Editorial Comment: Interaction between the impact of the Coronavirus disease 2019 pandemic and demographic characteristics on sexual/erectile dysfunction in Latin America: crosssectional study

Abstract

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the consequent lockdown had dramatic repercussions at both macrosocial, such as the economy and policy, and microsocial level, such as on the psychological and relational well-being of persons represents an unprecedented challenge for healthcare (1).In June 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease (2), and increased rates of post-traumatic stress disorder (PTSD), depression and anxiety were already expected in the general population, and even more in COVID-19 survivors, following the pandemic (3-6).It has already been shown that sexual dysfunction may be observed in PTSD patients (7), and that emotional numbness can prevent emotional intimacy and connectedness with a partner. So, PTSD symptoms can cause problems in sexual functions, and PTSD can be used as a predictive parameter for sexual dysfunction in these patients (8). The high level of anxiety, anger and irritability observed in PTSD patients not only creates sexual dysfunction independently but also affects sexual dysfunction indirectly due to negative effects on social or romantic relationships and intimacy with the opposite sex (9). It can worse preexisting dysfunctions. Moreover, anger and anxiety might have a bidirectional relationship with erectile function. That is, anger and anxiety can create erectile dysfunction, and sexual dysfunction can induce or increase these symptoms (10).The relationship between erection dysfunction and psychological state has also been examined in large-scale studies. In the National Health and Social Life Survey (NHSLS) study, data show that emotional problems and stress-related problems pose a risk of difficulty being experienced at all stages of sexuality. The researchers concluded that psychological state was an independent factor affecting sexual function (11).In 'The multinational men's attitudes to life events and sexuality' (MALES) study conducted in Europe and North and South America, which included 2,912 men, depression or anxiety was found in 25% of the patients who reported to have ED, while was found in 26% of the patients who reported to have depression or anxiety (12).So, as sexual activity is closely associated with mental and psychological health, it is unsurprising that sexual desire and frequency have declined in both genders during this pandemic (13,14).An interesting paper from Spain suggested that the social impact of the lockdown is related to gender, age and socioeconomic conditions. Authors found that women and young people had worse mental