The discovery of a new virus, SARS-COV-2, at the end of 2019 spread across the globe affecting so many people that by 11 March 2020 the World Health Organization (WHO) declared the novel coronavirus (Covid-19) outbreak a global pandemic.¹ 

It was hard to know at the outset what impact the pandemic and resulting lockdown would have on people. During lockdown, several factors are likely to have influenced intimacy between partners resulting in an alteration in sexual behaviours. According to Arafat et al. these factors include increased time spent together, little opportunity for recreation, less work burden, less social or family obligations. Similarly, they listed several factors that may adversely affect sexual life: more chance of interpersonal conflicts, stress, lack of privacy, and medical issues.² 

Early meta-analysis by Delcea et al. published in December 2020 on the effects of Covid-19 on sexual life showed there was a decrease in sexual activity during the period included in the analysis, which indicated the impairment of the individuals’ quality of sexual life.³ 

A study in Kenya among heterosexual married couples to see how perceived and experienced sexual satisfaction changed because of the Covid-19 pandemic and lockdown by Osur et al. found that 73.4% of participants were satisfied with their marital sex before Covid-19, but the proportion of those reporting satisfaction dropped to 58.4% when they were asked about their experience during the pandemic. The authors said the perceived increase in dissatisfaction with sex could be a pointer to the overall falling quality of life during the Covid-19 pandemic, especially among the most sexually active men aged 31−50 years living in places where Covid-19 control measures were stringently implemented.⁴ 

“To date, the precise mechanisms that trigger pandemic related sexual dysfunction are not completely understood,” reported Professors Andersen and Tufik, “although it has been suggested that psychogenic effects play an important role, in addition to the direct effects of the disease itself on those infected. There is evidence that the stress induced by the pandemic has had a significant impact on sleep, and sleep disturbances are known to induce erectile dysfunction (ED).” The Professors determined that the combined effect of Covid-19 and the psychogenic disorders triggered by isolation, grief, and anxiety might be associated with the increased prevalence of erectile dysfunction.⁵ 

Fortunately, with three phosphodiesterase type 5 (PDE5) inhibitors – sildenafil, vardenafil, and tadalafil – available as first-line treatment in SA,6 ED doesn’t signal the end to a healthy and satisfying sex life for couples. Equally effective in mild to moderate ED, the choice of which medication to prescribe would be based on side-effect profile and patient requirements, for example whether your patient wants to take a tablet once a day or only when they want to be sexually active. “Sildenafil and vardenafil have an onset of action of approximately 11-16 minutes after administration,” explained Schellack et al. “Tadalafil has a 16–30-minute post-dose onset of action, which is delayed compared to sildenafil and vardenafil. Tadalafil is the longest-acting PDE5 inhibitor. Its efficacy lasts up to 36 hours owing to its long half-life of approximately 20 hours.”⁶ 

While lockdowns have been completely lifted and some people have returned to work, there are still many people working from home and we’re all getting used to a new ‘normal’. As research is starting to be published it will be interesting to see what long term impact Covid-19 control measures, together with other social and economic impacts of Covid-19 may have had on sexual habits and satisfaction in couples. 

REFERENCES 

1. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020 Mar 19;91(1):157-160. doi: 10.23750/abm.v91i1.9397. PMID: 32191675; PMCID: PMC7569573. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569573/ 
2. Arafat S, Mohamed A, Kar S, Sharma P, Kabir R. Does COVID-19 pandemic affect sexual behaviour? A cross-sectional, cross national online survey. Psychiatry Res 2020;289:113050. https://doi.org/10.1016/j.psychres.2020.113050 
3. Delcea C, Chirilă VI, Săuchea AM. Effects of COVID-19 on sexual life – a meta-analysis. Sexologies. 2021;30(1):e49-e54. doi:10.1016/j.sexol.2020.12.001 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744015/ 
4. Osur J, Ireri EM, Esho T. The Effect of COVID-19 and Its Control Measures on Sexual Satisfaction Among Married Couples in Kenya. Sex Med. 2021 Jun;9(3):100354. doi: 10.1016/j.esxm.2021.100354. Epub 2021 Mar 18. PMID: 34077871; PMCID: PMC8240330. https://www.smoa.jsexmed.org/article/S2050-1161(21)00034-9/fulltext 
5. Andersen ML, Tufik S. The Association Between Sleep Disturbances and Erectile Dysfunction During the COVID-19 Pandemic. Sex Med Rev. 2022;10(2):263-270. doi:10.1016/j.sxmr.2021.12.001 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677465/ 
6. N Schellack (Senior Lecturer) & A Agoro (2014) A review of phosphodiesterase type 5 inhibitors, South African Family Practice, 56:2, 96-101, DOI: 10.1080/20786204.2014.10855345