Table 1.

Articles on women’s sexual health and sexual function during the pandemic

Author	Country	Study design	Data collection	Sample	Age mean ± SD; age group	Sex measures	Results
Ballester-Arnal et al [27]	Spain	Quantitative	April 2020	1448 (67.5% women)	31.92 ± 10.1 [18–60]	Ad hoc questionnaire	37.9% of participants reported worsening of sexual life during confinement. In women, better sex life was predicted by higher sexual desire during lockdown (overall and for and partner), living with partner, and lower stress. Worse sex life was predicted by not living with partner, not having privacy, and higher stress (and not by boredom). Those who included new sexual activities into their repertoire were three times more likely to report improvements in their sexual lives
Carvalho et al [28]	Portugal	Quantitative	May–June 2020	417 women 245 men	34.3 ± 10.97; 41.8 ± 13.07; [18–76]	FSFI [26] IIEF [77]	Sexual function was related with psychological adjustment during lockdown (anxiety, depression, and somatization), but not with confinement levels—contrary to men, where confinement, mediated by psychological adjustment, predicted sexual function
Cito et al [50]	Italy	Quantitative	April 2020	1018 women 558 men	[18+	Ad hoc questionnaire	Frequency of sexual intercourse was related with higher wellbeing scores during quarantine. Lower frequency was related with poor privacy and lack of psychological stimuli. The majority did not show decreases in sexual desire (71.3%). Men presented lower sexual desire than women
Cocci et al [35]	Italy	Quantitative	-	1515 women/men	Mdn = 21; [19–25]	Ad hoc questionnaire	40% of respondents reported an increase in sexual desire and autoerotism during the pandemic, but no increases in sexual intercourse or sexual satisfaction, which significantly decreased
Coombe et al [47]	Australia	Quantitative	April 23–May 11, 2020	965 (70% women)	Mdn = 24; [18–76, 78]	Ad hoc questionnaire	Most participants (53.5%) reported having less sex during lockdown than in 2019, especially those without a regular partner. Solo sex activities increased: 14.6% reported using sex toys more often and 26.0% reported masturbating more often
Culha et al [41]	Turkey	Quantitative	May 2–May 26, 2020	89 women 96 men in healthcare	30.65 ± 5.99; [18–53]	FSFI [26] IIEF [77]	Sexual desire, sexual intercourse/masturbation frequency, duration of foreplay, and duration of sexual intercourse decreased during the pandemic. Participants privileged non-face to face sexual positions
Daneshfar et al [39]	Iran	Quantitative	-	296 married women	33.68 ± 6.47; [18–27, 29–46]	FSFI [26]	Sexual dysfunction impacted quality of life and was related with lower marital satisfaction.
Feng et al [46]	China	Quantitative	May 27–June 6, 2020	150 women 134 men	27.04 ± 4.72; 27.35 ± 4.23; [18–27, 29–45]	Ad hoc questionnaire	43.3% of participants reported a decrease in sexual frequency during the pandemic. Higher sexual satisfaction predicted higher relationship satisfaction (or “intimacy”)
Fuchs et al [31]	Poland	Quantitative	March–April, 2020	764 women	25.1 ± 4.3; [18–27, 29–41]	FSFI [26]	Frequency of intercourse, sexual desire, arousal, lubrication, orgasm, satisfaction, and pain decreased during the pandemic. The women who did not work experiencing the highest decreases
Gillespie et al [56]	UK	Quantitative	April 19 – April 21, 2020	522 women 257 men 5 non-binary	30.56 ±9.59 [18–59]	Coping using sex inventory [79]	Coping using sex did not increase during the pandemic: 30% of participants reported increases, 29% reported decreases, and 41% did not report any changes
Gouvernet & Bonierbale [37]	France	Quantitative	April 27–May 11, 2020	741 women 338 men	Mdn = 31	Sexual Modes Questionnaire [80]	1/3 of participants reported a decrease in frequency of sexual activity and sexual satisfaction. Decreases in sexual satisfaction affected more women and were related with more negative sexual cognitions and less positive sexual emotions. Increases in digital sex use contributed to minimizing the likelihood of negative sexual emotions
Gul [38]	Turkey	Quantitative	June–July 2020	65 women 51 men	Mdn = 33; [18–65]	Arizona Sexual Experiences Scale [81]	Sexual dysfunction increased compared to pre-pandemic, but this was non-significant
Hidalgo & Dewitte [55]	Ecuador	Quantitative	-	431 women 159 men	26.5 ± 6.84; [18–58]	Brief Sexual Opinion Survey [82];Sexual Double Standards Scale [83]; Sexual Dysfunctional Beliefs Questionnaire [84]; New Sexual Satisfaction Scale [85]; FSFI [26]; IIEF [77]	Women’s sexual dysfunction was predicted by lower sexual and relationship satisfaction, sexual dysfunctional beliefs, and sexual double standards. Markers of sexual conservatism and sexual double standards were inversely related to sexual function and satisfaction, mainly in women
Hille et al [58]	Germany, Switzerland, and Austria	Quantitative	April 9–April 20, 2020	2515 (47.4% women)	Mdn 31–40; [18+	Ad hoc questionnaire, Revised Sociosexual Orientation Inventory [86], Questionnaire of Sexual Experience in Close Relationships	Both partnered and single participants reported declines in most sexual activities during the physical distancing measures. For partnered participants, the increase in new practices was associated with sociosexuality and physical attraction to one’s partner but not to affection towards partner or relationship satisfaction
Jacob et al [87]	UK	Quantitative	March 17, 2020 (launch)	548 women 320 men, epileptics	[18–75+]	Ad Hoc Questionnaire	Being a woman, younger age, and unmarried were all associated with lower sexual activity.
Karagöz et al [30]	Turkey	Quantitative	May 6–May 20, 2020	97 women 148 men	34.7 ± 6.67; 36.7 ± 7.1; [18–65]	FSFI [26] IIEF [77]	Sexual function and frequency of sexual intercourse decreased in men and women during the pandemic, but women showed higher sexual avoidance behaviors. Couples spending more time together during the pandemic reported better sexual function scores
Karakas [51]	Turkey	Quantitative	1 month after restrictions	135 pregnant women 45 controls	34 ± 4.73 [22–40]; 34 ± 4.76 [23–39]	FSFI [26]	The sexual function of pregnant women decreased during the pandemic. Women who had university degrees, were multiparous, and in the third trimester were more likely to develop sexual dysfunction
Karsiyakali et al [44]	Turkey	Quantitative	June 1–June 20, 2020	685 women 671 men	33.16 ± 8.31	FSFI [26] IIEF [77]	Being single, not having a child, having a regular sexual partner, living in a metropolitan area, and being unemployed during the pandemic were associated with a decline in both sexual intercourse frequency and sexual desire. Being older and a woman were associated with a decline in sexual desire
Kaya et al [32]	Turkey	Quantitative	May–June 2020	15 women with COVID-19	33.3 ± 5.6; [19–27, 29–50]	FSFI [26]	The frequency of sexual intercourse and of sexual satisfaction decreased after COVID-19 disease in these women
Lehmiller et al [57]	USA	Quantitative	March 21–April 14, 2020	1559 (71.1% women)	34.1 ± 10.3; [18–76, 78, 88–91]	FSFI [26]	Nearly half of participants reported a decline in sex life. One in 5 participants incorporated new activities and were more likely to report improvement of sex life. Common additions included sexting, trying new sexual positions, and sharing sexual fantasies. Being younger, living alone, and feeling stressed and lonely were linked to trying new things
Li et al [45]	China	Quantitative	March 13–March 15, 2020	189 women 270 men	[18–27, 29–46]	Ad hoc questionnaire	30% of women reported a decrease in the number of sexual partners, 37% reported a decrease in sexual frequency, and 39% reported decreases in sexual satisfaction. Multiple regression analysis showed that age, partner relationship, and sexual desire were closely related to sexual frequency
Li et al [40]	China	Quantitative	May 1 – May 5, 2020	426 women 541 men	26.6 ± 4.86; [16–27, 29–36]	Ad hoc questionnaire	22% of participants reported a decrease in sexual desire, 41% experienced a decrease in the sexual intercourse frequency, and 30% reported an increase in the frequency of masturbation. 31% reported a deterioration in partner relationships during the pandemic
Lorentz [53]	Brazil	Quantitative, longitudinal	November 2019–March 2020	50 women	Mdn = 25; [23–26, 29–34]	FSFI [26]	There were no changes in the FSFI scores at the three evaluated times were reported, but depressive symptoms increased across times
Luetke et al [60]	USA	Quantitative	April 10–April 20, 2020	381 women 365 men	[18–94]	Ad hoc questionnaire	Among individuals in relationships, 34% reported some degree of conflict with their romantic partners. Those experiencing frequent coronavirus-related conflict were more likely to report decreased frequency of solo and partnered sexual behaviors compared to those not experiencing any such conflict, exhibiting a dose-response trend among partnered sexual behaviors
Micelli et al [59]	Italy	Quantitative	-	944 women 538 men	[18–27, 29–47]	Ad hoc questionnaire	From 18.1% participants who were planning to have a child before the pandemic, 37.3% abandoned the intention, related to worries of future economic difficulties (58%) and consequences on pregnancy (58%). Of 81.9% who did not intend to conceive, 11.5% revealed a desire for parenthood during quarantine than before (mostly women), related to will for change (50%) and need for positivity (40%). 4.3% of these tried to get pregnant
Mirzae et al [52]	Iran	Quantitative	May–June 2020	200 pregnant women, 203 lactating women, 201 non-pregnant/non-lactating women	20.81 ± 5.92	FSFI [26]	Pregnant and lactating women presented higher sexual dysfunction and lower quality of life scores
Mollaioli et al [43]	Italy	Quantitative	April 7–May 4, 2020	4177 women 2644 men	32.83 ± 11.24; [18+	FSFI [26] IIEF [77] Orgasmometer [94]	50.3% of participants reported an interruption of sexual activity during lockdown. Logistic regression models showed that lack of sexual activity during lockdown was associated with higher risk of developing anxiety and depression
Omar et al [34]	Egypt	Quantitative	March 30–June 27, 2020	479 women 217 men	[16–75]	FSFI [26] IIEF [77] Index of Sexual Satisfaction [95]	Overall, sexual satisfaction was higher before lockdown. During lockdown, men were more satisfied than women. Most men did not have erectile dysfunction, while most women presented sexual dysfunction.
Panzeri et al [54]	Italy	Qualitative	April 11 – May 5, 2020	124 (73% women) in cohabiting relationships	34.01 ± 8.71; [23–60]	Brief Index of Sexual Functioning for Women [96] Brief Index of Sexual Functioning for Men [97], Sexual Desire Inventory [98]	Some women reported decreases and others increases in sexual function and pleasure/satisfaction. Decreases were related to worry, lack of privacy, and stress, whilst increases with having more free time and time with the partner, less stress, and boredom
Pascoal et al [29]	Portugal	Qualitative	March 22–June 1, 2020	24 women 15 men clinical sexologists	[27, 28, 34–73]	-	These clinical sexologists perceive that the pandemic contributed to worsening sexual problems and dysfunctions, mental health, relationship management, as well as to the rise of conservatism the use of technology
Schiavi et al [33]	Italy	Quantitative	February 2018–February 2020	89 women	Mdn = 39, [27, 30–51]	FSFI [26] Female Sexual Distress Scale [99]	Women cohabiting with their partners reduced their sexual activity. Women with higher level of education showed greater decline in terms of sexual activity, and quality of life
Wignall et al [49]	UK	Quantitative	May 14–May 18, 2020	565 (338 women)	25.35 ± 4.13; [18–26, 29–34]	Sexual Desire Inventory [98], Sexual Behaviors Catalog (Ad hoc), Revised Sociosexual Orientation Inventory [86]	Women reported decreases in sexual desire during lockdown, but men did not. Partnered participants reported increases in sexual activity compared to those who were single or dating casually. Individuals with high sociosexuality perceived higher impact of lockdown on their well-being
Yuksel & Ozgor [42]	Turkey	Quantitative	March 11–April 12, 2020	58 women	27.6 ± 4.4	FSFI [26]	Frequency of sexual intercourse increased during the pandemic compared with 6–12 months prior (2.4 vs 1.9; p = 0.001), but sexual function decreased (except for sexual desire)
Zattoni et al [48]	China, Italy, Spain, France, Sweden, and the USA	Quantitative	January 9, 2020 to May 25, 2020	-	-	-	China, Italy, Spain, and France showed increased searches for “PornHub” and “Porn” with an average weekend percentage change (AWPC) of 4.9 and 3.8, respectively, after the outbreak of COVID-19, but not Sweden or the USA. All the nations had a significant increase in WRSV coronavirus-themed pornography for each keyword (p < 0.01) with an AWPC, ranging worldwide between 18.5 and 61.8 (p < 0.01), after the beginning of self-quarantine

FSFI Female Sexual Function Index, IIEF International Index of Erectile Function, Mdn median