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Sexual Health During the COVID-19 Pandemic

BOSTON, May 11, 2020—A viewpoint published in Annals of Internal Medicine urges clinicians to counsel patients about their sexual health and well-being during the COVID-19 pandemic and offers practical advice that can be shared in brief conversations and referrals to relevant resources.

“More than 200,000 people have died of COVID-19, which has led to widespread concern about the ease with which the coronavirus, which causes COVID-19, is transmitted from one person to another,” said Dr. Jack Turban, resident physician in psychiatry at The Massachusetts General Hospital and McLean Hospital and lead author of the viewpoint.

SARS-CoV-2, more popularly known as the coronavirus, is readily transmitted when someone either breathes in respiratory droplets containing SARS-CoV-2 that have been emitted when an infected person talks, coughs, or sneezes, or when someone touches a surface contaminated with such respiratory droplets and then touches their face.

“This has resulted in broad guidance recommending that people avoid coming within six feet of each other. There has been a great deal of advice on how to avoid transmitting the coronavirus by wearing a face mask, frequently washing hands, and practicing good hygiene,” Turban added. “But the sexual health implications of these recommendations have received little attention, even though it appears that all forms of in-person sexual contact carry risk for transmission of the virus.”

Infected individuals may potentially spread respiratory secretions onto their skin or their personal objects, including sex toys, from which the coronavirus can be transmitted to a sexual partner.

“Abstinence is the lowest-risk approach to sexual health during the pandemic,” said Dr. Alex Keuroghlian, a co-author of the viewpoint who directs the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “But given the well-documented failures of abstinence-based public health interventions, this advice alone is unlikely to be successful for all patients. For some groups, including sexual and gender minority communities, a recommendation of abstinence may promote shame and sexualized stigma. It could also conjure traumatic memories of the AIDS crisis.”

Clinicians are advised to offer sex-positive advice across the spectrum of risk. These range from activities with a low risk of infection, such as masturbation, having sex with a partner with whom you are self-quarantining, or having sex via digital platforms such as video chat. Patients who use digital tools for sex should be counseled to use secure encrypted platforms and be warned about the risks for sexual partners taking screenshots and the relevant risk of sexual extortion. Those engaging in higher risk activities, such as having sex with people whom you are not self-quarantining, should be counseled on ways to reduce the risk of transmission by wearing a mask and showering both before and after having sex.

Going forward, clinicians will need to incorporate new technological advances regarding the coronavirus into how they think about sexual health and risk.

“As we learn more about the use of new technologies, like antibody tests, they may help us to develop best practices in advising people around safer sex, but for the time being, we need to assume all partners may be infectious,” said Kenneth Mayer, MD, a co-author of the viewpoint and Co-chair and Medical Research Director, The Fenway Institute and Professor of Medicine, Harvard Medical School. “Ultimately, it will be important for clinicians to discuss new knowledge about the coronavirus with their patients as this information will affect decisions about sexual health.”

The viewpoint, titled “Sexual Health in the SARS-CoV-2 Era” was published by the Annals of Internal Medicine. It is available free online here.

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