Abstract
To understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18–94 years; 62% response rate) from April 10–20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables–including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural).All solo and partnered sexual behaviors showed some amount of significant change–increased activity for some and decreased for others–for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more “normal” (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.
Keywords: COVID-19, Solo masturbation, Partnered sex, Household factors, Behavior change
Introduction
On March 11, 2020, The World Health Organization classified the novel coronavirus (SARS-CoV-2), and the illness it causes (COVID-19), as a pandemic (World Health Organization, 2020). By early April 2020, over one million COVID-19 cases had been confirmed in the USA, representing all 50 states, and close to 100,000 people had died from the virus (Centers for Disease Control & Prevention, 2020). Consequently, the USA—like many countries—implemented both “stay-at-home” orders (e.g., lockdown, shelter in place) and physical distancing guidelines as a means of controlling virus spread and mitigating corresponding infection. Although each state rolled out these measures at different times from the start of the pandemic, by the end of April 2020, most non-essential businesses closed, schools were moved entirely online, and more than 300 million American adults and children in the USA were urged to stay home (Crawford et al., 2020; Mervosh et al., 2020; Stephenson et al., 2021).
These mitigation measures, while necessary, introduced considerable disruption into the basic ways in which people experienced day-to-day life, including their intimate relationships and sexual behaviors. Many adults found themselves unexpectedly in constant close physical proximity to their romantic/sexual partner, either because one or both were working from home (Bick et al., 2020) or because they chose to self-isolate in the same place (Lopes et al., 2020). Being in a strong and positive relationship is one of the most robust predictors of well-being (e.g., Pietromonaco & Beck, 2019; Raque-Bogdan et al., 2011), serving to particularly protect health during times of stress (Pietromonaco & Collins, 2017). Partners who were already in positive relationships may have found that being near one another increased their opportunities for intimate activities. Couples may have also increased their sexual contact with one another—from hugging, kissing and cuddling to penetrative sex—as a means of maintaining intimacy and counterbalancing quarantine-associated stress (Bruce et al., 2019; Floyd et al., 2009; Van Raalte et al., 2021).
Existing data from around the world show partial support for the idea of greater COVID-19 pandemic-associated sex. An online nationwide study of married or romantically partnered US adults during summer 2020 showed that living with a partner was associated with more affectionate touching—like hugging and holding hands (Burleson et al., 2021). Our own COVID-19 pandemic-focused work emphasized that cuddling, hugging, holding hands and kissing was more frequent among adults cohabiting with a partner as compared to those not living with a partner (Luetke et al., 2020). A study of adults in Turkey noted an increase in broadly defined “sexual frequency” during the COVID-19 pandemic (Yuksel & Ozgor, 2020), and in a sample of Australian adults, between 12.1% and 13.0% reported more kissing, oral sex and vaginal sex with a primary partner (Coombe et al., 2020). In contrast, a survey of adults from several Southeast Asian countries found no significant pre- and post-pandemic differences in adult partnered sexual activity (Arafat et al., 2020).
There is also competing evidence that sexual activity could decrease during the quarantine periods. Different stressors associated with partner proximity–economic concerns, teleworking stress, lack of childcare or child activities, helping children with online school (Nelson et al., 2020; Pietromonaco et al., 2013)—could negatively impact the time, the space and the desire people have for physical affection as well as for more intimate sexual behaviors. These stressors could also increase exacerbate depression, loneliness or relationship conflict, all of which have been associated with sexual frequency (Luetke et al., 2020; Nicolosi et al., 2004; Zhang et al., 2020). Likewise, stay-at-home orders may have created barriers for sex among single individuals and/or among those who were separated from their primary partner, either because they were not living together or because one partner had to isolate from the other in the same house (Culp, 2020). Physical distancing recommendations for unpartnered or separated individuals focused on participating in solo masturbation, sex toys, leveraging communication technologies like Zoom or Facetime (e.g., phone or cybersex) and even text-messaging (e.g., sexting), as a means of meeting one’s sexual and intimacy needs (Alpalhão & Filipe, 2020; American Sexual Health Association, 2020; Döring & Poeschl, 2020; Lopes et al., 2020; Turban et al., 2020; Watson et al., 2021).
Research from China (Li et al., 2020), France (Landry et al., 2020), Italy (Mollaioli et al., 2021), and Poland (Fuchs et al., 2020) demonstrates a decrease in broadly defined partnered “sexual behavior” or “sexual intercourse” among adults during COVID. Likewise, in the UK, one fifth of adults reported a decline in mutual masturbation, and one-third noted a decrease in vaginal sex with a primary partner (Jacob et al., 2020). Data from the UK (Jacob et al., 2020) suggest increased solo masturbation, decreased sexting, and decreased pornography use, while research from Australia (Coombe et al., 2020) demonstrated a decline in solo masturbation, increased sexting and increased pornography use. A sample of adults from Panama showed more frequent sexting and cybersex (Gabster et al., 2021). Adults in the UK comparably suggested sex with casual partners decreased (Jacob et al., 2020).
In the current paper, we examine self-reported changes in solo and partnered sexual behaviors in a US nationally representative probability sample of adults early in the COVID-19 pandemic. We contribute to the existing literature in both measurement and in sampling ways. From a measurement perspective, rather than asking a general question about changes in “sexual behaviors,” we assess self-reported change in ten different solo and partnered behaviors. The ability to differentiate which solo and partnered sexual behaviors changed (e.g., hugging/cuddling vs. oral sex vs. sexually explicit media use vs. solo or partnered masturbation) and how they changed (e.g., increased vs decreased) is necessary to continue to adapt public health COVID-19 management in ways that are consistent with people’s fundamental rights to sexual health and well-being (Hussein, 2020; Tang et al., 2020). From a sampling perspective, while nationally representative data are available from other countries, the existing US research has primarily relied upon internet- and/or convenience-based samples. Nationally representative data are important for examining experiential patterns at a population level.
Accordingly, the objectives of the current paper were twofold: (1) evaluate the population-level prevalence and significance of self-reported changes in solo and partnered sexual behaviors in adults in the USA early in the pandemic; (2) examine differences in these outcomes by household context, including partnership structure, employment status, number of children in the home and number of adults in the home.
Method
Participants
Data were from the 2020 National Survey of Sexual and Reproductive Health during COVID-19, a cross-sectional, online, nationally representative survey of COVID-19-related attitudes, experiences and knowledge among US adults aged 18–94 years. The study was conducted in April 2020 by Ipsos Research using their KnowledgePanel® (Menlo Park, California) to recruit a probability-based sample that was representative of noninstitutionalized US citizens. Ipsos recruits households into the KnowledgePanel® using an address-based sampling (ABS) frame from the US Postal Service’s Delivery Sequence File—a database with full coverage of all delivery points in the USA. ABS not only improves population coverage, but also provides a more effective means for recruiting hard-to-reach individuals, such as young adults, those without landline telephones and racial/ethnic minorities. Panel member households without internet connection are provided with a web-enabled device and free Internet service to maximize the breadth of participation.
The 26-item online survey took a median of 13 min to complete, was available in English and Spanish languages, and was open for participation from April 10–20, 2020. Individuals randomly selected to participate were notified of the survey’s availability via email and through their online member page. Participants could take the survey at a time and location that was convenient for them. KnowledgePanel® members typically only receive up to one survey invitation per week, with an average of two to three per month. Reminder emails were sent to survey non-responders on the third day of the field period. Of the original individuals recruited (N = 1632), 1010 (62%) completed the survey and represent the analytical sample in this study. Ipsos operates a modest incentive program that offers points for survey completion; points can be accumulated and exchanged for cash or merchandise.
Ipsos provided post-stratification, study-specific weights to adjust for any over- or under-sampling as well as non-response. Geodemographic distributions for the corresponding population were obtained from the CPS, the US Census Bureau’s American Community Survey, or from the weighted KnowledgePanel profile data. For this purpose, an iterative proportional fitting procedure was used to produce the final weights. In the final step, calculated weights were examined to identify and, if necessary, trim outliers at the extreme upper and lower tails of the weight distribution. The resulting weights were then scaled to aggregate to the total sample size of all eligible respondents. Weighed and unweighted participant characteristics are included in Table 1.
Table 1.
Unweighted and weighted participant characteristics (N = 1010)
| N (%) or mean (SD) | ||
|---|---|---|
| unweighted | Weighted | |
| Gender (female) | 516 (51.1) | 521 (51.6) |
| Sexual identity (minority: yes) | 68 (6.7) | 55 (5.9) |
| Gay or lesbian | 30 (3.1) | 31 (3.2) |
| Heterosexual | 896 (92.9) | 879 (91.9) |
| Bisexual | 27 (2.8) | 33 (3.4) |
| Something else | 11 (1.1) | 13 (1.4) |
| Age group (number of years) | 34.4 (17.1) | 29.8 (17.77) |
| 18–19 | 15 (1.5) | 27 (2.7) |
| 20–29 | 114 (11.3) | 184 (18.2) |
| 30–39 | 34 (3.3) | 175 (17.4) |
| 40–49 | 138 (13.7) | 142 (14.1) |
| 50–59 | 215 (21.3) | 185 (18.3) |
| 60–69 | 206 (20.4) | 165 (16.3) |
| 70–79 | 129 (12.8) | 103 (10.2) |
| 80 + | 37 (3.7) | 28 (2.8) |
| Partnership status | ||
| Partnered and living together | 659 (65.8) | 617 (61.6) |
| Partnered and not living together | 63 (6.3) | 74 (7.4) |
| Unpartnered | 280 (27.9) | 311 (31.0) |
| Number of children | 0.55 (1.07) | 0.47 (0.99) |
| Five years or younger | 0.16 (0.51) | 0.19 (0.55) |
| Six to 12 years | 0.17 (0.49) | 0.18 (0.51) |
| 13 to 17 years | 0.14 (0.46) | 0.17 (0.53) |
| Current employment status | ||
| Working—as any kind of essential employee | 325 (33.6) | 336 (33.3) |
| Working—not as essential employee | 258 (26.7) | 253 (26.4) |
| Not working | 385 (38.1) | 368 (38.4) |
| Race/ethnicity (minority: yes) | 289 (28.6) | 371 (36.8) |
| White, non-Hispanic | 721 (71.4) | 639 (63.2) |
| Black, non-Hispanic | 85 (8.4) | 119 (11.8) |
| Other or 2 + races, non-Hispanic | 81 (8.0) | 87 (8.6) |
| Hispanic | 123 (12.2) | 165 (16.4) |
| Marital status | ||
| Married and/or living with partner | 668 (66.1) | 622 (61.6) |
| Separated/divorced | 129 (12.8) | 124 (12.3) |
| Widowed | 44 (4.4) | 40 (3.6) |
| Never married | 169 (16.7) | 224 (22.2) |
| Region | ||
| Northeast | 189 (18.7) | 177 (17.5) |
| Midwest | 228 (22.6) | 210 (20.8) |
| South | 341 (33.8) | 383 (37.9) |
| West | 252 (25.0) | 240 (23.8) |
| Household income | ||
| < $25 k | 95 (9.4) | 136 (13.5) |
| $25-49 k | 174 (17.2) | 184 (18.2) |
| $50-74 k | 183 (18.1) | 174 (17.2) |
| $75-99 k | 147 (14.6) | 141 (14.0) |
| $100-124 k | 108 (10.7) | 103 (10.3) |
| $125-149 k | 73 (7.2) | 66 (6.5) |
| $150-174 k | 90 (8.9) | 82 (8.1) |
| $175 k + | 140 (13.9) | 124 (12.3) |
| Education | ||
| Less than high school | 75 (7.4) | 98 (9.7) |
| High school | 278 (27.5) | 295 (29.2) |
| Some college | 273 (27.0) | 281 (27.8) |
| Bachelor’s degree or higher | 384 (38.0) | 336 (33.3) |
| Political orientation | ||
| Extremely liberal | 37 (3.9) | 87 (9.1) |
| Liberal | 149 (15.6) | 333 (35.0) |
| Slightly liberal | 85 (8.9) | 87 (9.1) |
| Moderate, middle of the road | 316 (33.0) | 333 (35.0) |
| Slightly conservative | 115 (12.0) | 113 (11.8) |
| Conservative | 209 (21.8) | 189 (19.9) |
| Extremely conservative | 47 (4.9) | 45 (4.7) |
| Mental health | ||
| Neither lonely nor depressed | 410 (41.7) | 383 (39.0) |
| Depressed only | 357 (36.3) | 368 (37.4) |
| Lonely only | 36 (3.7) | 38 (3.8) |
| Both lonely and depressed | 180 (18.3) | 195 (19.8) |
| Behavior applies to participant (yes) | ||
| Hugging, kissing or cuddling partner | 775 (76.7) | 764 (75.6) |
| Solo masturbation | 512 (51.2) | 522 (51.7) |
| Partnered masturbation | 432 (42.8) | 439 (43.5) |
| Oral sex | 496 (49.1) | 506 (50.1) |
| Penile-vaginal sex | 571 (56.5) | 577 (57.2) |
| Sent or received sexy or nude pictures with a partner | 272 (26.9) | 290 (28.7) |
| Watched sexually explicit videos (e.g., erotica or porn) | 368 (36.4) | 385 (38.1) |
| Used a vibrator or sex toy during solo masturbation | 293 (29.0) | 296 (29.3) |
| Used a vibrator or sex toy with a partner | 285 (28.2) | 290 (28.8) |
| Had phone or video chat sex with a partner | 244 (24.2) | 259 (25.7) |
| Change patterns reported | ||
| Increase only | 46 (5.4) | 52 (6.1) |
| Decrease only | 78 (9.2) | 73 (8.6) |
| Stability (no change) only | 431 (50.8) | 409 (48.5) |
| Increase and decrease only | 26 (3.1) | 33 (3.9) |
| Increase and stability only | 101 (11.9) | 104 (12.4) |
| Decrease and stability only | 104 (12.3) | 102 (12.1) |
| Increase, decrease and stability | 62 (7.3) | 70 (8.4) |
| Number of behaviors that increased | 0.43 (1.02); 9 | 0.51 (1.11); 9 |
| Number of behaviors that decreased | 0.60 (1.32); 9 | 0.63 (1.41); 9 |
| Number of behaviors that remained stable | 2.91 (3.07); | 2.86 (3.01); 9 |
Ipsos provided post-stratification, study-specific weights to adjust estimates for any over- or under-sampling as well as non-response. Study procedures were approved by the Indiana University Institutional Review Board (#2,004,194,314).
Measures
Outcome Variables
We assessed self-reported past month changes in ten solo and partnered sexual behavior categories: hugged, kissed, held hands or cuddled with a romantic partner; masturbated by yourself; masturbated together with a partner or touched each other’s genitals; gave or received oral sex; engaged in penile-vaginal sex; sent or received sexy/nude pictures with a partner; watched erotica or porn with a partner; used a vibrator/sex toy during solo masturbation; used a vibrator/sex toy with a partner; and had a phone or video sex chat with a partner. All items were assessed through a single prompt (“Since the new coronavirus started spreading in the USA, to what extent have the following behaviors changed or stayed the same for you?”) using six response categories (much more, a little more, no change, a little less, much less, does not apply). “Does not apply” was coded as missing for all models. Weighted and unweighted frequencies for participants who reported valid data for these variables are reported in Table 1. Weighted and unweighted frequencies for self-reported change in these behaviors are shown in Table 2.
Table 2.
Unweighted and weighted self-reported changes in solo and partnered sexual behavior (n = 1010). and weighted self-reported changes in solo and partnered sexual behavior among US adults (n = 1010)
| N (%) or Mean (SD); Range | Wilcoxon Rank Sum | |||
|---|---|---|---|---|
| unweighted | Weighted | Z | Bonferroni corrected p-value | |
| Hugged, kissed, held hands with or cuddled with a romantic/sexual partner | ||||
| Much more | 49 (56.3) | 61 (7.9) | 9.271 | < .001 |
| A little more | 90 (11.6) | 90 (11.8) | ||
| No change | 463 (59.7) | 440 (57.5) | ||
| A little less | 84 (10.8) | 84 (11.1) | ||
| Much less | 89 (11.5) | 89 (11.7) | ||
| Solo masturbation | ||||
| Much more | 19 (3.7) | 26 (3.1) | 19.768 | < .001 |
| A little more | 48 (9.3) | 59 (11.3) | ||
| No change | 387 (74.9) | 375 (71.8) | ||
| A little less | 26 (5.0) | 26 (5.0) | ||
| Much less | 37 (7.2) | 36 (6.9) | ||
| Masturbated together with a partner or touched each other’s genitals (e.g., fingering, hand jobs, etc.) | ||||
| Much more | 11 (2.5) | 14 (3.1) | 21.768 | < .001 |
| A little more | 29 (6.7) | 32 (7.4) | ||
| No change | 340 (78.7) | 337 (76.7) | ||
| A little less | 18 (4.2) | 22 (4.9) | ||
| Much less | 34 (7.9) | 34 (4.9) | ||
| Gave or received oral sex | ||||
| Much more | 11 (2.2) | 14 (2.7) | 18.942 | < .001 |
| A little more | 32 (6.5) | 38 (7.5) | ||
| No change | 369 (74.4) | 363 (71.7) | ||
| A little less | 24 (4.8) | 27 (5.4) | ||
| Much less | 60 (12.1) | 64 (12.7) | ||
| Engaged in penile-vaginal intercourse | ||||
| Much more | 17 (3.0) | 20 (3.4) | 16.392 | < .001 |
| A little more | 45 (7.9) | 53 (9.2) | ||
| No change | 403 (470.6) | 393 (68.0) | ||
| A little less | 40 (7.0) | 45 (7.7) | ||
| Much less | 66 (11.6) | 68 (11.7) | ||
| Sent or received sexy or nude pictures with a partner | ||||
| Much more | 8 (2.9) | 11 (3.9) | 25.989 | < .001 |
| A little more | 18 (6.6) | 20 (7.1) | ||
| No change | 224 (82.4) | 232 (80.1) | ||
| A little less | 4 (1.5) | 4 (1.3) | ||
| Much less | 18 (6.6) | 22 (7.5) | ||
| Watched sexually explicit videos (e.g., erotica or porn) | ||||
| Much more | 14 (3.8) | 18 (4.6) | 23.619 | < .001 |
| A little more | 34 (9.2) | 43 (11.2) | ||
| No change | 280 (76.1) | 278 (72.2) | ||
| A little less | 15 (4.1) | 19 (5.0) | ||
| Much less | 25 (6.8) | 27 (7.0) | ||
| Used a vibrator or sex toy during solo masturbation | ||||
| Much more | 6 (2.0) | 6 (2.1) | 24.874 | < .001 |
| A little more | 8 (2.7) | 8 (2.8) | ||
| No change | 242 (82.7) | 243 (72.2) | ||
| A little less | 15 (5.1) | 17 (5.0) | ||
| Much less | 22 (7.5) | 22 (7.0) | ||
| Used a vibrator or sex toy with a partner | ||||
| Much more | 1 (0.4) | 1 (0.4) | 24.972 | < .001 |
| A little more | 7 (2.5) | 8 (2.8) | ||
| No change | 245 (86.0) | 246 (84.7) | ||
| A little less | 8 (2.8) | 10 (3.3) | ||
| Much less | 24 (8.4) | 26 (8.9) | ||
| Had phone or video chat sex with a partner | ||||
| Much more | 10 (4.1) | 12 (4.8) | 26.46 | < .001 |
| A little more | 7 (2.9) | 9 (3.5) | ||
| No change | 209 (85.9) | 214 (82.5) | ||
| A little less | 6 (85.7) | 10 (3.8) | ||
| Much less | 12 (4.9) | 14 (5.4) | ||
Household Context Variables
We included several predictors, including relationship status (unpartnered, partnered and living together, partnered and living apart), employment status (working as an essential worker, working as non-essential worker, not working), number of children in the home, and number of adults in this home.
Control Variable
All household context effects were adjusted for gender, race/ethnicity, sexual orientation (heterosexual/sexual minority), and age.
Statistical Analysis
To evaluate Objective #1, we used frequencies to establish the population-level prevalence of self-reported change in each solo and partnered sexual behavior. We then performed a Wilcoxon ranked sign tests on each of the outcomes to establish whether the reported change was significantly different from stability, or no change, at the population level. Because ten total tests were conducted—one for each behavior—we applied Bonferroni corrections to adjust a standard p-value of 0.05 to a new threshold of 0.005 (0.05/10) in determining significant outcomes.
To evaluate Objective #2, we used ordinal regression (Stata, v.16) to evaluate the impact of household context variables on likelihood of reported change—from “much more” to “much less”—in each sexual behavior. In each model, we estimated the odds ratio (OR) and corresponding 95% confidence interval (CI) for each predictor variable’s influence on an outcome, adjusted for age, gender, sexual identity, location of residence, and past 30-day mental health symptoms. The latter was measured using five items (e.g., “ “Felt so depressed that it was difficult to function” or “Felt very lonely”) on out survey taken from the American College Health Association (2017). We chose this scale to tap into potential aspects of both loneliness and/or depressive symptoms reported by participants.
We weighted all analyses to account for non-response and to adjust estimates to the demographic distribution in the USA.
Results
Participant Characteristics
As shown in Table 1, the weighted sample was 51.5% female, 28.6% ethnic/racial minority (8.4% non-Hispanic Black, 12.2% Hispanic, 8.2% other or multiple races) with a mean age of 34.4 years (SD = 17.1 years; range: 18–94 years). Most were heterosexual (92.9%) and married and/or cohabitating (66.6%). About a third were employed as an essential worker (33.6%). The mean household size was about two people (SD = 1.5). About three quarters of participants (72.6%) had no children living at home, 10.8% had one child, and 16.6% had two or more children.
Most participants reported ever hugging, kissing or cuddling with a partner (75.6%), while about half reported ever masturbating by themselves (51.7%), having oral sex (50.1%) or engaging in penile-vaginal sex (57.2%). Four in ten adults ever masturbated with a partner (43.5%). Between one-quarter and one-third of the sample ever sexted with a partner (28.7%), watched sexually explicit material (38.1%), used a vibrator/sex toy by themselves (29.3%) or with a partner (28.8%) or participated in phone/video sex with a partner (25.7%).
Objective 1: Population Prevalence and Significance of Self-Reported Changes in Affectionate and Partnered Sexual Behavior
Table 1 displays the unweighted and weighted population prevalence of overall patterns of change. Table 2 shows the unweighted and weighted population prevalence of changes in solo and partnered sexual behaviors for participants who had ever engaged in those behaviors. Wilcoxon rank sign tests confirmed that self-reported change was significantly different from stability, or no change, at the population level in all ten behaviors (all p < 0.001).
Overall Patterns
Nearly half (48.5%) of adults in the USA reported no change in any solo and/or partnered sexual behaviors in the first month of the COVID-19 pandemic. About one in eight adults reported that some behaviors increased and remained stable (12.4%) or decreased and remained stable (12.1%). Less than ten percent of adults reported that their sexual behaviors only increased (6.1%) or only decreased (8.6%).
Increased Affectionate and Sexual Behavior
One in five adults reported that their hugging, kissing, cuddling or holding hands with a partner increased to some extent, while about 15% experienced an increase of some kind in solo masturbation or in pornography consumption. Between 10 and 12% of participants reported that oral sex (9.7%), penile-vaginal sex (12.6%) and sexting with a partner increased (11.0%). Five percent of adults or less experienced more partnered masturbation, solo vibrator/sex toy use or partnered vibrator/sex toy use.
Decreased Affectionate and Sexual Behavior
About 15% of adults reported that their hugging, kissing, cuddling or holding hands with a partner decreased to some extent. Less than ten percent of participants reported less solo masturbation (9.0%), penile-vaginal sex (7.5%) or pornography use (6.5%). Adults least frequently reported any decline in partnered masturbation (4.8%), oral sex (5.4%), sexting (3.3%), any vibrator use (solo: 1.5%; partnered: 1.0%) or phone/video sex (2.2%).
Stability in Affectionate and Sexual Behavior
Over half of participants (57.5%) reported stability in hugging, kissing, cuddling or holding hands with a partner. Nearly three quarters of adults experienced no change in solo masturbation (71.8%), partnered masturbation (76.7%), oral sex (71.7%), pornography use (72.2%) or solo vibrator use (72.2%). Eight in ten participants reported stability in sexting (80.1%), partnered vibrator us (84.7%) or phone/video sex (82.5%).
Objective 2: Association of Household Context Variables with Self-Reported Changes in Solo and Partnered Sexual Behavior
As shown in Table 3, controlling for demographic characteristics and past 30-day mental health challenges, hugging, cuddling, kissing and holding hands with a partner significantly increased in households with more adults in them (AOR = 1.20). These affectionate behaviors significantly decreased among those who were unpartnered (AOR = 0.37) or who were not living with their partner (AOR = 0.32) as compared to those who were living with their partner. Solo masturbation was threefold more likely to increase among adults who were not living with their partner (AOR = 3.02) or who were unpartnered (AOR = 2.40) as compared to adults cohabiting with their partner. Partnered masturbation was significantly decreased among those who were unpartnered (AOR = 0.33) or who were not living with their partner (AOR = 0.32) as compared to those who were living with their partner. Individuals not living with their partner reported significantly decreased oral sex (AOR = 0.28) versus adults who lived with their partner. Vaginal sex was significantly less frequent among individuals who were not living with their partner (AOR = 0.30).
Table 3.
Household context predictors of self-reported changes in sexual behaviors among US adults (n = 1010) early in the COVID-19 pandemic–hugging, cuddling or holding hands with a partner, solo masturbation, partnered masturbation, oral sex and vaginal sex
| Adjusted Odds Ratio (95% CI) | |||||
|---|---|---|---|---|---|
| Predictor Variable | Hugged, cuddled or held hands with a partner | Solo masturbation | Partnered masturbation | Any oral sex | Vaginal sex |
| Number of kids in house | 1.03 (0.88–1.21) | 0.96 (0.77–1.19) | 1.07 (0.84–1.35) | 0.96 (0.78–1.18) | 0.98 (0.81–1.18) |
| Number of people 18 + | 1.20 (1.03–1.40)* | 0.93 (0.73–1.18) | 1.16 (0.87–1.54) | 1.05 (0.85–1.31) | 1.11 (0.92–1.34) |
| Work status | |||||
| Employed as essential worker (referent) | - | - | - | - | - |
| Employed not as essential worker | 0.92 (0.51–1.69) | 1.37 (0.66–2.86) | 1.14 (0.43–2.96) | 0.87 (0.41–1.91) | 0.97 (0.47–2.01) |
| Not working currently | 0.55 (0.27–1.03) | 1.48 (0.68–3.23) | 0.81 (0.29–2.25) | 0.43 (0.18–1.02) | 0.71 (0.33–1.53) |
| Past 30-day relationship status | |||||
| Partnered and cohabiting (referent) | – | – | – | – | – |
| Partnered and not cohabiting | 0.37 (0.23–0.61)*** | 3.02 (1.67–5.36)*** | 0.33 (0.16–0.71)** | 0.41 (0.22–0.78)** | 0.57 (0.32–1.04) |
| Unpartnered | 0.32 (0.16–0.64)** | 2.40 (1.07–5.39)** | 0.32 (0.11–0..93)* | 0.33 (0.13–0.85)* | 0.30 (0.13–0.70)* |
*p < .05; **p < .01; ***p < .001; Note: All odds ratios are adjusted for age, gender, sexual identity, location of residence and mental health symptoms; CI = confidence interval. Higher odds ratio indicate movement toward increased activity and lower odds ratio indicate movement toward decreased activity
As shown in Table 4, controlling for demographic characteristics and past 30-day mental health challenges, both partnered and not cohabiting (AOR = 3.88) and unpartnered individuals (AOR = 3.82) were about four times more likely than partnered and cohabiting individuals to report more frequent sexting. No household variables were associated with changes in sexually explicit material consumption, in solo or partnered vibrator use or in phone/video sex.
Table 4.
Household context predictors of self-reported changes in sexual behaviors among US adults (n = 1010) early in the COVID-19 pandemic–sexting with a partner, watching sexually explicit media, solo vibrator use, partnered vibrator use and phone or video sex with a partner
| Predictor Variable | Adjusted odds ratio (95% CI) | ||||
|---|---|---|---|---|---|
| Sexting with a partner | Watching sexually explicit material | Solo vibrator use | Partnered vibrator use | Phone or video sex | |
| Number of kids in house | 0.93 (0.68–1.28) | 0.91 (0.71–1.16) | 0.83 (0.60–1.13) | 1.04 (0.73–1.49) | 0.81 (0.57–1.13) |
| Number of people 18 + | 1.00 (0.67–1.49) | 0.87 (0.65–1.15) | 1.28 (0.86–1.90) | 0.82 (0.51–1.34) | 1.26 (0.80–2.00) |
| Work status | |||||
| Employed not as essential worker (referent) | – | – | – | – | – |
| Employed as essential worker | 1.12 (0.34–3.67) | 0.95 (0.51–1.76) | 0.70 (0.24–2.05) | 0.58 (0.16–2.01) | 0.81 (0.21–3.15) |
| Not working currently | 0.73 (0.21–2.59) | 0.46 (0.18–1.19) | 0.73 (0.22–2.44) | 0.71 (0.17–2.88) | 0.63 (0.14–2.78) |
| Past 30-day relationship status | |||||
| Partnered and cohabiting (referent) | – | – | – | – | – |
| Partnered and not cohabiting | 3.88 (1.48–10.15)** | 1.47 (0.73–2.96) | 1.09 (0.43–2.73) | 0.46 (0.16–1.39) | 2.08 (0.64–6.76) |
| Unpartnered | 3.82 (1.02–14.24)* | 1.24 (0.46–3.32) | 0.57 (0.16–2.03) | 0.28 (0.06–1.33) | 1.51 (0.32–6.95) |
*p < .05; **p < .01; ***p < .001; Note: All odds ratios are adjusted for age, gender, sexual identity, location of residence and mental health symptoms; CI = confidence interval. Higher significant odds ratio indicate movement toward increased activity and lower significant odds ratio indicate movement toward decreased activity
Discussion
A primary contribution of this work is the examination of how household context factors—number of children and adults in the home, partnership status/proximity and employment type—may have constrained opportunities for intimate contact in some instances and created opportunities in other instances. As noted by many researchers, key among potential sexual disruptions is proximity to romantic and sexual partners. In support of existing work, we observed that partnered individuals not living with a partner reported a decrease in both affectionate behaviors (Burleson et al., 2021; Luetke et al., 2020) and in partnered sexual behaviors like oral sex and partnered masturbation (Coombe et al., 2020). Because these data reflect people’s lives early in the pandemic, it could be that some of this decrease can be attributed to simple lack of partner availability—either because people regularly lived in geographically distant locations and could not visit during quarantine, or because non-cohabitating partners in close geographic proximity chose to follow early public health recommendations to avoid extra-household close contact (Herbenick et al., 2022). While we did not query the reasons why changes in sex occurred, it is also possible that non-cohabiting partners who lived close to each other may have wanted more intimate contact, but competing needs (e.g., economic concerns, teleworking stress, lack of childcare or child activities, helping children with online school) (Nelson et al., 2020; Pietromonaco et al., 2013) negated the household privacy, the actual time, or the motivation for affectionate or sexual contact. Subsequent qualitative studies would be helpful to understand better how these stressors—as well as the mental health challenges that accompany them (e.g., depression, loneliness or relationship conflict) (Luetke et al., 2020; Nicolosi et al., 2004; Zhang et al., 2020)—impact how people negotiate both short- and long-term decisions about sex during a public health emergency. We additionally do not know how the impact of these stressors may have changed in the months following our data collection period. While our models did adjust for past 30-day mental health status using measures that tapped into dimensions of both depressive symptoms and being lonely, we did not find evidence in supplementary models that these issues significantly varied by partnership status, work status or household size (all p > 0.05).
We also found that unpartnered individuals and partners not living together were more likely that cohabiting partners to report increased sexting. Such findings likely reflect early key public health mitigation recommendations for unpartnered or partnered-but-separated individuals to creatively leverage communication technologies like Zoom or Facetime (e.g., phone or cybersex), and even text-messaging (e.g., sexting), as a means of meeting one’s sexual and intimacy needs (Alpalhão & Filipe, 2020; American Sexual Health Association, 2020; Döring & Poeschl, 2020; Lopes et al., 2020; Turban et al., 2020; Watson et al., 2021). We were unable to assess participants’ reasons for choosing such technologies, so it is possible that some unpartnered individuals used these platforms to interact within casual partnerships they had established pre-pandemic or that unpartnered individuals were meeting new partners during the pandemic. Additional work can help to better separate the processes by which people engage technology for interaction within existing casual partnerships, as compared to using them for findings new partners. Such data could support—particularly in preparation for future pandemic events—technology-based programming to facilitate safe and satisfying sex for people who don’t have access to in-person partners.
It is also worthwhile to note that that solo masturbation significantly increased for both non-cohabiting partners and unpartnered individuals as compared to cohabiting partners. Solo masturbation has long been recognized as a key contributor to individual mental and physical well-being, general happiness, sexual pleasure and relationship satisfaction (Gianotten et al., 2021; Kaestle & Allen, 2011; Lindau et al., 2007; Mitchell et al., 2013). It also remains one of the only sexual behaviors that is accessible to everyone regardless of age, class, race, living situation and as underscored by Herbenick et al. (2022), particularly in terms of relationship status. From this perspective, solo masturbation likely serves several important roles for both unpartnered and non-cohabiting partnered individuals in terms of sexual pleasure, enjoyment, stress release and self-care (Dewitte et al., 2020; Herbenick et al., 2022; Hille et al., 2021).
Finally, we also examined the extent to which work status—working as an essential worker, working in a non-essential job or being unemployed—was linked to self-reported changes in sexual behaviors. While we found no significant association of work status to past 30-day sexual behavior changes after controlling for demographic and mental health characteristics, it remains unclear how different types of paid employment vs. being unemployed could impact the time structure for sexual activity (Gabster et al., 2021). In addition, multiple studies have documented the intense stressors experienced by “front line” essential workers, including time away from their family, job resources and efficacy and worry about getting sick themselves and/or passing the virus to their loved ones (Gaitens et al., 2021). While supplemental analyses did not show any differences in sexual behaviors by type of essential job (all p > 0.05) in the short-term, because some (e.g., grocery store workers), but not other, (e.g., medical personnel) essential workers may have returned to more “standard” job operating conditions, it will be important for ongoing research to understand how these differential, essential worker experiences uniquely influence people’s sexual decision making over the longer-term.
Finally, surprisingly, the number of children at home and household size largely did not predict changes in sexual behaviors. While some research has speculated that increased child related needs (e.g., child care and online schooling) now falling to parents could independently disrupt sexual activity (Ibarra et al., 2020), it also could be that children’s needs simply magnified the barriers associated with other factors in our sample, such as employment status and partnership status. We also do not know the extent to which children in the home had routines that were upended by quarantine. Some families may have had children already in regular care by one or more stay-at-home caregivers, while other children may have already been engaged in at-home learning. Additional qualitative research would be helpful to more accurately understand the specific management strategies that families used to negotiate early quarantine, and the extent to which this impacted their sexual lives.
Strengths and Limitations
Our research had several limitations. We did not assess the infection status of participants, their sexual partner(s) or household members, and we did not measure the extent to which a participant or anyone around them had exhibited COVID-19 symptoms in the past month. Confirmed positive COVID infection status or exhibiting COVID-like symptoms could have impacted the degree to which a person had access to and/or time for sexual activities. Moreover, at the time our survey was conducted, less was known about the extent to which COVID could be sexually transmitted through bodily fluids. We did not measure people’s concern about COVID transmission through partnered sexual contact, and it is possible that people decreased sexual activities as a means of controlling infection spread even within their own household.
In addition, we did not ask about any changes to anal sex activities. Some work examining sexual behavior changes in men who have sex with men has focused on anal sex (Shilo & Mor, 2020) but in the current work, due to space limitations and relative infrequence of anal behaviors at the population-level (Herbenick et al., 2010), we were unable to query this behavior. Moreover, we did not ask participants about their formal inclusion in a stay-at-home/shelter-in-place order and/or the extent to which they were following such an order, though we do know that most of the country was subjected to such in the month prior to the study period. This information could have implications for the structure of time available for sex, particularly in the context of other obligations like work or childcare.
Additionally, this survey assessed self-perceived sexual behavior changes at one time point relatively early in the pandemic, and we were not unable to gauge any changes related to initial levels of people’s sexual behavior. While self-reported data can be subject to social desirability, recall or other biases, electronic self-reported survey data are a valid, frequently utilized method of data collection, and has been shown to support reporting of sensitive behaviors including on sexuality-related topics (Burkill et al., 2016). Cross-sectional data do not permit us to disentangle the causal order of the variables chosen in our analyses, nor do they allow for evaluation of how earlier pandemic experiences (e.g., early vs. later social distancing practices) could change behavioral practices later in the pandemic. It will be important for future pandemic-associated work to link alteration of behavior more fully to typical “frequency.” In addition, these cross-sectional data asked participants to retrospectively assess how they perceived their sexual behavior had changed. We do not have access to data collection approaches (e.g., repeated measures) that permit us to assess actual change. Future studies should seek to implement longitudinal studies to build on these results.
We also did not fully explore the role that aspects of degraded mental health may have impacted people’s desire, time and space for affectionate behavior, solo sex or partnered sex. While we adjusted estimates for a measure of mental health that tapped experiencing both depressive symptoms and loneliness in the same time frame as sexual behavior change was measured, as we pointed out earlier in this paper, many factors (e.g., day-to-day home stressors, relationship challenges, job challenges) could influence how people feel at any given moment, and by extension, the extent to which they are physically and emotionally able to participate in sex. Such effects also likely vary over the short- and long-term of people’s lives during COVID-19. In addition, we engaged a self-reported.
Moreover, while we did assess the impact of partnership type with self-perceived changes in solo and partnered sexual behavior, we did not assess how the characteristics of the partnerships themselves (e.g., quality, communication, sexual satisfaction, length) may have served to mediate how sexuality was organized in these relationships. As the pandemic continues, it will be important for ongoing research to explore the granularity associated with how issues like stay-at-home orders provide or constrain opportunities for sex.
These limitations are balanced with several methodological and substantive strengths of this study. From a methodological perspective, our use of a nationally representative probability sample permits generalization of findings to the broader population of adults in the USA. Other sampling approaches common in sexual and reproductive health research, including convenience, clinical or community-based recruitment, do not allow this level of comparison. In addition, our use of the Ipsos KnowledgePanel® affords several advantages, including access to already experienced survey participants, increased survey security (e.g., closed and panel-specific surveys, prevention of bot breach) and sending of participation reminders to potential respondents. Ipsos also controls the number of surveys sent to each member, minimizing the unit- and item-level missingness on any given survey (Hensel et al., 2021). Another methodological strength is online data collection, which facilitates survey completion in a setting of the participant’s choosing, thereby increasing data confidentiality and participant comfort with answering questions about potentially sensitive topics, like sexual behavior. Online data collection additionally permitted a safe and feasible way to ensure ongoing research during the pandemic when many studies with in-person recruitment had to be halted so as not to increase participant COVID risk (Luetke et al., 2020).
Conclusions
As the world nears the end of its third pandemic year, emerging sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives. While many aspects of social life look more “normal,” (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.
Acknowledgements
The authors (some of whom are parents) would also like to acknowledge their own partners and/or children who made space for this research to happen during the pandemic and working from home.
Author Contributions
MR and DH conceived the study. DH, MR, ML and DH designed the survey. DH conducted the analysis and wrote the first draft of the manuscript with scientific contributions from DH, TF and DH All authors contributed to the interpretation of the findings, critical review of the manuscript and approval of the final manuscript as submitted.
Funding
The 2020 National Survey of Sexual and Reproductive Health during COVID-19 (NSRHDC) was supported by grants from Pure Romance as well as the Indiana University Office of the Vice Provost for Research.
Declarations
Editor’s note
This paper was to be part of the Special Section on the Impact of COVID-19 on Sexual Health and Behavior (Guest-Edited By Lori A. J. Scott-Sheldon, Kristen P. Mark, Rhonda N. Balzarini, and Lisa L. M. Welling), which was published in the January 2022 issue of the Journal. Unfortunately, the paper was not accepted for publication until after the January 2022 issue went to press.
Conflict of interest
The authors have not disclosed any competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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