Table 1.
Recommendations regarding sexual health during the COVID-19 pandemic
| Sexual partners |
| Solitary sexual activity |
| Masturbation is allowed: It is safe and may have significant psychological benefits (relief of tension and anxiety).76 |
| Cohabiting partner |
| Sex with an asymptomatic cohabiting partner is safe76 |
| Sex should be avoided with a quarantined partner following infection or exposure.76 |
| Sex should be avoided with the symptomatic partner76 |
| If the partner is at risk for severe disease due to background morbidity, sexual activity should be allowed only if both partners are staying at home76 |
| Partner outside household |
| Sexual contact with anyone outside one’s household should be avoided76 |
| Noncohabiting couples may stay intimate through erotic phone conversations, sexting, and video |
| Multiple and new partners |
| Sex with multiple partners and casual sex is firmly discouraged5,21 |
| Video dates, sexting, or chat rooms are a feasible and safe alternative65 |
| Sexual practices |
| Kissing and oral sex |
| Kissing is allowed between healthy, unexposed cohabiting partners.6 |
| Kissing should be avoided with anyone symptomatic or with people outside one’s household.6 |
| Vaginal intercourse |
| Vaginal intercourse is allowed, as there is no evidence that COVID-19 is transmitted through vaginal secretions and ejaculate.6 |
| Anal intercourse |
| Anal intercourse is allowed, provided fecal-oral transmission is carefully avoided.12,17 |
| Analingus, or “rimming”, should be avoided as the fecal-oral transmission of the virus has been documented.76 |
| Virtual sexual activity |
| Video dates, sexting, chat rooms, and erotic phone conversations are a safe alternative to sexual contact.6 |
| Sexual dysfunction |
| General considerations: |
| Call for increased awareness that stress, anxiety, and depressed mood resulting from direct and collateral effects of the pandemic may negatively impact all types of sexual dysfunction. |
| Treatment of sexual dysfunction should be higher prioritized than other nonurgent medical issues. |
| Counselling sessions and medical consultations should shift even more to different online platforms and telemedicine. |
| Guidelines & recommendations should be available for free because the financial loss can make it difficult to pay for weekly psychological and sexual treatment sessions.49 |
| Call for awareness that only motivated couples may find home confinement an occasion to comply with sexual therapy exercises, as the daily schedule is flexible. |
| Sexual desire and desire discrepancies |
| Anxiety around infirmity and mortality may be linked to either increased or decreased sexual interest in different individuals.63,64 |
| Stress and extended proximity to one’s partner may exacerbate differences in desire. |
| Erectile dysfunction (ED) |
| Men at greatest risk for having serious complications secondary to COVID-19 are also those traditionally at risk for ED (older age/comorbidities).67–69 |
| Psychosocial changes such as economic pressure or job instability can both cause and exacerbate ED76 |
| Economic instability may lead men to have difficulties obtaining their medications80 |
| Orgasmic and ejaculatory disorders |
| Low mood, anxiety, depression, irritability, and fear may worsen orgasmic disorders81,82 |
| Genito-pelvic pain penetration disorders (GPPPD) |
| PTSD, a common antecedent to GPPPD, may undergo symptom reactivation following fear of infirmity and confinement during the pandemic95,96 |
| Home confinement may amplify and exacerbate the interpersonal responses that maintain GPPPD. |
| Lack of privacy can prevent compliance with home exercises.105 |