The psychiatric impact of COVID-19 pandemic on sexual health.

The new coronavirus pandemic has been considered the greatest challenge for the health system in the modern era. Although social distancing and quarantines have been necessary as public health strategies, they may contribute to psychological and mental problems. There is evidence that reduced interpersonal communication may increase the incidence of depression and anxiety and exacerbate pre-existing conditions. In fact, loneliness, denial, anxiety, depression, insomnia and despair have been reported among suspected cases of coronavirus disease (COVID19). In addition, some studies have shown an increased risk of aggressiveness and suicide in infected individuals. Anxiety and depression are commonly seen in men with sexual disorders such as erectile dysfunction and premature ejaculation. Anxious men are more likely to experience performance anxiety, while those with depression tend to report lack of libido. In female patients, depression is strongly linked to hypoactive sexual desire disorder and anxiety has been shown to interfere with arousal and the ability to achieve orgasm. Chronic dyspareunia is 3-10 times more common in women diagnosed with depression or anxiety. Although no published study has directly investigated changes in sexual function and behavior during COVID19, negative effects on sexual health are expected. Previous pandemics have shown that social isolation associated with fear of being infected significantly reduces sexual contact. Pornography consumption has also increased concomitantly with the pandemic. On March 13, 2020, the Pornhub website reported an 11.6% increase in accesses. Excessive masturbation can interfere in a couple’s relationship, leading to growing feelings of isolation and breakups. The spread of COVID-19 through sexual activity is also concerning. Since the virus is present in upper airway fluids, it might be transmissible during sex. The International Society for Sexual Medicine produced a set of recommendations regarding the safety of sexual activity during the pandemic, including that healthy couples in confinement may maintain normal sexual activity. Individuals with respiratory symptoms or immunocompromised partners should abstain from sexual activity. Masturbation is safe as long as hygiene standards are maintained. Alternative sexual activity, such as exchanging messages, pictures or videos by digital means are not risky, and may even be good method for exploring a couple’s sexual fantasies. Therefore, COVID-19 could directly and indirectly impact the sex lives of many couples. Increasing rates of anxiety and depression may translate into higher rates of psychogenic sexual dysfunction. Protective measures to guarantee safe sex might also lead to situational difficulties, especially for those at risk of or with preexisting sexual dysfunction. The medical community must be aware of such phenomena and provide proper counseling, especially during these times, when many traditional psychological support modalities are unavailable.