These are not sexy times.
As an obstetrician and gynecologist in the Bay Area, I’ve been caring for my patients via telemedicine for the past three weeks because of the coronavirus pandemic. When I ask patients about new sex partners — a standard question for me — the answer is a universal “no.” They are taking California’s shelter-in-place very seriously.
In fact, many of my patients are more interested in updates about the virus than the medical (and often sexual) problem for which they were referred.
The pandemic has most of the world practicing exceptional hand hygiene and social distancing. This coronavirus is so new that we don’t know what we don’t know, and while fresh information is coming at an incredible pace, one medical recommendation has remained constant: the need for social distancing.
This time has been an exercise in prioritizing needs from wants. So where does sex fall on that spectrum?
Q: Are we even wanting sex these days?
A: It’s hard to know yet. While some people may turn to sex for comfort or as a temporary distraction, these are unprecedented times and we don’t have much data.
Depression and anxiety have a negative effect on libido. Some people are out of work, too, and unemployment can affect sexual desire. The kind of worry people are experiencing crosses so many domains: job security, health, friends’ and family’s health, retirement and the ability to have access to medical care, to name a few.
One study that looked at the effect of the 2008 Wenchuan earthquake in China on the reproductive health of married women found sexual activity decreased significantly, and not just in the week after the earthquake.
Before the earthquake, 67 percent of married women reported they were having sex 2 or more times a week. One week after the earthquake, that number fell to 4 percent. By 4 weeks, only 24 percent reported they were having sex 2 or more times a week, well below the baseline.
While this study is retrospective data — women were asked to recall their sexual activity eight weeks after the earthquake — and an earthquake isn’t the same thing as a pandemic, it seems unlikely that sexual activity overall will increase.
However, trauma — and these are certainly traumatic times for some — can also lead to sexual risk-taking, like unprotected sex or sex under the influence of drugs or alcohol.
Q: What is considered ‘safe sex’ right now?
A: Your risk for infection with the coronavirus starts as soon as someone gets within 6 feet of you. (And of course, if you do have sex, your risk for pregnancy and sexually transmitted diseases remains the same, and the previous definition of “safe sex” still applies.)
You’ve read this elsewhere: COVID-19 is transmitted by droplet nuclei, tiny specks of infectious material far too small to see. They are sprayed from the nose and mouth by breathing, talking, coughing and sneezing.
A person contracts the virus sharing the same airspace — a 6-foot radius, the distance droplet nuclei are believed to travel (although with coughing they may travel farther) — and inhaling the infectious particles. Or the droplet nuclei land on an object or surface, making it infectious. Touch that surface and then your face and the chain of transmission is complete.
If you do have sex with someone who is infected with the coronavirus, there is nothing we can recommend, be it showering head to toe with soap before and immediately after sex, or using condoms, to reduce your risk of infection. (The New York City Department of Health and Mental Hygiene issued these guidelines.)
We don’t know if the coronavirus is present in vaginal secretions or ejaculate, but it has been identified in stool. Based on what we currently know about transmission of the coronavirus, penetrative vaginal or anal sex or oral sex seem unlikely to pose a significant risk of transmission.
Q: Who are the safest partners?
A: It’s best to limit sex to your household sex partner (HSP), who should also be following recommendations for hand hygiene and social distancing. The World Health Organization currently lists the risk of household transmission as 3 percent to 10 percent, but this is based on preliminary data. We don’t know what role kissing or sexual activity plays in transmission.
The idea of limiting sexual contact to your household partner and social distancing in general is about ending the chain of transmission to your household should one person become infected.
If your HSP is sick with symptoms of COVID-19, or has been exposed, definitely don’t have sex. They may be too fatigued anyway, but your risk of being infected will likely go up in close, intimate contact. Sleep in separate bedrooms if possible.
If you have more than one bathroom, designate one for the sick or exposed person. Try to stay 6 feet apart and be fastidious about cleaning surfaces. If they were exposed, living as separate as possible in your home for 14 days is recommended.
Q: What if I’m in a new relationship and had planned to get other STD testing done?
A: Many labs are overwhelmed with coronavirus testing, so you may not get results for some STDs — like gonorrhea, chlamydia and herpes — as fast as before. Given the short supply of test kits for COVID-19, many medical centers and labs are taking swabs and liquid from other test kits to jury-rig testing kits for the coronavirus, so sampling kits for genital infections may be in short supply.
Ask your health provider because workflows may vary locally and may change day today. But if you are at risk of an STD, you should still seek out a test as soon as possible.
Q: What if I don’t have an HSP? Am I now celibate?
A: Yes, I’m sorry to say, those are the recommendations. For now.
But this doesn’t mean you can’t meet people online — start talking on the phone, have video chats, sext or have phone sex if that’s your thing.
And if someone you meet online is encouraging you to meet in person? That not only tells you how they view their own safety, but, even more important, how they view yours.
Q: What about a ‘COVID sex buddy’?
A: I’ve heard people talk about this: A sexual partner who agrees to socially distance with everyone else, but the two of you will hook up for mutual release.
I really discourage this (for now): Social distancing means limiting contact with people outside of your household. Each additional person added to the household increases risk. And of course, you are depending on this person to be as vigilant with social distancing as you are — not to mention the risk during transportation between your home and your partner’s. At the moment, the risk is too high.
Might we see people in close proximity hooking up who both tested positive for COVID-19 and are now 14 days postpositive test? It would not surprise me. However, we don’t know much about immunity (protection from reinfection) against COVID-19 after an infection. And because tests are in short supply, many people have presumptive infections but can’t be tested.
With seasonal coronaviruses that cause a common cold, immunity lasts about a year, but with the more serious coronaviruses like SARS or MERS, immunity seems to last longer. But we still don’t know enough to make concrete recommendations in terms of post-illness behavior.
Q: What will safe sex look like in the future?
A: Right now the only safe sex is no sex with partners outside your household.
If you or your HSP are at high risk, should you take extra precautions to further reduce the risk of transmission — giving up sex and kissing, sleeping in separate bedrooms — in case one of you has an asymptomatic infection? Asking your doctor for guidance here is probably wise.
But what about when we emerge from our homes again — which may be some months away — and start thinking about in-person dating, and even mating?
No one knows if we are all going to have the urge to have sex after this quasi-hibernation. One concern is a potential surge in risk-taking and STDs in the immediate aftermath of the pandemic. (After all, you can’t assume that if someone was celibate during the pandemic they don’t have an STD; most STDs don’t cause symptoms and could have predated the coronavirus.)
If that all sounds fairly bleak, well, it is. For now, the coronavirus probably means less partner sex overall, whether that’s because of the lack of a household sex partner for some or a drop in desire for others. Or both.
Hopefully, though, this is just for now.
Because the more everyone commits to social distancing, the faster we can all get back — and down — to business.