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The COVID-19 pandemic has affected the global community in countless ways, some of which are more obvious than others.
Business closures, remote schooling, and social distancing have all been regularly in the news and discussed widely both in public and private. Then there are some of less well-publicized downstream effects of the pandemic – things like unemployment, mental health issues, and social isolation.
A recent article by Bhambhvani et al took a look at another downstream consequence of the COVID-19 pandemic – female sexual function and frequency. This study utilized the Female Sexual Function Index (FSFI), a validated questionnaire consisting of 19 questions focused on 6 unique domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. A total of 91 women who had visited a partner cannabis dispensary completed 2 surveys: 1 pre-pandemic (between October 20, 2019 and March 1, 2020) and an intra-pandemic survey (between August 1 and October 10, 2020). Along with the FSFI, intra-pandemic surveys included the addition of questions related to sexual frequency, mask-wearing habits, job loss, whether participants knew anyone who tested positive for COVID-19, recent relationship changes, and recent anxiety/depression symptoms.1
Results showed that overall FSFI scores significantly decreased during the COVID-19 pandemic (27.2 vs. 28.8, P=.002), although the absolute difference in scores was modest. Several domains, including arousal, lubrication, and satisfaction, were specifically impacted. There was no impact on sexual frequency among the 58 women in the survey cohort with known sexual frequency during the course of the full survey period.1
Subset analyses showed that nearly half of all participants knew someone who had tested positive for COVID-19 (45/91, 49.5%); a similar percentage had suffered job loss or reduction in employment hours (46/91, 50.5%). Due to these and other factors, it was not surprising that 42 women (46.5%) screened positive for anxiety and 22 (24.2%) for depression. These women were specifically found to be at greater risk for female sexual dysfunction (RFSD) during the COVID-19 pandemic (defined at FSFI score <26.55). RFSD was not found to be impacted by other domains such as age, mask-wearing habits, relationship changes, or job loss/reduction.1
Previous research has consistently demonstrated an association between sexual dysfunction and mental health issues such as depression, anxiety, and stress. Early estimates and observational studies suggest that these mental health issues have been exacerbated during the pandemic, making it no surprise that RFSD also would be impacted among sexually active patients.2,3 The impact of COVID-19 on sexual function is thought to be regionally specific based on the variability of the disease and policy interventions that have been introduced in each country. Some studies have shown both an increase in RFSD as well as frequency of intercourse in specific regions (eg, Italy, Turkey) while others have shown no impact on sexual lifestyle.4-6
“The direct relationship between female sexual dysfunction and depression, anxiety, and stress has been studied extensively,” the study authors wrote. “Many pharmacologic therapies for depression and anxiety have (female sexual dysfunction) as a potential adverse effect, but depression and anxiety are themselves, even in the absence of treatment, risk factors for (female sexual dysfunction)…In light of recent evidence that demonstrates that sexual activity can have a protective effect on the development of quarantine-related anxiety and mood disorders, optimization of patients’ sexual health and optimization of patients’ mental health are reciprocal and synergistic goals.”
Based on the results of this study by Bhambhvani et al, it is suggested that ob-gyns and other providers who encounter patients with sexual function be especially vigilant in screening for pandemic-related mental health issues such as depression and anxiety.