Sexual health and behaviors in the COVID-19 pandemic era: a systematic review protocol

doi:10.21203/rs.3.rs-885709/v1

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Sexual health and behaviors in the COVID-19 pandemic era: a systematic review protocol

https://doi.org/10.21203/rs.3.rs-885709/v1

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Background: Sexual health as an essential component of life, has been affected by COVID-19 pandemic. Changing in sexual life has consequences for couples and society. A critical review of current literature on sexual function in general populations will shed light on possible determinants as well as at-risk groups. Thus, the aim of this systematic review is to assess the consequences of COVID-19 on sexual and reproductive health.

Methods/Design: A systematic review of literature on data reporting changings of individuals’ sexual life during the COVID-19 pandemic will be performed. The scientific databases of PubMed, Embase, Scopus, Web of Science, ScienceDirect, the World Health Organization, as well as protocols and guideline related to sexual health, behaviors, function and practices will be systematically searched from the onset of the disease in the world until August 15, 2021. We will consider, appraise, and synthesize studies including the change of sexual function and behaviour (physical, emotional, mental and relational health), SRH-care and services (contraception, birth control, STIs management), and sexual rights (gender-based and sexual minorities violence). Screening of search results and extraction of data from included studies will be conducted cooperatively by two authors. The quality of the studies will be appraised and documented. Results will be compiled and presented in evidence tables. Risk of bias (the quality assessment) will be evaluated by two review authors using the Critical Appraisal Skills Programme (CASP) tool. This protocol has been conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P) guidelines. Also, this protocol is registered in PROSPERO with number CRD42021275387.

Discussion: Given the potential impacts of the COVID-19 pandemic on the people’s sexual life and reproductive health, this review aims to provide accurate information on different aspects of sexual function and behavior in populations from various age groups, cultures, and sexual orientations sexual health and reproductive care delivery (contraception, and birth control, SDTs management) and sexual rights (gender-based and sexual minority, sexual violence) to provide a better understanding of COVID-19 pandemic’s effect on people’s sexual lives The findings could be used by health planners and health care providers to address the adverse effects of this period on reproductive health and sexual lives.

Systematic review registration: PROSPERO CRD42021275387

Infectious Diseases

COVID-19

Systematic review

Sexual function

Sexual behavior

Sexual health

Introduction

The COVID-19 pandemic is considered as one of the most major health problems with the significant effect on the general population well-being (1, 2). It was identified by World Health Organization (WHO) as a worldwide pandemic on March 11, 2020 (3). Based on the official data sources, the rate and severity of this disease were demonstrated to be high in all countries (3). Worldwide, approximately 208 million infections (confirmed cases) and 4.37 million deaths have been reported to the WHO, as of August 18, 2021 (3, 4). This pandemic event affects general population life and values and has a significant negative influence on their psychological, emotional and socioeconomic status. People reported more anxiety and high stress in their daily living (5, 6). Fear of death, fear of contagion, weight increase due to the physical inactivity, alteration of sleep patterns, fear of losing the job are the most important consequences of COVID-19 disease in general (7).

Various signs and symptoms were reported for corona virus from mild to severe in all ages (7). The respiratory system is infected via direct contact with contaminated objects and therefore, wide range of outputs were demonstrated for this infection from mild to severe illness into death specifically among the most vulnerable people (4). During this pandemic period of coronavirus, societies have experienced stay-at-home directions, isolation, non-necessary professions shut down, unemployment, and lower income (8). Social distancing has changed people lifestyles and habits. Individuals may experience loss of relatives, life-threatening situations, poor mental health, activity limitations, and separation from partners or family (9). This isolation reduces the people’s healthcare seeking and the tendency of people to have sex is reported to be increased (10, 11). According to the previous studies findings, the sexual behavior was determined to be risky during lockdown resulted in sexual dissatisfaction and dysfunction, many unplanned and unwanted pregnancies, several contacting sexually transmitted infections and also deterioration of people’s quality of life (12, 13).

Some previous studies conducted on the effect of COVID-19 on sexual behavior in general population (14, 15). The findings of study carried out by Baran and Aykac in 2021 demonstrated that Turkish men reported fear of infection and disease transmission to the partner during COVID-19 pandemic and also the rate and quality of their sex decreased (16). The results of another study conducted by Bonato et al 2021, on Italian people, showed the significant increase in early phase of syphilis and all participants reported that they had unprotected sex (17).

To date, there is little information about the effect of corona virus on sexual behavior and function, but there are some gaps and conflicts about the effect of COVID-19 on: consultation and sexual and reproductive health (SRH) care services, sexual stigma and receiving proper care; sexual and reproductive rules and regulations; social distancing and isolation on people harshness, couple conflict, partner strategies and unfaithfulness; the socioeconomic impact on SRH in general populations, risky sexual behaviors, especially among high-risk groups such as young people, lesbian, gay, bisexual, and transgender people, refugees and migrants, the poor and uninsured, and people who are living with HIV and other STIs; and the impact of education and workplace remoteness on sexual health, and sexual quality (18).

According to the effect of COVID-19 on sexual behavior in general and high-risk populations, lack of obvious information about this issue and also the presence of many gaps and conflicts in the previous studies conducted on sexual health during COVID-19 pandemic, the purpose of the present study was to systematically review the sexual behaviors and changes in sexual and reproductive health during the COVID-19 pandemic.

Protocol and registration

The methods of this systematic review have been developed according to recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021275387.

Objective

The objective of this systematic review is to identify the impact of Covid-19 pandemic on sexual health and behaviors.

Search strategy

A systematic literature search carried out using the databases of PubMed, Embase, Scopus, Web of Science, ScienceDirect, the World Health Organization, as well as protocols and guideline related to sexual health, behaviors, function and practices from the beginning of the disease outbreak to 15 August, 2021. We also conduct hand searches from the reference lists of retrieved studies of journals or conference proceedings. In addition, gray literature and resource lists of related articles scanned to make sure complete coverage of the literature. Finally, reference lists have been searched manually for relevant studies. For a list of terms which have been searched, see Supplementary file 1.

Selection criteria

The population include adults and adolescents regarding of their age, gender, job, and sexual orientation. Randomized controlled trials (RCTs), nonrandomized studies, cross-sectionals, single case series, and case-control studies will be included in this systematic review. This review will report the sexual life of people during the COVID-19 pandemics. There is no geographical limitation on the included studies and only publications in the English language will be included.

Study selection

Search results were imported into Endnote. Two reviewer screened titles and abstracts for their potential relevance. In case of any uncertainty at this stage, the article remained included until the full text is reviewed. Articles identified through reference lists of included studies and relevant systematic reviews will be considered for inclusion on the basis of their title. Four reviewers (MKV, SQE, KQ, and SN) will then assess the full text of all articles identified in the screening process for potential inclusion. Where information pertinent to inclusion criteria is not contained within the article text, the effort will be made to contact the listed corresponding author. Where no reply is received, the article will be excluded. Consensus between the authors undertaking review of the study will need to be reached before the article is included. Inclusion disagreement will be discussed and resolved by consensus or arbitration by another investigator (ASH). A PRISMA flow chart of the study selection process will be prepared, and a log of excluded studies will be maintained.

Data extraction

Data will be extracted from the included studies using a pre-designed, pilot-tested electronic data form (Microsoft Access). The form has been pilot-tested on ten randomly selected publications on the sexual behaviors of people during COVID-19 pandemics era. Based on the results of the pilot test, the form was revised by the authors. Using the electronic form, three review authors will extract the data from the included studies and another author (ASH) will validate the extracted data. Disagreements will be resolved by discussion between the reviewers; if no agreement can be reached, consensus will be sought through discussions with another author (ASH). Data will be extracted on the following:

1. Publication details: author(s), country in which the study was conducted

2. Design: type of study (RCT, cross-sectional, cohort, case-control), eligibility (inclusion and exclusion criteria), name of assessment tool(s), validation of assessment tool(s)

3. Study participant details: number and the group of persons interviewed or surveyed, population characteristics including age, relationship status, demographic information

4. Data for outcome measures: the change of sexual function and behaviour (physical, emotional, mental and relational health), SRH-care and services (contraception, birth control, STIs management), and sexual rights (gender-based and sexual minorities violence).

5. Limitations: selection bias, response bias, information bias, limitations of assessment instrument(s) used

Assessment of methodological quality (risk of bias)

For quality assessment the Critical Appraisal Skills Programme (CASP) tool will be used to assess the methodological quality of the selected studies by two reviewers independently. The consensus meeting will resolve any disagreement. If we encounter other types of studies, tools appropriate to that type of study will also be used such as The National Institutes of Health (NIH) (19).

Data synthesis

Descriptive analyzes will be performed, and the characteristics of the included studies will be reported in summary tables and narrative text. If more than three studies report similar outcomes, a meta-analysis will be conducted. Data management and statistical analysis will be undertaken using the Review Manager, RevMan 5.4.1 (the Cochrane Collaboration) or R Software (R Foundation for Statistical Computing, Vienna, Austria) with the “metafor” package (20). After conducting a systematic review and determining the frequency of each of the reported outcomes, pooled prevalence/incidence for all outcomes of interest will be computed applying random-effects meta-analysis models. Considerable variation is expected to see among studies and heterogeneity within included studies will be assessed using the I² statistic and visual inspection of forest plots (21). Depending on data availability, we plan to account for heterogeneity conducting—where relevant and possible—meta-regressions and subgroup analysis according population, sex, age groups, and other risk factors for which data are available. Funnel plots, Begg’s adjusted rank correlation, and Egger’s test will be used for the investigation of Publication bias (P <0.10). The “trim-and-fill” method will be used to evaluate the level of the bias, If publication bias is detected (22). Sensitivity analysis will be performed to consider the effect of dropping weaker study designs and studies at high risk of bias.

This systematic review will analyze the existing research evidence to provide an answer to this question “Has the COVID-19 is affected the sexual health and behaviors of adults and adolescents (regarding of their age, gender, job, and sexual orientation)?” The global response to the COVID-19 pandemic highlighted the health inequality and disproportionate social and economic burden on women, girls, and vulnerable population which affect their health and well-being and sexual function (23-25). Due to the lake of definite treatment and specific vaccine for coronavirus, almost all health attention and health care resources were focused on symptomatic treatment of the disease, social distancing, and personal protective equipment and health protocols, and consequently attention to other aspects of physical and mental health and well-being e.g., sexual and reproductive health was ignored. Little is known about the effects of COVID-19 on sexual health and behaviors in a general and high-risk population, however, evidence supports that the COVID-19 could impair sexual and reproductive health directly and indirectly (26). Given the effects of the COVID-19 pandemic on sexual and reproductive health, the results of this study will provide accurate information on different aspects of sexual function and behavior (physical, mental, …), sexual health and reproductive care delivery (contraception, and birth control, SDTs management, …) and sexual rights (gender-based and sexual minority, sexual violence, …). The findings of this study could be used by health care providers and policymakers to address the COVID related sexual and reproductive problems, and support family health and marital life.

Strengths and Limitations:

The planned systematic review has strengths and weaknesses. Its strengths include independent data extraction by four reviewers, assessment of the quality of the recruited studies, and conducting sensitivity analysis for high risk of bias studies. Using a transparent and reproducible procedure for a rapid systematic review is one of the strengths of this study. The review will be powered by hand searching of the reference lists of retrieved studies, conference proceedings, and covering gray literature as much as possible.

The planned review should be read in line with some limitations. One of the limitations of this review will be including studies published in the English language that may result in missing some studies published in other languages. Also, it is possible that some studies will be missed (for example due to not responding to authors or missing some unpublished studies) and as such not included in the review. Despite a predefined systematic approach, the study will also involve judgments made by reviewers; which can be resulted in bias.

Dissemination

Findings will be disseminated through publication in peer reviewed journals and conference presentations at relevant conferences.

Competing interests

The authors declare they have no competing interests in relation to the planned systematic review.

Authors’ contributions

KQ initiated and conceptualized the study, reviewed previous systematic reviews, and wrote the manuscript. NR advised on background and methodology section and revised the manuscript for important intellectual content. ASH provided insight on epidemiological aspects of the review and helped draft the manuscript. All authors read and approved the final manuscript.

1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. 2020;395(10223):497-506.

2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. 2020;395(10223):507-13.

3. Mota P. Avoiding a new epidemic during a pandemic: The importance of assessing the risk of substance use disorders in the COVID-19 era. Psychiatry research. 2020;290:113142.

4. int/table WHOJ--hcw. WHO coronavirus (COVID-19) dashboard-situation by region, country, territory & area. 2021.

5. Piko BF, Luszczynska A, Fitzpatrick KM. Social inequalities in adolescent depression: The role of parental social support and optimism. International Journal of Social Psychiatry. 2013;59(5):474-81.

6. Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, Ganz F, Torralba R, Oliveira D, et al. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. 2020:1-10.

7. Sandín B, Valiente RM, García-Escalera J, Chorot PJRdPyPC. Impacto psicológico de la pandemia de COVID-19: Efectos negativos y positivos en población española asociados al periodo de confinamiento nacional. 2020;25(1).

8. intelligence C-NIRSTJCd. COVID-19, Australia: epidemiology report 17 (fortnightly reporting period ending 24 may 2020). 2020;44.

9. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. The lancet psychiatry. 2020;7(4):300-2.

10. Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. 2020;18:1-15.

11. Hussein J. COVID-19: What implications for sexual and reproductive health and rights globally? : Taylor & Francis; 2020.

12. Fleming CM, Eisenberg N, Catalano RF, Kosterman R, Cambron C, Hawkins JD, et al. Optimizing assessment of risk and protection for diverse adolescent outcomes: do risk and protective factors for delinquency and substance use also predict risky sexual behavior? 2019;20(5):788-99.

13. Merrill RA, Liang XJC, Review YS. Associations between adolescent media use, mental health, and risky sexual behaviors. 2019;103:1-9.

14. Ballester-Arnal R, Nebot-Garcia JE, Ruiz-Palomino E, Giménez-García C, Gil-Llario MD. “INSIDE” project on sexual health in Spain: the impact of the lockdown Caused by COVID-19. 2020.

15. Bourne PA, Walters K, Scott S, Hibbert C, Burke M, Foster CJGJoTiPF, et al. The Effects of COVID-19 pandemic on the Sexual Behaviour, Sexual Health, and General Health Status of Jamaicans: Has the sexual behaviour of Jamaicans changed, or is it the same as before the COVID-19 pandemic? 2021;2(1).

16. Baran O, Aykac AJIJoCP. The effect of fear of covid‐19 transmission on male sexual behaviour: A cross‐sectional survey study. 2021;75(4):e13889.

17. Bonato F, Ferreli C, Satta R, Rongioletti F, Atzori LJCiD. Syphilis and the COVID-19 pandemic: Did the lockdown stop risky sexual behavior? 2020.

18. Scott-Sheldon LA, Mark KP, Balzarini RN, Welling LLJAosb. Call for proposals: Special issue of archives of sexual behavior on the impact of COVID-19 on sexual health and behavior. 2020;49(5):1393-4.

19. Ma L-L, Wang Y-Y, Yang Z-H, Huang D, Weng H, Zeng X-T. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Medical Research. 2020;7(1):1-11.

20. Viechtbauer W. Conducting meta-analyses in R with the metafor package. Journal of statistical software. 2010;36(3):1-48.

21. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in medicine. 2002;21(11):1539-58.

22. Duval S, Tweedie R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics. 2000;56(2):455-63.

23. Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. Lancet Respir Med. 2020;8(6):547-8.

24. Pareek M, Bangash MN, Pareek N, Pan D, Sze S, Minhas JS, et al. Ethnicity and COVID-19: an urgent public health research priority. Lancet (London, England). 2020;395(10234):1421-2.

25. Phillips Ii G, Felt D, Ruprecht MM, Wang X, Xu J, Pérez-Bill E, et al. Addressing the Disproportionate Impacts of the COVID-19 Pandemic on Sexual and Gender Minority Populations in the United States: Actions Toward Equity. LGBT Health. 2020;7(6):279-82.

26. Li F, Lu H, Zhang Q, Li X, wang T, Liu Q, et al. Impact of COVID-19 on female fertility: a systematic review and meta-analysis protocol. BMJ Open. 2021;11(2):e045524.

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Sexual health and behaviors in the COVID-19 pandemic era: a systematic review protocol

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