COVID-19 impairs sexual function in women

Being infected with COVID-19 may reduce the sexual function of cisgender women, while having long COVID can worsen the already impaired sexual function as compared to those who do not have long COVID, a study has found. However, the mechanisms as to why these effects occur remain unclear.

“While knowing that the effect exists allows for clinical awareness and screening, understanding the mechanism(s) will have important implications for treatment development,” the researchers said.

“Thus, while more research is needed, we encourage clinicians treating cisgender women who have experienced COVID-19 to consider proactively discussing sexual function and offering resources, such as psychoeducation and psychotherapy,” they added.

A total of 2,329 adult cisgender women were enrolled in this study through an online recruitment. Half of them reported having had COVID-19, while the other half reported not having been infected. Of those who had COVID-19, 170 (25 percent) reported experiencing long COVID.

The researchers then compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). They used four path models to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress mediated the association between COVID-19 and sexual function.

The FSFI was used to measure sexual function, while the Centers for Disease Control (CDC) working symptom set was applied to assess the long COVID symptoms. Finally, the 21-item Depression, Anxiety, and Stress Scale (DASS-21) was used to measure emotional distress.

Impaired sexual function

Overall, 1,313 participants had suitable data for analysis. Women in the never-COVID group (n=645, 49.1 percent) showed higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] FSFI total M_{never COVID}, 27.98 vs M_COVID, 27.05) than those in the combined only-COVID (n=498, 37.9 percent) and long-COVID (n=170, 12.9 percent) groups. [J Sex Med 2024;21:129-144]

On the other hand, the only-COVID group had significantly higher FSFI subscale scores for Arousal, Lubrication, and Orgasm, lower scores for the Pain subscales, and higher scores for overall sexual function (FSFI total M_{only COVID}, 27.49 vs M_{long COVID}, 25.77) than the long-COVID group.

These findings supported those of earlier studies, which reported reduced sexual function during the pandemic. [Eur J Contracept Reprod Health Care 2020;25:445-448; Sex Med Rev 2021;9:3-14]

However, “since the specific effects of COVID-19 infection were not studied, some of that effect may be better attributed to the broad social changes associated with the pandemic, and not the direct impact of a COVID-19 infection,” the researchers said. [J Obstet Gynaecol Res 2022;48:2285-2295; Int J Environ Res Public Health 2020;17:7152]

Notably, none of the proposed mediation models had adequate fit.

“Though our findings did not support a model in which either the CDC symptom set for long COVID or depression and anxiety mediates the relationship between COVID-19 and sexual function, we again note that this model should not be dismissed on the basis of these results alone,” the researchers said. “It is possible that different assessments of long COVID symptoms may have yielded a better-fitting model.”

The current study was limited by the noninclusion of transgender or gender-diverse persons and its correlational findings, so causal conclusions could not be derived. In addition, the mechanism of action was not explored.