DISCUSSION
Gender-parsed data for COVID-19 reveals that while it has so far shown
an equal number of cases between men and women, vulnerability to death
and disease differs in the context of gender. According to the gender
distribution of COVID-19 cases in Turkey, the incidence of cases is 9%
higher in men than in women (16).
Since the onset of the COVID-19 pandemic, numerous series of cases have
been published in which clinical features specific to COVID-19 disease
have been reported. Meta-analyses of these studies indicate that the
most common clinical symptom is fever, followed by coughing (17-20). In
our study, the most common clinical feature when applying to a health
care facility was identified as a cough with 33.3%. Symptoms of fever,
muscle pain, loss of smell, vomiting, and loss of taste (13.3%),
diarrhea (26.7%) were also found to be the most common clinical
features.
It has been reported that the frequency of sexual intercourse in women
is associated with age and duration of marriage (21). It was reported
that the frequency of sexual intercourse in women decreases during life
periods such as pregnancy and climacteric periods, as well as bipolar
disorder (22-26). In people infected with the COVID-19 virus and
quarantined, there has not been enough information about changes in
sexual habits. In a study conducted in China, where the disease was
first observed, examining the impact of the COVID-19 pandemic on sexual
and reproductive health, 41% of participants reported a decrease in the
frequency of sexual intercourse (27). Another study found that the
average frequency of sexual intercourse decreased from 6.3 ± 1.9 per
month to 2.3 ± 1.8 with social distance measures taken during the
COVID-19 pandemic (28). A study evaluating the effect of the COVID-19
pandemic on female sexual behavior in women in Turkey found that the
frequency of sexual intercourse during the pandemic increased
significantly compared to 6-12 months ago (29). In our study, it was
determined that women’s intercourse frequency decreased after COVID-19
disease.
In a study conducted in Italy, the total FSFI score before and after
COVID-19 disease was found to be 29.2 ± 4.2 and 19.2 ± 3.3,
respectively, and was statistically significant (p < .0001)
(28). In our study, the FSFI total score before and after COVID-19 was
found to be 24.75±6.55 and 23.03±7.87, respectively. When we looked at
the lower areas, the satisfaction score decreased, and there was no
statistical difference in the other areas and the total score.
A group of experts from the Spanish Association for Sexuality and Mental
Health agreed on recommendations for maintaining lower-risk sexual
activity, depending on the person’s clinical and partner status, based
on available information about SARS-CoV-2. The main advice is to return
to safe sex after the quarantine is over and the symptoms disappear.
(depending on the SARS-CoV-2 carrying time, 28 days, or 33 days for
60-year-olds). In all other cases (those under quarantine, those with
some clinical symptoms, health professionals in contact with COVID-19
patients, and during pregnancy), it is recommended that sexuality should
be avoided (30).
A study examining the absolute difference in SF-36 scores between those
with COVID-19 disease and the normal population in China found that sick
people had higher pain and vitality scores, but lower physiological
function, social function, and role difficulties scores (31). In our
study, the median value of pain differs from COVID-19 before and after
diagnosis (p=0.008). The median pain score before COVID-19 was 86.67,
while after COVID-19, it was 76.83. Physical function, role
difficulties, general health, vitality, social function, role
difficulties, emotional, mental health scores do not differ according to
COVID-19 before and after diagnosis (p>0.050).
While the main limitation of this study was the limited number of the
participants; to preventive measures such as social distance taken to
prevent COVID-19 disease, anxiety and uncertainty about the future have
an impact on sexual function and quality of life in people. Information
about changes in sexual habits and the impact on the quality of life in
the isolated population and people infected with COVID-19 is so far
scarce. It is also important to note that in cases of outbreaks such as
COVID-19, women are more affected, and gender norms pose a risk. In our
study, we examined the effect of COVID-19 on sexual dysfunction and
quality of life in women and concluded that the frequency of sexual
intercourse, FSFI total score, and sexual satisfaction of women
decreased after COVID-19 disease, and the quality of life scores did not
change in a statistically significant way. Studies that need to be done
with the wider patient population are needed to better identify the
issue. Given the limitation of literature information on the subject, we
believe that our study will lead to further studies.