Pandemic safe sexual activity had lasting impact

The reduction in “risky” sexual activity during the early stages of the COVID-19 pandemic continued for a year after Britain’s first lockdown, according to a major new study published today.

The Natsal COVID-19 study found while there were fewer reported unplanned pregnancies and abortions than indicated by a comparable survey a decade earlier, respondents reported significantly higher prevailing levels of sexual dissatisfaction and worries about their sex life.

There were changes in sexual behaviour in the pandemic’s early months because of the reduced opportunities for people to have sex with others with whom they were not cohabiting. Most studies found the frequency of sex with partners also declined.

However, the timeframe for these studies was too short to reliably detect changes in sexual behaviour and outcomes, such as sexually transmitted infection testing, pregnancy, and abortion.

The Natsal COVID-19 study was conducted in two waves: the first July-August 2020 and the second March-April 2021.

The second wave, which informs this study published in Sexually Transmitted Infections, was designed to track behaviour over a longer period and provide one-year estimates of particular outcomes: patterns of sexual behaviour; sexual health service use; pregnancies, abortions, and fertility management; sexual function and quality of sex life in the year after the first lockdown, which started on 23 March, 2020, in Britain.

A total of 6,658 British residents, aged 18–59, completed the online Natsal-COVID-Wave 2 survey, more than 92% of whom had had some lifetime sexual experience.

The responses were compared with those of Natsal-3, which took place between 2010 and 2012 and involved 15,162 participants aged 16–74, and were set against national data on the numbers of recorded sexually transmitted infection tests, conceptions, and abortions in England and Wales between 2010 and 2020.

In the year following the first lockdown, more than two thirds of respondents reported one or more sexual partners (women 72%; men 70%), while fewer than one fifth of all respondents reported a new partner (women about 10.5%; men 17%), compared with one quarter in Natsal-3 (women 18%; men 23%).

Respondents also reported less sex without condoms with new partners than 10 years earlier, but there were differences by gender in Natsal-COVID-Wave 2: nearly half as many women as men reported two or more partners in the previous year, while women were also about half as likely to report one or more new sexual partners and one or more new partners with whom they had not used condoms.

The average number of times respondents said they had sex was twice a month compared with three in 2010 (Natsal-3). However, the researchers, led by Professor Kirstin Mitchell, of the University of Glasgow, say this average has been falling since 1990, so may reflect a secular trend unrelated to the pandemic.

This pattern of behaviour was particularly noticeable in the young and among gay/bisexual men—groups who tend to have high rates of sexually transmitted infections.

One in 10 women reported a pregnancy, which is fewer than in 2010–12, and these pregnancies were also less likely to be unplanned. There were also fewer abortions.

However, the researchers found increased levels of distress and dissatisfaction, with about 19% of women and 23% of men reporting that they were distressed or worried about their sex life. This is a significant increase from the 2010–12 study.

Dissatisfaction with sex increased with age, rising from 20% and 17%, respectively, among 18–24 year old women and men, to more than 28% and 41.5%, respectively, among 45–59 year old women and men. Levels of distress did not change with age.

The researchers say comparison with Natsal-3 should be interpreted cautiously but add: “While all the data sources we report here have limitations, they provide largely consistent evidence about the effects of the pandemic on [sexual and reproductive health].”

They write “Taken together, these data suggest COVID-19 had a significant influence on sexual and reproductive health, probably through a combination of restrictions on social mixing, disruption to [sexual and reproductive health] services, and pandemic-related uncertainty and stress. However, the longer-term implications are difficult to predict.

“These data suggest that recovery should focus on restoring [sexually transmitted infection] prevention behaviours, provision of free or low-cost condoms, catching up on service-provision backlogs, counselling for sexual difficulties, and sex education for young people who missed out during the pandemic.”

Mitchell KR, Willis M, Dema E et al. Sexual and reproductive health in Britain during the first year of the COVID-19 pandemic: cross-sectional population survey (Natsal-COVID-Wave 2) and national surveillance data. Sexually Transmitted Infections 28 March 2023; doi 10.1136/sextrans-2022-055680


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