Impacts of COVID-19 on sexual behaviour in Britain: findings from a large, quasi-representative survey (Natsal-COVID)

Objectives Physical restrictions imposed to combat COVID-19 dramatically altered sexual lifestyles but the specific impacts on sexual behaviour are still emerging. We investigated physical and virtual sexual activities, sexual frequency and satisfaction in the 4 months following lockdown in Britain in March 2020 and compared with pre-lockdown. Methods Weighted analyses of web panel survey data collected July/August 2020 from a quota-based sample of 6654 people aged 18–59 years in Britain. Multivariable regression took account of participants’ opportunity for partnered sex, gender and age, to examine their independent associations with perceived changes in sexual frequency and satisfaction. Results Most participants (86.7%) reported some form of sex following lockdown with physical activities more commonly reported than virtual activities (83.7% vs 52.6%). Altogether, 63.2% reported sex with someone (‘partnered sex’) since lockdown, three-quarters of whom were in steady cohabiting relationships. With decreasing relationship formality, partnered sex was less frequently reported, while masturbation, sex toy use and virtual activities were more frequently reported. Around half of all participants perceived no change in partnered sex frequency compared with the 3 months pre-lockdown, but this was only one-third among those not cohabiting, who were more likely to report increases in non-partnered activities than those cohabiting. Two-thirds of participants perceived no change in sexual satisfaction; declines were more common among those not cohabiting. Relationship informality and younger age were independently associated with perceiving change, often declines, in sexual frequency and satisfaction. Conclusions Our quasi-representative study of the British population found a substantial minority reported significant shifts in sexual repertoires, frequency and satisfaction following the introduction of COVID-19 restrictions. However, these negative changes were perceived by some more than others; predominantly those not cohabiting and the young. As these groups are most likely to experience adverse sexual health, it is important to monitor behaviour as restrictions ease to understand the longer term consequences, including for health services.


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Appendix 1: Timeline of Natsal-COVID study and COVID-19 restrictions in Britain Created by the authors by adapting a figure created by Dr Caisey Pulford, Senior Surveillance and Prevention Scientist at Public Health England, who provided permission for the authors to do so. All others figures and tables created by the authors.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) CI=confidence intervals. ǂ Denominator: All men/women (including trans men/women) ∞ 24 participants who identified "in another way" are included in data presented for all participants but excluded from "Men" and "Women". Trans men and trans women are included in data for men and women, respectively.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Of those who did, frequency since lockdown**:  Of those who did, frequency since lockdown**: Denominator (  Of those who did, frequency since lockdown**: Of those who did, frequency since lockdown**: Denominator ( Of those who did, frequency since lockdown**:

Mercer CH
CI=confidence intervals· * Denominator: All respondents ** Denominator: All respondents who reported the activity in lockdown † Reported at least one of the following since lockdown: vaginal, anal or oral sex, other contact with someone's genital area, masturbating, using sex toys (by yourself or with someone else) † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, looking at pornography, paying for online sexual services (e.g. live streaming) † † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, paying for online sexual services (e.g. live streaming) ǂ ǂ Unweighted denominator <30· Results not shown due to small denominator· BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Of those who did, frequency since lockdown**: Of those who did, frequency since lockdown**: Of those who did, frequency since lockdown**:  Of those who did, frequency since lockdown**:  Of those who did, frequency since lockdown**: Denominator ( Of those who did, frequency since lockdown**:  Of those who did, frequency since lockdown**: Denominator ( Of those who did, frequency since lockdown**: CI=confidence intervals. ∞ 24 participants who identified "in another way" are included in data presented for all participants but excluded from "Men" and "Women". Trans men and trans women are included in data for men and women, respectively. * Denominator: All respondents ** Denominator: All respondents who reported the activity in lockdown † Reported at least one of the following since lockdown: vaginal, anal or oral sex, other contact with someone's genital area, masturbating, using sex toys (by yourself or with someone else) † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, looking at pornography, paying for online sexual services (e.g. live streaming) † † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, paying for online sexual services (e.g. live streaming) ǂ Unweighted denominator <50. Results should be interpreted with caution due to small denominator. ǂ ǂ Unweighted denominator <30. Results not shown due to small denominator.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Denominator ( CI=confidence intervals. * Denominator: All respondents † Reported at least one of the following since lockdown: vaginal, anal or oral sex, other contact with someone's genital area, masturbating, using sex toys (by yourself or with someone else) † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, looking at pornography, paying for online sexual services (e.g. live streaming) † † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, paying for online sexual services (e.g. live streaming) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Denominator ( Denominator ( CI=confidence intervals. * Denominator: All respondents † Reported at least one of the following since lockdown: vaginal, anal or oral sex, other contact with someone's genital area, masturbating, using sex toys (by yourself or with someone else) † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, looking at pornography, paying for online sexual services (e.g. live streaming) † † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, paying for online sexual services (e.g. live streaming) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Denominator ( CI=confidence intervals. * Denominator: All respondents † Reported at least one of the following since lockdown: vaginal, anal or oral sex, other contact with someone's genital area, masturbating, using sex toys (by yourself or with someone else) † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, looking at pornography, paying for online sexual services (e.g. live streaming) † † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, paying for online sexual services (e.g. live streaming) ǂ Unweighted denominator <50. Results should be interpreted with caution due to small denominator.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance CI=confidence intervals. * Denominator: All respondents † Reported at least one of the following since lockdown: vaginal, anal or oral sex, other contact with someone's genital area, masturbating, using sex toys (by yourself or with someone else) † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, looking at pornography, paying for online sexual services (e.g. live streaming) † † † Reported at least one of the following since lockdown: messaging via dating apps/online, sexting (images or recorded videos), using video or voice calls to interact with someone sexually, paying for online sexual services (e.g. live streaming) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance CI=confidence intervals. ∞ 24 participants who identified "in another way" are included in data presented for all participants but excluded from "Men" and "Women". Trans men and trans women are included in data for men and women, respectively. * Denominator: All respondents (excluding those with no partnered experience ever) who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease· ** Denominator: All respondents who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease ǂ Unweighted denominator <50. Results should be interpreted with caution due to small denominator. ǂ ǂ Unweighted denominator <30. Results not shown due to small denominator.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) CI=confidence intervals. ∞ 24 participants who identified "in another way" are included in data presented for all participants but excluded from "Men" and "Women". Trans men and trans women are included in data for men and women, respectively. * Denominator: All respondents (excluding those with no partnered experience ever) who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease· ** Denominator: All respondents who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease ǂ Unweighted denominator <50. Results should be interpreted with caution due to small denominator. ǂ ǂ Unweighted denominator <30. Results not shown due to small denominator.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) CI=confidence intervals. * Denominator: All respondents (excluding those with no partnered experience ever) who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease. ** Denominator: All respondents who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease ǂ Unweighted denominator <50. Results should be interpreted with caution due to small denominator. ǂ ǂ Unweighted denominator <30. Results not shown due to small denominator BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) CI=confidence intervals. * Denominator: All respondents (excluding those with no partnered experience ever) who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease. ** Denominator: All respondents who reported the activity since lockdown OR did not do the activity during lockdown and reported a decrease ǂ Unweighted denominator <50. Results should be interpreted with caution due to small denominator. ǂ ǂ Unweighted denominator <30. Results not shown due to small denominator BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) ⁑ Denominator: All respondents who reported partnered sex ever (excluding those missing/ 'did not answer' question on change in frequency) ⸹ Adjusted for RAG -relationship status, age and gender ꜛExcluded from analysis as this group reported no partnered sex since lockdown, therefore would not have the opportunity to report an increase.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)