Social distancing in order to slow the spread of COVID-19 has radically changed the way we live. But that doesn’t stop people from needing each other, in every sense of the word. This has healthcare practitioners considering how to talk to patients about an entirely new kind of safe sex.
In a commentary published in early May in the journal Annals of Internal Medicine, a group of doctors at Harvard Medical School highlighted the need to talk to patients about sex during COVID-19. “Given the important role of sexuality in most people’s lives, health care providers… should consider counseling patients on this topic whenever possible,” they write. “Facilitating brief conversations and referrals to relevant resources can help patients maintain sexual wellness amid the pandemic.”
The physicians included suggested best practices such as prioritizing masturbation and engaging in online sexual behaviors. Sex with others, even people in your quarantine bubble, creates risk for infection, they write.
Of course, that doesn’t mean it isn’t happening. The desire to be close to others and to engage in sexual behavior is common during stressful times like the period we are in. While social distancing best practices, set by the CDC, recommends staying at least six feet away from people who aren’t part of your household, that’s just not always possible. And shaming people for breaking social distancing rules isn’t the answer in every context. “Messaging around sex being dangerous may have insidious psychological effects at a time when people are especially susceptible to mental health difficulties,” the researchers write.
“History has taught us that abstinence-only recommendations do not work, and they result in poor health outcomes,” lead author Jack Turban, a Massachusetts General Hospital psychiatrist, told Popular Science by email. “Physicians must meet patients where they are and offer risk reduction strategies that will minimize their risk as much as possible.”
New York City jumped on the sex talk early in the pandemic, releasing a PDF of guidance for the public. Most of their suggestions line up with those the doctors suggest in the new commentary, although there are a few distinctions, specifically around when people have sex with others outside their bubble. The New York guidance advises people to limit the number of partners they have sex with and to “talk about COVID-19 risk factors, just as you would discuss PrEP, condoms, and other safer sex topics.” But the Harvard team also suggests that hookups outside the bubble can be made safer by showering before and after, avoiding contact with other bodily fluids (including kissing), and wearing a mask during sex.
Those recommendations could change over time. “We are constantly learning more about how this virus is transmitted, what protection positive antibody tests may imply, and how to best counsel patients,” writes Alex Keuroghlian, a co-author who directs the National LGBT Health Education Center at the Fenway Institute and Massachusetts General, in an email interview.
And adding higher levels of screening into the mix could help people make the right choices, says Amy Nunn, executive director of the Rhode Island Public Health Institute. “I think that we should move towards universal screening,” she says. “If you look at the countries that have stamped this out, that’s what they have done.” Screening would make having sexual partners outside your bubble much less risky, she says.
During her career, Nunn has done numerous studies on HIV prevention and says there are many lessons to be learned from the past 30 years of HIV research about risk communication and stigma reduction in relation to COVID-19. Letting people know they have options to make sex less risky has the potential to reduce harm. There’s already a lot of stigma around sexual health, especially for young people and marginalized groups, that stands in the way of them getting proper preventive care. Add the stresses of a pandemic on top of that and care suffers, says Carmen Logie, a professor of social work at the University of Toronto who is studying potential stigma surrounding COVID-19.
And that’s not just true for specific sexual encounters. “We’re going to see limited access to clinics, to abortion, to many other things that were already stigmatized,” Logie says. That’s another reason why it’s important for care providers to help people figure out the best sexual options for their patients right now.