Fewer unplanned pregnancies and abortions but more sexual dissatisfaction and distress

The lower prevalence of ‘risky’ sex—with multiple or new partners without using condoms—which occurred during the early stages of the COVID-19 pandemic, was still evident a year after Britain’s first lockdown, reveal the results of a major national survey, published online in the journal Sexually Transmitted Infections.

While there were fewer reported unplanned pregnancies and abortions than indicated by a comparable survey a decade earlier, there were significantly higher prevailing levels of sexual dissatisfaction and worries about their sex life among the respondents.

During the pandemic’s early months, changes in sexual behaviour were primarily due to reduced opportunities to have sex for people not cohabiting with a partner. And most studies found that the frequency of partnered sex declined, overall, note the researchers.

But the timeframe for these studies was too short to reliably detect changes in sexual behaviour and outcomes, such as sexually transmitted infection testing, pregnancy, and abortion.

The Natsal COVID-19 study was conducted in two waves, the first of which was 4 months after the first UK lockdown (July-August 2020) and the second in March-April 2021.

The second wave, which informs this current study, was designed to track behaviour over a longer period and provide 1 year estimates of particular outcomes: patterns of sexual behaviour; sexual health service use; pregnancies, abortions, and fertility management; sexual function and quality of sex life in the year after the first lockdown (which started 23 March) in Britain.

With the aim of achieving a nationally representative sample, 6658 British residents, aged 18–59, completed the online Natsal-COVID-Wave 2 survey. Over 92% had had some lifetime sexual experience.

The responses were compared with those of Natsal-3 (2010-12;15,162 participants aged 16–74), and set against national data on the numbers of recorded sexually transmitted infection tests, conceptions, and abortions in England and Wales between 2010 and 2020.

In the year following the first lockdown, more than two-thirds of survey respondents reported one or more sexual partners (women 72%; men 70%), while fewer than a fifth of all respondents reported a new partner (women around 10.5%; men 17%), compared with a quarter reporting this over the past year in Natsal-3 (women 18%; men 23%).

Respondents also reported less condomless sex with new partners than was the case 10 years earlier. But there were differences by gender in Natsal-COVID-Wave 2.

Nearly half as many women as men reported 2 or more partners in the past year. Women were also around half as likely to report 1 or more new sexual partners and 1 or more new partners with whom they hadn’t used condoms.

The average number of times respondents said they had sex was twice a month compared with 3 in 2010 (Natsal-3), although this average has been falling since 1990, so may reflect a secular trend unrelated to the pandemic, suggest the researchers. 

This pattern of behaviour was particularly noticeable in the young and among gay/bisexual men—groups who tend to have high rates of sexually transmitted infections.

One in 10 women reported a pregnancy—fewer than in 2010–12: these pregnancies were also less likely to be unplanned.  And there were fewer abortions.

Levels of distress and dissatisfaction were common. Nearly 1 in 5 (just over 19%) of women and nearly 1 in 4 (23%) of men said they were distressed or worried about their sex life—significantly more than in 2010–12. 

Dissatisfaction with sex increased with age, rising from 20% and 17%, respectively, among 18–24 year old women and men, to more than 28% and 41.5%, respectively, among 45–59 year old women and men. Levels of distress, however, didn’t change with age.

Around a quarter of men and women felt their sex life during the pandemic was worse than in the previous year. This increased with age for men, but not for women.

Compared with surveillance trends from 2010 to 2019, use of sexual health services and testing for HIV and chlamydia were lower. Only 16% of participants who said they had at least one new partner in Natsal-COVID-2 reported a chlamydia test in the past year compared with nearly 39% of respondents in Natsal-3. 

Comparison with Natsal-3 should be interpreted cautiously, say the researchers as that was a household interviewer-led survey, added to which Natsal-3 data were collected 10 years ago, since when sexual behaviour, sexual mores, and service provision have all changed. 

But, say the researchers: “While all the data sources we report here have limitations, they provide largely consistent evidence about the effects of the pandemic on [sexual and reproductive health].” 

They conclude: “Taken together, these data suggest COVID-19 had a significant influence on sexual and reproductive health, probably through a combination of restrictions on social mixing, disruption to [sexual and reproductive health] services, and pandemic-related uncertainty and stress. However, the longer-term implications are difficult to predict.” 

They add: “These data suggest that recovery should focus on restoring [sexually transmitted infection] prevention behaviours, provision of free or low-cost condoms, catching up on service-provision backlogs, counselling for sexual difficulties, and sex education for young people who missed out during the pandemic.”  


Notes for editors
Sexual and reproductive health in Britain during the first year of the COVID-19 pandemic: cross-sectional population survey (Natsal-COVID-Wave 2) and national surveillance data Doi 10.1136/sextrans-2022-055680
Journal: Sexually Transmitted Infections

Funding: Primarily the Wellcome Trust

Link to AMS press release labelling system:

Externally peer reviewed? Yes
Evidence type: Observational; survey data
Subjects: People