Changes in sexual behaviour, anxiety symptoms, and quality of couple relationship of patients with infertility during the COVID-19 lockdown

Abstract

Purpose This study aimed to explore the perceived changes in sexual behaviour during COVID-19 lockdown, anxiety symptoms, and couple relationship of patients with infertility. Methods We performed an observational cross-sectional study between 20 November 2020 and 15 January 2021. We used stratified analysis of different stress levels and Quality of Marriage Index (QMI) scores to compare the perceived changes in sexual behaviour, anxiety symptoms, and couple relationship. The logistic regression model was performed to assess factors correlated with couples’ relationship quality during the lockdown. Furthermore, we performed pathway analyses to assess whether the changes in sexual behaviour, stress level, or psychological anxiety during the lockdown could predict the quality of couple relationship. Results A total of 940 patients with infertility were included in this study. When we conducted a stratified analysis of the participants, significant differences were found between the changes in their sexual behaviour, stress levels, and couple relationship quality. The logistic regression model showed that sex, anxiety symptoms, decreased sexual satisfaction, sexual activity frequency, and income levels were closely related to couple relationship quality. Pathway analyses indicated that changes in their sexual behaviour, anxiety symptoms, and stress levels could all predict the quality of couple relationship. Conclusions The perceived changes in sexual behaviour with different stress levels and couple relationship quality showed significant differences. Analysing the related factors that affect the quality of couple relationship, especially in times of crisis, is of great significance as this information can contribute to the improvement of treatment for patients with infertility. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-021-02361-4.

Is There a Direct Link between Sexual Satisfaction and Restrictions during the Second Wave of the COVID-19 Pandemic?

“…Some previous studies showed that the female gender is more vulnerable to dysfunctional changes in sexual behavior during the pandemic [24,25,39,46,55]. In contrast, other research showed that male participants experienced a more significant worsening in sexual function and satisfaction than females [19,26,34]. Among adults from Egypt, sexual stress was also significantly greater in females than males [24].…”

“…On the other hand, research during the pandemic indicates that a worsening of sexual well-being was experienced overall by those who were at base more vulnerable to high distress. High distress, anxiety, and depression were predictors of high risk of sexual dysfunction and low sexual satisfaction in numerous studies (e.g., [19,20,24,25,28,29,32,35,36,[39][40][41]43,44,46]). Zhang et al [39] showed that Chinese participants who experienced a high stressful impact of the COVID-19 pandemic on their life were likelier to assess the quality of their sex life as worse and to declare a lower frequency of sexual activity.…”

“…A greater decline in sexual satisfaction was found in people who did not at the time live with their partners [17,33] than in people living as a couple. Besides relationship status (i.e., being single), poor couple relationship quality [19,41,57] and partnership conflicts [28,46] also contributed to a weakening in sexual behavior and worsening satisfaction during the pandemic. A recent mediation study showed that increased COVID-19-related stress contributes to worsening well-being via decreased levels of sexual and romantic functioning [58].…”

“…Research on changes in sexual behavior during the pandemic indicated ambiguous results. Decrease in frequency of sexual activity and casual sex, or increased risk of sexual dysfunction, masturbation and pornography use, were reported in adults from Brasil [17], Canada [18], China [19][20][21][22][23], Egypt [24], France [25], Germany [26][27][28], Indonesia [29], Italy [30], Poland [31,32], Singapore [33], United Kingdom (UK) [34], and United States of America (USA) [35,36]. A decrease in sexual satisfaction was reported during the pandemic (when compared to pre-pandemic time) among healthcare professionals from Brasil [17], adults from Egypt [24], France [25], Germany [28], Kenya [37], and Singapore [33]; among patients with infertility from China [19]; and among women from Poland [31], Italy [30], and the USA [35].…”

“…Decrease in frequency of sexual activity and casual sex, or increased risk of sexual dysfunction, masturbation and pornography use, were reported in adults from Brasil [17], Canada [18], China [19][20][21][22][23], Egypt [24], France [25], Germany [26][27][28], Indonesia [29], Italy [30], Poland [31,32], Singapore [33], United Kingdom (UK) [34], and United States of America (USA) [35,36]. A decrease in sexual satisfaction was reported during the pandemic (when compared to pre-pandemic time) among healthcare professionals from Brasil [17], adults from Egypt [24], France [25], Germany [28], Kenya [37], and Singapore [33]; among patients with infertility from China [19]; and among women from Poland [31], Italy [30], and the USA [35]. By contrast, in comparison to the period before the pandemic, the frequency of sexual activity increased during the lockdown in Bangladesh, India, Nepal [38], China [39], Singapore [40], in seven countries of the European Union (the Czech Republic, Croatia, Germany, Portugal, the Netherlands, France and Sweden) and Turkey [41], in a nationwide sample of men from Germany [42], and in a large convenience sample of men from the United States of America [43].…”