Women’s Sexual Health During the Pandemic of COVID-19: Declines in Sexual Function and Sexual Pleasure. Leonor de Oliveira & Joana Carvalho. Current Sexual Health Reports, Jul 3 2021. https://rd.springer.com/article/10.1007/s11930-021-00309-4
Purpose of the Review: The World Health Association declared COVID-19 a pandemic more than 1 year ago. We conducted a systematic review of the literature on the topic of women’s sexual health during the pandemic, with a focus on sexual function and sexual pleasure. Our aim is to describe current findings and to discuss implications for women’s sexual health during this period.
Recent Findings: Thirty-four articles, from 18 countries, were identified. These studies addressed topics ranging from individual aspects, such as cognitive, emotional, and personality factors affecting sexuality during the pandemic, to contextual factors, including relationship, childrearing, and employment status in this period.
Summary: Research identified a deterioration of women’s sexual function across countries, with an emphasis on sexual desire. Most studies found decreases in the frequency of sexual intercourse during the pandemic and increases in solitary sexual behavior. Many women also experienced declines in sexual satisfaction and relationship satisfaction. Findings suggested that gender inequalities contributed to lower indices of sexual function and satisfaction, and might have exacerbated the pleasure gap between men and women.
This review suggested that women’s sexual health and well-being might have been disproportionately affected during the COVID-19 pandemic throughout 2020, as predicted. According to our findings, women experienced more sexual problems than men, including low sexual desire and low sexual satisfaction [e.g., 32, 35, 48]. Most studies found decreases in the frequency of sexual intercourse during the pandemic, but also found increases in solitary sexual behavior [e.g., 28, 39, 43], which may imply that the declines in sexual desire were affecting mostly partner relationships. While the fact that there was an increase in masturbation and pornography use fits the media narratives described by Döring [2], the speculated “coronavirus babyboom” seems unlikely considering the drops in sexual intercourse, and in intention to conceive during 2020 [59]. This does not mean, however, that this trend is carried on in 2021. As for the prevision of the rise of the new genre of coronavirus themed pornography, this proved to be correct [48].
Research found negative relationships between some individual aspects and sexual function, such as age, level of stress, anxiety, and depression, and negative sexual cognitions and emotions [28, 30, 37, 43, 55]. These do not appear to be pandemic specific, considering that previous research has established that anxiety and depression and their treatments contribute to higher rates of sexual dysfunction [61, 62]. As well, dysfunctional sexual beliefs and emotions were also proven to negatively affect women’s sexual health [63, 64]. Nevertheless, the fact is that during this period, many people experienced higher levels of stress, and this seems to have put them at greater risk for sexual dysfunction.
This review also found that higher boredom was related with increased sexual activity and sexual function [27, 54] and that some individuals used sex to cope during lockdown [56]. Some researchers suggest that sex can be a coping mechanism for managing boredom, which has been linked to masturbation and hypersexuality [65, 66]. Boredom was identified as an important stressor for those in isolation during the pandemic [67]. Possibly, for some individuals feeling bored due to isolation, sex was welcomed as a positive distraction. As for individuals who score highly on measures of sociosexuality, who were unable to pursue sex on their terms, including casual sex, they perceived higher impact of lockdown on their well-being [49]. On the other hand, sociosexuality and physical attraction to the partner were associated with introducing new sexual practices during this period [58]. In fact, improvements in sex life during the pandemic were related with higher sexual desire overall and for partner, and with incorporating new sexual activities [27, 57]. Pre-pandemic studies found that sexual novelty was inversely correlated with sexual boredom [68] and that the inability or unwillingness to engage in novel sexual behavior was positively correlated with sexual boredom [69]. In a recent qualitative study with a large community sample, participants described sexual boredom as the sexual monotony and/or lack of sexual interest that is often linked to the interpersonal aspects of long-term sexual relationships [70]. During COVID-19, many couples changed their lifestyles to comply with restrictions and were forced to face monotony. It seems as if this did not necessarily send them to sexual boredom, as some seemed to have reacted to feelings of boredom by introducing new sexual activities and enhancing sexual desire. Nevertheless, some individuals might not have had the tools to fight pandemic induced boredom and sexual boredom, and this could have affected their sexual function. Yet, that assumption was not investigated.
Relationship factors are known to affect sexual health [71,72,73]. However, the extent to which the pandemic impacted relationship quality is unclear. This is especially relevant for women in sexual violent relationships, who became more vulnerable and isolated during this pandemic [2, 9]. Yet, this review did not focus on sexual violence. Additionally, this review found that women living with their partners and having more free time and better opportunities for partnered quality time [30, 54], or women having higher relationship satisfaction, felt more sexually satisfied [46, 55] and had less sexual dysfunction [39, 43]. On the other hand, those experiencing conflict in their relationship had sex less often [40, 60]. Also, negative changes in relationship satisfaction during COVID-19 were related with having dyadic conflict, poor coping [74], and with having children at home for school, irrespectively of work status [75]. Although the current review did not include studies examining same-sex couples, other research has identified that in the pandemic context, being a person of color and having higher internalized homophobia exacerbated the pandemic’s negative effects on relationship satisfaction [76]. Thus, it seems highly relevant that these populations are investigated.
Working was one of the life areas where individuals faced more changes. Many people had to adjust their routines to work from home, while essential workers had to manage additional risk at their workplaces. These shifts impacted on individuals’ sexual health [31, 33], particularly in subjects who were, or who became, unemployed [31, 44], or in healthcare workers [36, 41], possibly due to increased stress levels. Conversely, those working from home also saw declines in sexual health [31], specifically those who struggled with anxiety, depression, and somatization, although for women, this was not related with their level of confinement [28].
Some authors [41, 44, 51] speculated that the declines in sexual function and sexual activity were a result of the level of education or information on the virus of COVID-19. That is, well-informed or educated individuals were more afraid and/or compliant with social distancing, experiencing higher dysfunction and less sexual activity. Even though we might consider that access to information may have privileged solitary sexual behavior at some level, we are not sure whether it was a major factor determining sexual function. In reality, research shows that interventions aiming at sexual education favor women’s sexual function and pleasure [78, 88]. In addition to possible spillover effects, the declines in the sexual function of women with more access to education or information seem to us a more likely result of lack of parity between men and women. There were several authors who alerted that the advent of teleworking would exacerbate gender inequalities [9, 89, 90]. This review suggests that these inequalities, including childrearing, contributed to lower indexes of sexual function and satisfaction, which in turn provide evidence of pleasure inequality. Because some women may struggle with negotiating sexual pleasure and tend to favor men’s sexual pleasure [91, 92], it is possible that during this pandemic, these women engaged in sex in the absence of sexual desire or in the presence of sexual pain. This is likely to have resulted in pleasureless sex and, consequently, to even have lowered levels of sexual function. Although not many studies used measures of sexual pleasure, and rather of sexual satisfaction, the findings of this review leave one to guess that the pandemic may have had stretched the pleasure gap between men and women.
Implications
Because pleasure is an important dimension of sexual health [93], equality in sexual pleasure is not just relevant, it is essential. The fact that women’s sexual pleasure might have been particularly affected due to COVID-19 related downfalls, it is a symptom of gender inequality in sexuality. Although it seems impossible to determine at this stage if there will be long-term negative effects of the pandemic in women’s sexual health, this matter should be further investigated as the effects of pandemic are still felt globally. An important note on this topic is that studies were mainly focused on women from western cultures, masking the specific challenges of women from developing countries, who have probably faced additional difficulties. In addition, there is a big gap in research regarding sexual minorities, as we did not find any studies focused on LGBTQIA+ or non-monogamous populations. Research on COVID-19-related sexual problems also raises questions on whether sexual dysfunctions should be diagnosed when they are likely caused by identifiable external factors. The main opportunity stemming from the ongoing pandemic might be that the current lack of resources for meeting with the community may lead to the improvement and dissemination of e-Health tools as applied to the context of sexual health and pleasure, and finally reach a wider population.
Posts
