July 2020

While many states across the country are easing COVID-19-related restrictions and businesses are beginning to open up, the threat posed by the pandemic is still present. Data as of late June showed that the daily number of new coronavirus cases was climbing in 22 states. But with restrictions loosening and people emerging from quarantine, what do you tell your patients who ask —is sex safe? The question is explored by ASHA­­­­—the American Sexual Health Association.[i] (The authors of Contraceptive Technology are pleased to partner with ASHA for our September virtual conference.)

The answer, in short—it can be, but experts say any type of in-person sexual activity does carry some risk. But there are ways to have intimate contact and remain connected.

How is it transmitted?

Let’s start with what we know right now. COVID-19 is a respiratory disease, so direct contact with saliva—through kissing, for example—can easily pass the virus. While COVID-19 has not yet been found in vaginal fluid, it has been found in feces of people who are infected. So this means that rimming (oral/anal contact) and anal sex may spread COVID-19 as well. Remember that condoms and dental dams reduce contact with saliva and feces during anal and oral sex or oral/anal contact.

A recent study has also found the coronavirus in semen, both in men who had active infections and those who had recovered, but it isn’t clear at this point if it can be sexually transmitted through semen.

What’s the risk?

So where does that leave us? With different levels of risk. Given we currently know about COVID-19 and how it’s transmitted, the safest sexual activity is solo or remote. Solo sex (a.k.a. masturbation) can be both satisfying and safe—just remember to wash your hands! And technology makes different types of remote options, like video chats, sexting, available too.

The next safest option is sex with someone you already live with, provided that person is also taking steps to reduce their potential exposure to COVID-19 (like social distancing, hand washing, wearing a mask in public spaces).

The New York City Department of Health and Mental Hygiene has some excellent guidance (recently updated) on safer sex during these times, which you can read in full here. But here are a few basic tips from NYC Health on how to enjoy sex and to avoid spreading COVID-19:

• You are your safest sex partner. Masturbation will not spread COVID-19, especially if you wash your hands (and any sex toys) with soap and water for at least 20 seconds before and after sex.
• The next safest partner is someone you live with. Having close contact—including sex—with only a small circle of people helps prevent spreading COVID-19. All partners should be consenting.
• You should limit close contact—including sex—with anyone outside your household. If you do have sex with others, have as few partners as possible and pick partners you trust. Talk about COVID-19 risk like you would other safer sex topics (e.g. PrEP, condoms). So ask: do they have symptoms or have they had symptoms in the last 14 days? Have they been diagnosed with COVID-19? People are considered likely no longer infectious if at least 10 days have passed since the day their symptoms started and if they have not had fever for at least three days.
• If you usually meet your sex partners online or make a living by having sex, consider taking a break from in-person dates. Video dates, sexting or chat rooms may be options for you.

See the full guidance doc from the NYC Department of Health for more on staying safe.

ASHA expert H. Hunter Handsfield, MD, also offers some good summary advice: “We would strongly recommend sexually active persons be very selective in their sexual partnerships, pay attention to partners’ health, and limit new partnerships to the fewest possible. The lowest sexual risk of course will exist for mutually monogamous couples.”

For couples from whom pregnancy is a concern, don’t forget contraception as well. Once again, condoms can fill that role, and telemedicine options are available as well, if you can’t venture out to a clinic or pharmacy. Emergency contraception is an important option for anyone who experiences unprotected, underprotected, or forced sex. In their fact sheet on EC in the COVID-19 Era, the American Society for Emergency Contraception recommends keeping a supply on EC on hand before you need it, especially when heading to a pharmacy or clinic may feel risky or appointments may be harder to come by.

Relationships Under Lockdown

Some of you may be thinking, “Sex?! Are you kidding? My partner is driving me crazy!” You’re not alone. Even couples with healthy, strong relationships may find themselves under strain during this time—struggling with being confined 24/7 under stay-at-home orders. Others may be pressed because of distance, forced to live apart due to health concerns or quarantine.

If you’re feeling the stress, there are resources to help. You can get tips on how to respect and help one another and disagree fairly. If you need more support, you can find a counselor who can offer phone or online support.

COVID-19 restrictions can be particularly dangerous for those in abusive relationships. The National Domestic Violence Hotline cites specific ways the pandemic can a survivor of intimate partner violence, from an abuser withholding necessary items or threatening to cancel health insurance, to the lack available shelters due to COVID-related closures.

The National Sexual Health Coalition suggests taking specific steps to stay safe in this situation, including making some space between you and you abuser by taking walks or a drive if possible and They also suggest making an a safety plan and having an emergency bag ready in case you need to leave your home quickly. Loveisrespect.org has an Interactive Guide to Safety Planning that can take you a series of steps and identify your safety options.

A Note of Caution for Parents

With schools cancelled across the country, many kids are spending more time online, possibly with less supervision than usual as parents are struggling to work remotely while caring for children. For this reason, law enforcement has warned that kids are particularly vulnerable to online predators at this time. Some reports suggest an increase in digital activity among sexual predators who target children.

So what can parents do? Talk to your kids about the risks and help them learn how to identify “red flag behavior” in people they may meet online, like asking for personal information or encouraging secrecy. Be an askable parent—willing to talk to your kids without judgement or shame.

The Global Partnership to End Violence Against Children has an extensive list of resources for parents to help their kids stay safe online, including how to access privacy and security settings on a number of apps and online platforms as well as ways to block and report users.

More resources

• Intimacy, sex, and COVID-19 from Harvard Health
• COVID-19 and Your Sexual Health from Planned Parenthood
• COVID-19 and Your Sexual Health from Fenway Health
• Sex and Coronavirus (COVID-19) from Avert
• Prevention, Relationships, and Accessing Services from the National Coalition for Sexual Health
• EC in the COVID-19 Era from the American Society for Emergency Contraception

(The authors of Contraceptive Technology are pleased to partner with ASHA for our September virtual conference!)

[i] American Sexual Health Association. Sex in the time of Covid-19. Accessed June 24, 2020.  This page continues to be updated to reflect new information and guidance on COVID-19 as it becomes available.