4.1. Changes in Sex Life
Most respondents reported no change in their sex life during the COVID-19 pandemic, whereas 13.4% reported the decrease satisfaction with their sex life, 13.5% decreased sexual activity, 6.7% decreased sex-seeking activity, and 1.6% reported the increased use of protection for sex. By contrast, 1.9% reported the increased satisfaction with their sex life, 2.9% increased sexual activity, 1.9% increased sex-seeking activity, and 1.4% reported the decreased use of protection for sex. Sexuality is a central aspect of human health [12
]. Considering the ineffectiveness of recommendations of long-term sexual abstinence [39
], health care providers should consider counseling people on their sexual health whenever possible to help them maintain or even improve their sexual wellness amid the COVID-19 pandemic; in general, the human need for intimacy should be balanced with personal safety and pandemic control [12
]. Further study is also warranted to understand the psychological mechanisms underlying sexuality during a pandemic. Although only 1.4% of respondents reported the decreased use of protection for sex in the present study, the increased risk of contracting COVID-19 and sexually transmitted diseases should also be investigated in people who engage in sexual activity more but use protection less during the pandemic.
4.2. Factors Relating to Changes in Sex Life
The present study found that risk perception, general anxiety, gender, age, and sexual orientation related to various aspects of changes in sex life during the COVID-19 pandemic. Firstly, a higher risk perception of COVID-19 was significantly associated with decreased frequencies of sexual activity and sex-seeking activities. Because in-person sexual contact carries the risk of COVID-19 transmission [12
], we can hypothesize that people with a high risk perception of COVID-19 reduce their sexual activity, whether casual or with long-term partner, as a means to protect themselves against getting COVID-19. However, Leung et al. noted that the self-perceived likelihood of contracting or surviving SARS did not predict personal protective behavior [36
]. In addition to sexual inactivity as a personal protective behavior, other reasons may also account for the association between risk perception of COVID-19 and the decreased frequencies of sexual activity and sex-seeking activities. People who perceive a high risk of COVID-19 tend to invest greater time and effort to learning more about pandemic prevention and using facemasks and disinfectant alcohol. Moreover, as with governments in many other countries, the Taiwanese government has suspended the sex industry to prevent the spread of COVID-19. This policy may have led people with a high risk perception of COVID-19 to perceive having sex in general as being unsafe during the pandemic. These personal and environmental factors may have contributed to the decreased frequencies of sexual activity and sex-seeking activities during the pandemic.
The present study found that higher general anxiety was significantly associated with decreased satisfaction of sex life and frequencies of sexual activity and sex-seeking activities during the COVID-19 pandemic. Greater general anxiety may result in less pleasurable sex or make sex difficult, which depresses a person’s interest in sex; sexual dysfunction may further exacerbate anxiety [40
]. However, anxiety is one of most common affective responses to the respiratory infectious disease epidemics or pandemics [41
]. During the respiratory infectious disease outbreaks, social distancing and quarantine are inevitable methods to prevent spreading of the illness; however, both may precipitate anxiety [42
]. Thus, health care providers should help people manage their anxiety in particular and mental health in general.
A study on Turkish women found that despite the increased frequency of sexual intercourse during the COVID-19 pandemic, quality of sexual life decreased during the pandemic [15
]. The present study extends the scope of genders in participants and found that men were more likely to report a change, whether an increase or decrease, in their frequencies of sexual activity, sex-seeking activities, and use of protection for sex. A UK study also noted that men in the general population were more likely to engage in sexual activity during COVID-19 self-isolation [27
]. Both biological and socioenvironmental factors may influence sexual behaviors across genders. Research on 3- to 6-year-old children found significant gender differences in sexual behavior [43
]. Gender stereotypes in societies may also affect the way people behave in sexual activities [44
]. There might be multiple etiologies accounting for gender difference in changes of sexual activities during the COVID-19 pandemic that warrant further study. Moreover, research in China has demonstrated that women tend to be more psychologically affected by the COVID-19 outbreak with respect to stress, anxiety, depression, and posttraumatic stress symptoms [46
]. The results of previous and present study indicated that the COVID-19 pandemic might have various impacts on sexual activities differently compared with and psychological wellbeing, as well as that changes in sex life might not be influenced by psychological status only.
Younger people were noted to be at greater risk of mental illnesses, such as general anxiety disorder, during the COVID-19 pandemic [24
]. Consistent with the aforementioned study, the present study found that older respondents were less likely to have increased sexual activity during COVID-19 pandemic [48
]. Gender and age differences in sexual activity have already been noted by a Taiwanese study before the pandemic; these differences include men being more likely to have multiple sexual partners and older people being more likely to have a lower frequency of sexual activity [49
]. The results of the present study demonstrate that the COVID-19 pandemic has had differential effects on sex life across gender and age. The factors that explain the reason that men are more likely to have a pandemic-induced change in their sex life—whether an increase or decrease in the aspects analyzed in this study—should be investigated further.
The present study found that sexual minority respondents were more likely to report decreased satisfaction with their sex life and decreased frequencies of sexual activity and sex-seeking activities during the pandemic; a gender difference with respect to the aforementioned frequencies was also noted. Sexual minority individuals have faced the threat of HIV infection since the 1980s [50
], and health information pertaining to HIV prevention and treatment strategies is transferable to knowledge on COVID-19 [51
]. Thus, being more knowledgeable about pandemic prevention, sexual minority individuals may reduce their sexual activity, albeit at the expense of reducing their satisfaction with their sex life. However, the decreases in sexual activity could also be explained by sexual stigma, which sexual minority communities have experienced since the AIDS pandemic [52
Recommendations for sexual abstinence during the COVID-19 pandemic may elicit memories of the widespread stigmatization of sexual minorities during the AIDS crisis [12
]. Such sexual stigma contributes to a hostile social environment against sexual minority individuals and makes mental health problems more likely [53
]. Sexual minority individuals may reduce their sexual activity under the interpersonal strain caused by the COVID-19 pandemic. However, a group of sexual minority individuals have increased their sex-seeking activity during the COVID-19 pandemic. Whether this is a response to the unhappy atmosphere during the pandemic warrants further study.
The present study has some limitations. First, the present study did not ask participants about their current sexual relationship status or relationship quality, which are major factors affecting people’s sexual satisfaction during a pandemic like Covid-19 where people’s social lives may have been curtailed. Sex between intimate couples can be an activity to support psychologically fragile people living in restricted areas for longer quarantine periods [54
]. Second, although recruiting respondents through Facebook is a promising research method for targeting the general public during fast-moving infectious disease outbreaks [55
], Facebook users may not be representative of the population. A review of a study that recruited respondents through Facebook reported a bias in favor of women, young adults, and people with higher education and incomes [56
]. Third, the cross-sectional design of this study limited causal inference between changes in sex life and general anxiety. Fourth, this study did not survey the various aspects of respondents’ sex life before the pandemic. This study also did not follow-up on the changes in respondents’ sex life during the mitigating period of the COVID-19 pandemic. Last, some factors such as physical health and self-confidence that might influence sex life in the COVID-19 pandemic were not examined in the present study.