Luxembourg: Sexual problems increased during the COVID-19 measures while sexual satisfaction decreased compared to prior the COVID-19 measures (assessed retrospectively)

Sexual Satisfaction and Sexual Behaviors During the Covid-19 Pandemic: Results From the International Sexual Health and Reproductive (I-SHARE) Health Survey in Luxembourg. Fischer VJ, Gómez-Bravo R, Brunnet AE, Michielsen K, Tucker JD, Campbell L, Vögele C. Preprint from Research Square, Jan 7 2022. DOI: 10.21203/rs.3.rs-1178513/v1 PPR: PPR440376 

Abstract 

Aim: To identify the impact of COVID-19 measures on sexual behaviors and sexual satisfaction in Luxembourg residents.

Methods: We conducted a cross-sectional online survey of adults (> 18 years of age) residing in Luxembourg, while COVID-19 restrictions were in place. The survey was available in four languages (French, German, English and Portuguese). Survey questions focused on masturbation, cuddling, condom use, sex frequency, sexting, cybersex, watching porn, and sexual satisfaction.

Results: 557 volunteers completed the survey (35.5% men, 64.3% women). Sexual problems increased during the COVID-19 measures while sexual satisfaction decreased compared to prior the COVID-19 measures (assessed retrospectively). Factors associated with increased odds of sexual satisfaction were: having a steady relationship before COVID-19 restrictions, engaging in sexting, reporting good mental health and not altering alcohol intake.

Conclusions: The context of the COVID-19 pandemic and the measures implemented in Luxembourg affected sexual behaviors and sexual satisfaction. Sexual and reproductive health care centers and health professionals in general should take these results into consideration when providing care. Recommendations on the importance of sexual health for general wellbeing and behaviors associated with sexual satisfaction should be offered and possibilities to experience sexuality while reducing contamination risks be discussed.

Discussion

The present study examined the impact of measures imposed by the Luxembourgish government to fight the COVID-19 pandemic on self-reported sexual behaviors, substance use and mental health.

We found a decrease in sex frequency during COVID-19 compared to the period before the introduction of the COVID-19 measures. The proportion of respondents reporting a decrease in sexual activities was higher in those with steady partners (35.8 %) compared to those with casual partners (14.3%). This decrease was larger than the one found in a study comparing individuals from the English and Spanish populations (7), but smaller than the decrease found in a multi-country study with 30 different countries (18). The reasons for these differences between studies are unclear. Nevertheless, any decrease in sexual activity could have overall health implications, as a decrease in sexual intercourse has been reported to be associated with an overall decline in well-being (11).

A large proportion of the present sample (46.5%) reported low sexual satisfaction. Similar findings were also found in other I-SHARE countries where, overall, 39.6% reported low sexual satisfaction (18). This demonstrates the need for health professionals to address sexual and reproductive health issues during the COVID-19 pandemic and the importance of sexual health for general health and wellbeing.  

Our data indicate that being in a relationship before the implementation of the COVID-19 measures increased the chances of sexual satisfaction during COVID-19. This is in line with the literature, which found that people in steady relationships during the COVID-19 measures were more sexually active and also more satisfied (18). This corroborates the evidence on the association between sexual satisfaction and more frequent sexual activity (19, 20). In addition, this is in accordance with the finding that an increase in self-masturbation was associated with higher odds of increased sexual dissatisfaction. In this context, it is plausible that self-masturbation might have been used as a coping strategy for some. In the present sample, we found a 18% increase in the frequency of masturbation, which is almost twice the percentage reported by Ibarra et al. (7), but a very similar prevalence of no change in autoerotism when compared to an Italian study (61.2% in Italy, 59.9% in Luxembourg) (11).

Findings on the relationship between masturbatory behavior and sexual activity and satisfaction are inconsistent. Masturbation offers the possibility of sexual pleasure independent of a partner’s availability and sexual health. For women, masturbation seems to be related to more consistent orgasms compared with partnered sex (21, 22, 23). Nonetheless, weak or negative associations between solitary and partnered sexual activity or satisfaction have been found (24, 25).

With regards to sexual problems, our findings show an increase in sexual problems in those in partnership (either oneself or of the partner) during the pandemic. This result is in line with other studies that have addressed this question. Since the beginning of the pandemic, an increase in sexual problems has been found in a range of populations in different countries, for instance in COVID-19 positive women (26) and in uninfected pregnant women in Turkey (27), in women in the U.S. (28) and in men and women in Egypt (29).

Our data suggest that people who increased sexting (exchange of sex-content messages such as naked/semi-naked pictures, audios or videos with a partner) had higher odds of reporting sexual satisfaction. Sexting and cybersex might have acted as a tool for different sexual activities in a person or couple’s sexual repertoire (30). Our results are in line both with other studies conducted during the COVID-19 pandemic that found the use of digital means for sexual communication a way to maintain oneself sexually active (7) and with the literature on sexting and relationship satisfaction that found higher relationship satisfaction in people who engaged in sexting (31, 32, 33).

With respect to mental health, the ability to adapt to the new pandemic context benefitted levels of sexual satisfaction. This becomes clear when observing that respondents who reported good general mental health presented higher scores of sexual satisfaction. This is in line with the literature, that found a higher risk of developing anxiety and depression among those who were not sexually active during the lockdown (13). Similarly to the adaptation findings regarding mental health, participants who reported no change in alcohol consumption had higher odds of reporting sexual satisfaction. This can possibly be explained by better personal resources to adapt to the pandemic context, and not using alcohol as a coping strategy to deal with the COVID-19 measures.  Alcohol consumption as a coping strategy has been identified in previous pandemic outbreaks, e.g. severe acute respiratory syndrome (34). So far, during the COVID-19 pandemic, an increase in alcohol consumption has been reported both in the general population (35, 36) and among university students (37).

Strengths and Limitations 

This study has several limitations. First, our study was conducted online which can lead to selection bias (e.g., only people with internet access could take part). Second, our sample was recruited using a convenience approach, predominantly via social media platforms and invitations to key sexual health organizations of the country, which limits the generalizability of the study findings. To overcome such conditions, we employed a broad recruitment strategy (38), using different social media, traditional media, press release, partnering with key governmental and non-governmental institutions as well as invitations to participants of previous COVID19 studies who agreed to be contacted for further studies.  

Despite these limitations, this study contributes to the literature on sexual behavior during COVID-19, and the results indicate the importance of continuing research to support policy and help care provision. From a research and policy perspective, longitudinal assessments of the population are needed to properly identify their health needs. On a care provision level, sexual and mental health professionals should be trained and updated to face the population’s new demands with reference to sexual behaviors and satisfaction during times of crises such as infectious disease outbreaks.