Study shows long COVID’s hidden effect on women’s sex lives

From work to school to socializing, COVID-19 has impacted just about every part of our lives – and now Boston University research has shown that also includes what happens in the bedroom. A study of more than 2,000 cisgender women found the coronavirus disease can impair sexual function, with long COVID having an especially detrimental effect.

If you're sick with COVID, you're probably less interested in sex and maybe your body is less prepared to have sex. But what might be surprising to some folks is that long COVID symptoms really may have a physiological and psychological impact on sexual well-being for women."

Amelia M. Stanton, BU College of Arts & Sciences assistant professor of psychological and brain sciences

Although previous research has investigated the effect of the pandemic on peoples' sex lives – particularly in men – Stanton says this is the first study to highlight long COVID's fallout on sexual health in women. An expert on sexual and mental health, she helped lead the study with researchers from Middlebury College, McLean Hospital, and the University of Vermont. The findings were recently published in the Journal of Sexual Medicine.

Long COVID and sexual dysfunction

To figure out COVID's impact on intimacy, Stanton and her colleagues conducted an online survey. Roughly half of the women taking part had reported never having had COVID, the rest said they'd tested positive. Participants were quizzed using the Female Sexual Function Index (FSFI), an established tool that measures factors like arousal and satisfaction with questions such as, "Over the past 4 weeks, how often did you feel sexual desire?" Only women who'd had sex in the previous month were included in the results.

Among those who'd had COVID, levels of desire, arousal, lubrication, and satisfaction were all lower than in those who hadn't; orgasm and pain scores weren't significantly different between the two groups. But while women in the COVID group were still classed within the index's functional range, participants with long COVID had "an average FSFI full scale score in the dysfunctional range," according to the researchers. They found women with long COVID – a broad condition with cognitive and physical symptoms that linger for weeks, sometimes months, after an initial infection – had markedly worse arousal, lubrication, orgasm, and pain scores.

"I hope it's validating. If women type in 'sex long COVID,' something will come up now," says Stanton, who is also a clinical health psychologist at The Fenway Institute, a Boston clinic focused on the health of sexual and gender minorities. "Sex, sexuality, and sexual function are still relatively taboo subjects. But this offers something patients can bring to their providers and say, 'This is going on for me,' and maybe create an open dialogue around sex."

In their paper, Stanton and her colleagues say the results suggest "that COVID-19 infection may be associated with impairment of both cognitive and physiological aspects of sexual function." Just as the body and mind might take some time to get back to firing on all cylinders when it comes to work, study, and exercise, the same may apply to sex. They also speculate that wider societal changes caused by the pandemic may be a factor, with fewer social events and kids hanging around at home more reducing opportunities for shared or solo sexual activities.

Talking about sex

While a COVID infection might impact women's sexual health, previous BU research has found vaccination does not cause infertility, reduce pregnancy chances, or have a significant impact on menstruation.

"COVID-19 vaccination in either partner is unrelated to fertility among couples trying to conceive through intercourse," Amelia Wesselink, an SPH research assistant professor of epidemiology, told The Brink in 2022 when discussing her study on vaccines and fertility. That same research did, however, find that men who'd tested positive for COVID within the past 60 days had reduced fertility.

Stanton is the principal investigator of BU's Sexual, Reproductive, and Mental Health Disparities Program – an effort to explore sexual and mental health in minoritized and marginalized populations – and says possible future routes for the latest project would be to expand the study's sexual and gender minority diversity, talk to women for their qualitative experiences, and design tools to help providers better support their patients.

"I'm an interventionist, so I always think about intervention design as a next step," says Stanton. In other research, she's working to develop new approaches clinicians can use to talk about sex with their patients, as well as studying how to improve sexual well-being and mental health in low-resource communities.

"I always encourage providers to initiate conversations about sex," says Stanton. "If they have someone who's coming in for long COVID, maybe ask, 'How are you doing sexually?' Asking that one question could open the door for people to say, 'You know, I've been ashamed to say that this is going on, and I really need help.' Any way we can iterate to folks that there is hope and there are strategies – your symptoms are meaningful and relevant, and they're important to talk about."