Less Risky Sexual Behavior During the Pandemic

Comparison of annual surveillance data on sexual and reproductive health outcomes, 2010 to 2020, with equivalent results in Natsal-3 (2010-2012) and Natsal-COVID-2 (2021). Chlamydia testing surveillance data comes from routine returns from sexual health services and community settings to the GUMCAD STI Surveillance System and the CTAD Chlamydia Surveillance System (UK Health Safety Agency (UKHSA). )). Surveillance data on HIV testing and clinic attendance are obtained from routine sexual health services reporting to the GUMCAD STI Surveillance System. Clinical care surveillance data are limited to sexually transmitted infection (STI)-related care only. Surveillance data are reported as event counts per 100 people. Natsal survey data are presented as percentages of participants who reported at least one event. We use dates through 2019 to visualize baseline trends. Data points for 2020 were not used for trend analyzes as they include pre- and post-pandemic events. Conception and abortion surveillance rates include all women over 18 years of age. Chlamydia testing, HIV testing, and clinic attendance rates include women and men ages 18 to 44.  

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Fewer unplanned pregnancies and abortions, but more sexual dissatisfaction and distress

The lower prevalence of ’risky’ sex, with multiple or new partners without using condoms, which occurred during the early stages of the COVID-19 pandemic, was still evident a year after Britain’s first lockdown, results from a study reveal. important national survey, published online in the journal Sexually Transmitted Infections.

While there were fewer unplanned pregnancies and abortions reported than indicated by a comparable survey a decade earlier, there were significantly higher prevailing levels of sexual dissatisfaction and concerns about their sex lives among respondents.

During the first months of the pandemic, changes in sexual behavior were mainly due to reduced opportunities to have sex for people who do not cohabit with a partner. And most studies found that the frequency of partnered sex decreased, overall, the researchers note.

But the time period for these studies was too short to reliably detect changes in sexual behavior and outcomes, such as screening for sexually transmitted infections, pregnancy, and abortion.

The Natsal COVID-19 study was conducted in two waves, the first of which was 4 months after the first UK lockdown (July-August 2020) and the second in March-April 2021.

The second wave, which informs this current study, was designed to track behavior over a longer period and provide 1-year estimates of particular outcomes: patterns of sexual behavior; use of sexual health services; pregnancies, abortions and fertility management; sexual function and quality of sexual life in the year after the first lockdown (which began on March 23) in Britain.

Aiming to achieve a nationally representative sample, 6,658 British residents, aged 18 to 59, completed the Natsal-COVID-Wave 2 online survey. More than 92% had had some lifetime sexual experience.

Responses were compared to Natsal-3 (2010-12; 15,162 participants aged 16-74) and compared to national data on the number of sexually transmitted infection tests, conceptions and abortions recorded in England and Wales between 2010 and 2020. .

In the year after the first lockdown, more than two-thirds of respondents reported having one or more sexual partners (women 72%; men 70%), while less than a fifth of all respondents reported a new partner (women around 10.5%; men 17%), compared to a quarter who reported this over the past year in Natsal-3 (women 18%; men 23%).

Respondents also reported less condomless sex with new partners than 10 years earlier. But there were gender differences in Natsal-COVID-Wave 2.

Nearly half as many women as men reported having had 2 or more partners in the past year. Women were also about half as likely to report 1 or more new sexual partners and 1 or more new partners with whom they had not used condoms.

The average number of times respondents said they had sex was twice a month compared to 3 in 2010 (Natsal-3), although this average has been falling since 1990, so may reflect a secular trend unrelated to the pandemic, researchers suggest.

This pattern of behavior was particularly notable in young people and among gay/bisexual men, groups that tend to have high rates of sexually transmitted infections.

One in 10 women reported a pregnancy, down from 2010-12: these pregnancies were also less likely to be unplanned. And there were fewer abortions .

Levels of distress and dissatisfaction were common. Almost 1 in 5 (just over 19%) of women and almost 1 in 4 (23%) of men said they were distressed or worried about their sex life, significantly more than in 2010–12.

Dissatisfaction with sex increased with age, rising from 20% and 17%, respectively, among women and men aged 18 to 24, to more than 28% and 41.5%, respectively, among women and men from 45 to 59 years old. However, distress levels did not change with age.

About a quarter of men and women felt their sex lives during the pandemic were worse than the previous year. This increased with age for men, but not for women.

Compared to surveillance trends from 2010 to 2019, use of sexual health services and HIV and chlamydia testing were lower. Only 16% of participants who said they had at least one new partner in Natsal-COVID-2 reported having had a chlamydia test in the past year compared to almost 39% of respondents in Natsal-3.

The comparison with Natsal-3 should be interpreted with caution, the researchers say, as this is a survey conducted by household interviewers, to which Natsal-3 data was added 10 years ago, when sexual behavior, sexual mores and service delivery have changed. .

But, the researchers say: "While all data sources we report here have limitations, they provide largely consistent evidence about the effects of the pandemic on [sexual and reproductive health]."

They conclude: “Taken together, these data suggest that COVID-19 had a significant influence on sexual and reproductive health, likely through a combination of restrictions on social mixing, disruption of [sexual and reproductive health] services. and the uncertainty and stress related to the pandemic. However, the long-term implications are difficult to predict.”

They add: “These data suggest that recovery should focus on restoring [sexually transmitted infection] prevention behaviors, providing free or low-cost condoms, catching up on delays in service provision, counseling for sexual difficulties and sexual education for young people who were lost during the pandemic.”