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COVID-19 patients: Sexual Function before and after COVID19 infection. A witness by those who survived.

Lorenzo Spirito
Department of Neurosciences
Reproductive and Odontostomatological Sciences
Unit of Urology
Federico II University, Naples, Italy

Giuseppe Celentano
Department of Neurosciences
Reproductive and Odontostomatological Sciences
Unit of Urology
Federico II University, Naples, Italy

The Coronavirus Disease 2019 (COVID-19) pandemic started in Wuhan, China, and spread worldwide in less than 3 months between the end of 2019 and the beginning of 2020. The responsible of such outbreak was Sars-Cov-2, a coronavirus that probably originated in bats and whose intermediate host remains still unknown (1,2). Towards the end of February 2020, such disease landed in Italy, precisely in the north of Italy where many clusters were confirmed. On the 8th of March the Italian prime minister launched unprecedented strict quarantine measures that kept a large number of people in isolation affecting many aspects of people’s lives. Nevertheless, to date more than 300,000 people have contracted the disease in Italy and the number is likely to increase in the near future.

The literature confirms that the elderly are more susceptible to severe illness, and the overall survival is much higher in younger patients (3). Thus, it is very important to study all aspects of well-being in order to recognize and treat all the possible consequences of the disease.
Considering the extraordinary circumstances and the impact that such measures may have on mental health it is important to determine whether this has also triggered a variety of sexual and reproductive problems. At the present time no data have suggested whether and how the coronavirus could affect the sexuality of these patients. However in our department we are in the process of obtaining data on patients affected by coronavirus evaluating their sexual function before and after COVID-19 infection. Despite data are incomplete and statistical analysis have yet to be performed there are few interesting cases that are worth to be discussed.

Roberto is a 39 years old engineer who is married with Anna, a beautiful 29 years old teacher. They were having a perfect life, nice working environment, excellent salary and brand new apartment to build a life together and a common passion for travelling. Roberto had a perfect erectile function in January 2020 and both of them were fully satisfied with their sexual activity.
On the 27th of February he and his wife started to have mild respiratory symptoms. After one week of antibiotic they remained symptomatic and eventually after their notification to the local General Practioner they underwent nasopharyngeal swab which resulted positive for Sars-Cov-2. Despite the symptoms disappeared after 2 weeks the he and his wife remained positive to the swabs for 57 and 64 days respectively. Both of them were frightened and frustrated during the first month of infection and they did not attempt any sexual intercourse during that period.

During the second month of the infection, since they became completely asymptomatic, they tried to get back to their normal sexual life. Roberto immediately noted a dramatic decrease of his erectile function and surprisingly the intercourse satisfaction and orgasmic function appeared completely worsened. On the other hand Anna’s sexual desire appeared to be nullified, despite a recent study of Yuksel et al. have demonstrated that women’ (without infection) sexual desire and frequency of sexual intercourse significantly increased during COVID-19 pandemic. They discussed about the situation and they blamed the strict quarantine measures and the stress related to the still positive nasopharyngeal swabs. After few attempts they gave up.
Three months after the infection (roughly one month after the end of the infection) they returned to their “normal” working life, however they realized something was different. Roberto realized his erectile function was not as good as before and the zest of the intimacy was changed. He is slowly recovering but according to him “pre-COVID-19 sexual pleasure is still far”. On the contrary Anna found herself completely recovered.

The story of Roberto and Anna is emblematic of the sexual discomfort that such situation may lead to. Clearly stressful lifestyle is a factor known to impact couple’s sexual relationship, even though no trials have been conducted in such circumstances. Previous studies on sexual health have been conducted during mass disasters such as earthquakes or wars, however such conditions cannot be compared to COVID-19 pandemic since there is no loss of living space and the strict quarantine is an unprecedented measure.
At the present time the scientific world is putting Sars-Cov-2 under the magnifying glass to better understand the spread, the pathophysiology, the possible consequences of such disease. However the scientific world should not put sexual disorders aside and further studies will be necessary.

References

1. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270–273. doi:10.1038/s41586-020-2012-7
2. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi:10.1056/NEJMoa2001017
3. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513. doi:10.1016/S0140-6736(20)30211-7
4. Paoli D, Pallotti F, Colangelo S, et al. Study of SARS-CoV-2 in semen and urine samples of a volunteer with positive naso-pharyngeal swab [published online ahead of print, 2020 Apr 23]. J Endocrinol Invest. 2020;10.1007/s40618-020-01261-1. doi:10.1007/s40618-020-01261-1

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