Sex Redefined in the Age of COVID-19

By: Adaora Yvonne Ntukogu

Impact of COVID-19 on Sexual Health Services and Safe Sex Practices

The COVID-19 pandemic has taken over news headlines for months. As of December 21, 2020, 217 countries and territories have reported about 77.1 million COVID‑19 cases and 1.7 million deaths from the virus. It is not surprising that COVID-19 is dominating the scenes. There has been discussion about the pandemic’s impact on sexual behaviors and attitudes, as well as the availability of sexual health services. 

Has the consistent national concern for the status of COVID-19, especially with increasing talk about future widespread vaccinations, diminished attention from sexual health issues? 

How has the delegation of health services towards addressing COVID-19 affected community sexual health needs like the detection of sexually transmitted infections and sexual dysfunction treatments? 

Have widespread COVID-19 concerns led to a decline in intimacy, which could have serious ramifications on the mental health of individuals and populations?

Medical attention has shifted priority to COVID-19, so healthcare clinics and workers have been redirected to COVID-19 duties. This has led to a decline in appointment availability for sexual health services and a reduction in services offered like contact tracing. Contact tracing is an important part of the management of sexually transmitted infections (STIs) because it prevents reinfection and reduces the prevalence of STIs in the community.[1] Other important sexual health services like sexual health education, abortion services, pregnancy counseling, and STI screening and treatment are necessary for the sexual and reproductive health of communities. If sexual health resources are continuously redirected toward COVID-19, there is potential for a rapid increase in STIs. 

New York was the epicenter at the onset of the COVID-19 pandemic in the United States.[1] Key sexual health clinics that serve New York residents were either dramatically reduced or completely cut. In March 2020, the NYC Department of Health and Mental Hygiene informed community members that 7 of 8 sexual health clinics would be closed as a result of the pandemic. The one clinic that was open only offered limited and emergent services.[1] A survey assessing changes in NYC health department’s services offered during the pandemic found that 19 percent of the respondents stated their clinics had been closed. The study found that the majority of clinics indicated a significant decrease in provided sexual health services.

Even with lockdowns and other safety mandates, people may still have unprotected sex, continuing the spread of STIs. With the reduction of STI contact tracing, as well as other sexual health services, sexual health needs of communities are overlooked. The previous report on sexual services offered was from April of 2020. Presently, there may be improvements in STI contact tracing, and an increase in sexual health services offered by clinics and community health centers as a result of adaptations made due to the persistence of COVID-19.  An updated survey should be conducted to assess if adjustments have been made.

In April 2020, the CDC also released guidelines for sexual health clinics where services have been disrupted.[1] The guidance focuses on oral treatment options to consider for patients displaying symptoms of infections when in-person clinical evaluation and treatment is not possible. To counter limitations on sexual health services, clinicians have also been innovating ways to accommodate the needs of their community. At the New York-Presbyterian Columbia campus, a system to address the sexual health concerns of patients with symptoms of COVID-19 has been implemented. Patients with symptoms of COVID-19 are evaluated, and if patients also have STI symptoms, they can conduct a Telehealth visit with a sexual health provider. The sexual health provider can then order the necessary treatment and testing. However, the issue is that these interventions (i.e. CDC and New York-Presbyterian Columbia) only account for STIs that are symptomatic and there are several asymptomatic STIs. This may lead to a substantial decrease in the number of STIs detected and treated. In fact, HIV testing has decreased since the surge of the COVID-19 pandemic. This is concerning because STI rates have been increasing prior to the pandemic, and the decrease in detection could lead to another global health crisis.

Recently, researchers and medical experts from Testing.com, a resource that provides at-home-testing and a plethora of testing information, have investigated the rampant spread of STDs in Atlanta and across the United States. In order to address the lack of STD education and accessibility to testing sites, Testing.com has created an extensive resource, featuring a directory of local non-profit organizations in Atlanta that provide free health care services to help stop the spread of STDs.[2] 

The paucity of sexual health services may also have severe implications on the ability of individuals with sexual dysfunction to cope with their condition. Despite the accessibility of telehealth services and other online therapy options, there may be treatment plan interruption and a return of symptoms because of the postponement of medical treatments that are non-urgent. 

Fears of contracting the virus have highlighted the importance of safe-sex practices.[2] COVID-19 transmission occurs through the inhalation of respiratory droplets and touching infected surfaces, so kissing should be avoided with anyone with symptoms or with people outside one’s household.[2] Sexual behavior studies show that people with many partners play a key role in transmitting STIs, as well as other illnesses. Sex with partners living together is permissible unless they are displaying COVID-19 symptoms. However, monogamous or not, close contact between sexual partners may increase the risk of contracting COVID-19.

Impact of COVID-19 on Sexual Intimacy and Recreational Sex Redefined

COVID-19 has also affected sexual intimacy between romantic partners and single individuals. Social distancing and stressful circumstances can increase the need for emotional bonding. Sex is a popular leisure activity that is extremely beneficial to our phsyical and psychological well-being. Sex activates a variety of neurotransmitters that impact our brains and several other organs in our bodies.[2] However, in the wake of COVID-19, heightened stress and diminished quantity and quality of social networks due to restrictions on social activities and fear of contracting the virus, have limited opportunities for recreational sex. A study that sought to examine how people’s sexual lives have been shifted during the pandemic issued an anonymous online survey between March and April 2020.[3] 43.5% of participants reported a decline in the quality of their sex life. About one in five participants reported making a new addition to their sex life since the pandemic began. Adapting to COVID-19 restrictions, individuals have shifted their sexual behaviors.[3] There has been a rise in online pornography searches, sex toy sales, and dating app downloads. 

Afrosexology, a sex-education duo, has been guiding communities on how to live a pleasurable, liberated, and healthy sex life despite the persistence of the COVID-19 pandemic. Afrosexology has a a blog, Pillow Talk, where they answer sex-related questions, and a video series, Intercourse, that advocates for removing the shameful stigma from “sex-talk”. 

COVID-19 has shifted attention away from sexual health needs of populations. It is imperative that public health leaders continue to exam and prepare for the effects of the pandemic on STI rates, especially HIV. Interventions and funding should be redirected towards supporting community health centers and clinics that offer sexual health services. Further studies should be conducted to assess the impact of COVID-19 on sexual intimacy. Sex education trailblaizers like Afrosexology are vital because they create spaces for people to openly discuss sexual exploration and liberation in the age of COVID-19. 

References

[1] Nagendra, G., Carnevale, C., Neu, N., Cohall, A., & Zucker, J. (2020). The potential impact and availability of sexual health services during the COVID-19 pandemic. Sexually transmitted diseases, 47(7), 434.

[2] Pennanen-Iire, C., Prereira-Lourenço, M., Padoa, A., Ribeirinho, A., Samico, A., Gressler, M., … & Girard, A. (2020). Sexual Health Implications of COVID-19 Pandemic. Sexual Medicine Reviews.

[3] Lehmiller, J. J., Garcia, J. R., Gesselman, A. N., & Mark, K. P. (2020). Less sex, but more sexual diversity: Changes in sexual behavior during the COVID-19 coronavirus pandemic. Leisure Sciences, 1-10.