranoia, risk-taking, and sociability (because of security in numbers). During night-time, individuals are generally tired and show decreased self-control and increased impulsive behaviors. The lower visibility during night-time favors the partial concealment of identity and opens more opportunities for disinhibition of self-interested behaviors. Indeed, individuals with an evening-oriented chronotype are more paranoid, risk-taking, extraverted, impulsive, promiscuous, and have higher antisocial personality traits. However, under some circumstances, such as respiratory pandemics, the psychobehavioral traits favored by the nocturnal niche might be counter-productive, increasing contagion rates of a disease that can evade the behavioral immune system because its disease cues are often nonexistent or mild. The eveningness epidemiological liability hypothesis presented here suggests that during the COVID-19 pandemic, the evening-oriented psychobehavioral profile can have collectively harmful consequences: there is a clash of core tendencies between the nocturnal chronotype and the recent viral transmission-mitigating safety guidelines and rules. The pandemic safety protocols disrupt much normal social activity, particularly at night when making new social contacts is desired. The SARS-CoV-2 virus is contagious even in presymptomatic and asymptomatic individuals, which enables it to mostly evade our evolved contagious disease avoidance mechanisms. A growing body of research has indirectly shown that individual traits interfering with social distancing and anti-contagion measures are related to those of the nocturnal chronotype. Indeed, some of the social contexts that have been identified as superspreading events occur at night, such as in restaurants, bars, and nightclubs. Furthermore, nocturnal environmental conditions favor the survival of the SARS-CoV-2 virus much longer than daytime conditions. We compare the eveningness epidemiological liability hypothesis with other factors related to non-compliance with pandemic safety protocols, namely sex, age, and life history. Although there is not yet a direct link between the nocturnal chronotype and non-compliance with pandemic safety protocols, security measures and future empirical research should take this crucial evolutionary mismatch and adaptive metaproblem into account, and focus on how to avoid nocturnal individuals becoming superspreaders, offering secure alternatives for nocturnal social activities.

Design of Fear and Anxiety of COVID-19 Assessment Tool in Spanish Adult Population

The aim of this study was to develop a specific scale to measure anxiety and fear levels in the general Spanish population. For this, a transcultural adaptation to Spanish of the fear of coronavirus disease 2019 (COVID-19) scale, in its original version of 10 items, was carried out. Then, the Anxiety and Fear of COVID-19 Assessment Scale (AMICO, for its acronym in Spanish) was designed by translating the tool and Delphi technique into three rounds. Ten experts participated voluntarily, and inter-observer match rates and the reliability study of the designed scale were calculated. A pilot study was carried out with the final version of the scale for the validity and reliability study. The instrument did not raise problems in semantic and cultural terms during the first and second rounds of the translation process, with an overall weighted Kappa value of 0.9. In the third round, eight new items were designed and consensual, obtaining a weighted overall value of 0.89. The pilot study sample was made up of 445 subjects, of which 60.3% were women with a mean age of 46.2 years. The final version consisted of 16 items, 2 factors, and a Cronbach's alpha value of 0.92. The AMICO scale was developed to assess the level of anxiety and fear of COVID-19 and proved to be valid and reliable for its use in the adult Spanish population.

Examination of the effect of COVID-19 on sexual dysfunction in women

OBJECTIVE

To investigate the effect of COVID-19 on sexual dysfunction in women.

MATERIAL AND METHODS

The women diagnosed with COVID-19 and hospitalised at a tertiary hospital were included. They completed the Introductory Data Form, the Female Sexual Function Index-(FSFI) and the Short Form-36 Quality of Life Scale (SF-36).

RESULTS

Fifteen women between the ages of 19-49 who completed the treatment protocol, discharged at least 14 days before and who had not been diagnosed as sexual dysfunction; sexually active earlier were included in the study. It was detected that weekly sexual intercourse before and after COVID-19 significantly differed (P = .047). The frequency of relationships decreased statistically after COVID-19. The mean value of the FSFI satisfaction score differs from COVID-19 before and after diagnosis (P = .012). The mean satisfaction score before COVID-19 was 3.47, and after COVID-19 was 2.93. The score of the subgroups of FSFI did not differ from COVID-19 before and after diagnosis (P > .050). The median value of SF-36 pain differs from COVID-19 before and after diagnosis (P = .008).

CONCLUSION

It was concluded that the frequency of sexual intercourse and sexual satisfaction in women decreased after COVID-19 disease, and the quality of life scores did not change in a statistically significant way.

The impact of COVID-19 on sexual behaviors of young women and men: A protocol for systematic review and meta analysis

BACKGROUND

The worldwide impact of COVID-19 has reached all spheres of human health. Individuals may also experience unique changes in their sexual behaviors during the COVID-19 self-isolation/social distancing period. Studies in many countries have assess the effects of the pandemic on sexual behavior, or quality of sexual life. However, no systematic review has comprehensively explored the association between COVID-19 and the sexual behaviors of young women and men to date. This systematic review and meta-analysis protocol aims to ascertain the association between COVID-19 and sexual behaviors of young women and men that may get targeted interventions to improve health and well-being of young people's sexual health.

METHODS

This systematic review and meta-analysis will be reported following the PRISMA guidelines. Observational designs (including cross-sectional, case-control, and cohort) will be eligible. Studies eligible for inclusion must contain participants aged 15 to 45 in any country affected by the pandemic of COVID-19. The search will be conducted in the following databases, including PubMed, Cochrane Library, EMBASE, EBSCO, Ovid, WHO COVID-19 database, China National Knowledge Internet (CNKI), WanFang Data, Chinese Scientific and Technological Journal Database (VIP), and Chinese Biomedical Databases (CBM). A pre-designed search strategy of medical subject heading (MeSH) terms and free words for the concepts "COVID-19" and "sexual behaviors" will be used. Two authors will independently complete literature screening, data extraction, and risk of bias assessment. Disagreements will be resolved by consensus with a third reviewer. The reviewer will follow the PECOS steps (population, exposure, comparator, outcomes, and study design) to obtain eligible extraction items. The risk of bias and quality of included studies will be assessed using RevMan 5.3. We will assess heterogeneity according to the I2 statistics. If there is substantial heterogeneity in the included trials, subgroup analysis will be carried out to seek the potential causes.

ETHICS AND DISSEMINATION

It is not necessary to obtain ethical approval as we will use data from published articles. The findings of this systematic review will be published in a peer- reviewed journal.

PROSPERO REGISTRATION NUMBER

PROSPERO 2020: CRD42020190867.

COVID-19 Infection in the Human Reproductive Tract of Men and Nonpregnant Women

SARS-CoV-2 is an enveloped non-segmented positive-sense RNA virus, classified as a beta coronavirus, responsible for the COVID-19 pandemic. Angiotensin-converting enzyme 2 (ACE2), reported as a SARS-CoV-2 receptor, is expressed in different human tissues (lung, intestine, and kidney) and in the testis, ovaries, uterus, and vagina. This suggests a potential risk to the human reproductive tract in COVID-19 patients. In addition, SARS-CoV-2 RNA has been detected in the blood, urine, facial/anal swabs, semen, and vaginal secretion, suggesting other potential means of transmission. However, little has been reported about SARS-CoV-2 infection in the male and nonpregnant female reproductive tracts, which may provide direct evidence on sexual transmission and fertility problems. Therefore, we focused this narrative review mainly on the distribution of ACE2 and SARS-CoV-2 positivity in the male and nonpregnant female reproductive tracts, providing an overview of the potential threat of COVID-19 to reproductive health and sexual transmission.