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.