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Sex and the Coronavirus: Reader Questions, Answered

Last week, we asked for your questions about sex and the coronavirus. You had many.

Common queries involved the levels of precautions that one could theoretically take to reduce exposure during sex. But don’t worry: It’s hard to imagine we’ll all have to have sex in decontamination suits with appropriate cutouts going forward.

Several people wondered if avoiding kissing or wearing a mask during sex may lower the risk of coronavirus transmission. We don’t know. What we do know is risk starts when you get within six feet. If one person is infectious, the air and the bed — or any surface on which you have sex or sleep — will be contaminated with droplet nuclei.

“But, wait!” some of you have said, “what if we don’t sleep in the same room, and we manage sex standing up, not facing each other and neither of us needs to steady themselves against a surface?” While I salute your core strength, you are still in the same room, breathing the same air — and breathing heavily on each other — and thus you have assumed risk.

“What if I use an N95 mask?” a few of you asked. Please don’t. Health care workers are putting themselves at risk to provide medical care because they don’t have enough of this equipment. If you have a stash of N95s, the sexiest thing to do is to donate them to your local hospital.

Now, on to your other questions.

What is the likelihood of a Covid-19 baby boom around Christmas? Just curious. — Nick, 76, Charleston, S.C.

Highly unlikely.

We’ve all heard about so-called blizzard babies and furlough fertility. The belief is when we’re stuck inside with another person, people quickly turn to sex. And if you are heterosexual, fertile and not using contraception, the result is a baby boom nine months later.

Except, cooped-up conceptions are a myth.

The fable may have originated from the New York City blackout of November 1965, where there were observations of labor and delivery units being deluged nine months later. However, once the data was analyzed, there was actually no baby boom.

But, you may say, what we’re experiencing is different from a single night or two of being homebound because of a blackout or blizzard.

The best comparison is likely from the influenza pandemic of 1918. Afterward, there was a decrease in birthrate of 5 percent to 15 percent in the United States and in three Scandinavian countries.

There are believed to be two causes (keep in mind there may be other factors that have been missed considering we are looking at data from a hundred years ago): first, an increased risk of first trimester miscarriages because of illness during the pandemic (we have no information to tell us there is an increased risk of miscarriage with Covid-19, so please don’t extrapolate and panic).

Second is something we may see again: less sex as a result of stress — economic uncertainty, illness, you name it — and the reduced availability of sexual partners. That one may sound familiar, and thus, a baby boom toward the end of 2020 or in early 2021 seems unlikely.

I’ve read that the protease inhibitor in PrEP protects against coronavirus. Does that mean people on PrEP (or H.I.V.-positive people using the same medications as part of their treatment) can continue to have sex without being as worried? — Nate, 39, London

No.

There is no evidence to suggest the medications in PrEP are useful in protecting against coronavirus.

PrEP, otherwise known as the pre-exposure prophylaxis (PrEP) for H.I.V., involves taking two medications — tenofovir and emtricitabine — every day to protect against H.I.V. exposure from sexual activity. Truvada and Descovy are the two FDA-approved names for this combination of medications.

These two medications may also be taken as part of a treatment regimen for people living with H.I.V. Tenofovir and emtricitabine inhibit the enzyme reverse transcriptase, which is used by H.I.V. to make more copies of itself but is not used by coronaviruses.

Just as not all antibiotics work for all bacteria, not all antiviral medications work for all viruses.

The confusion is understandable considering that two other medications used for H.I.V. — lopinavir and ritonavir, which act on the enzyme proteasehave been investigated as treatment for Covid-19. The first publication did not show benefit, but other research in continuing.

In the meantime, I would assume nothing but distance and hand-washing can protect us against Covid-19, while masks may help us protect others.

What are your thoughts on trying to get pregnant now? — Doug, 33, Somerville, Mass.

Based on limited data, pregnant people don’t seem to be at increased risk for serious illness from coronavirus. However, pregnancy increases the risk of serious outcomes for other respiratory viruses, like influenza, so pregnant people are currently considered an at-risk population for Covid-19. The risk of a preterm birth may also increase if you get sick with Covid-19.

With so many unknowns about what to expect when you are expecting during a pandemic, here are some considerations:

  • Pregnancy increases interactions with the health care system — blood tests, ultrasounds, blood pressure checks — and interactions with the health care system increase your risk of exposure to coronavirus.

    Many medical centers are trying to limit routine in-person visits for the safety of their patients and workers, and are instead conducting some appointments virtually; many are also asking that partners not accompany women to these appointments.

  • If you have an underlying medical condition, like diabetes or high blood pressure, or had a complication, such as preterm delivery, in a prior pregnancy, then you are at higher risk for complications in your next pregnancy and will probably need more access to the heath care system.

  • If you have an unforeseen pregnancy complication, you may need an emergency department. In addition to potentially increasing your risk of exposure, if the hospital is at capacity with coronavirus patients or has no supply of personal protective equipment, there may be an impact on your care.

While most people have uncomplicated pregnancies, I would consider those factors. Many of us have taken for granted the ability to get the medical care we need in a true emergency. We can’t do that anymore.

I’ve seen a lot of articles on sex and the coronavirus, and yet none include guidelines for those of us who are extremely high-risk for complications because of pre-existing conditions. Is sex OK for these groups? Is it better to avoid altogether? I have very severe asthma, some autoimmune issues and a recent history of recurrent, severe pneumonia. What should someone like me know about intimacy during corona times? — Phoebe, 26, Berkeley, Calif.

Unfortunately, we don’t have good recommendations based on specific medical risk factors. It’s not because we haven’t considered these groups — it’s because we currently have substantial knowledge gaps, I’m sorry to say.

As with everyone else — those in low- or high-risk categories — I would recommend no sex with anyone outside your household and no sex with anyone inside your household if they have symptoms (like a dry cough or fever) or if they have a known exposure and are quarantined and/or waiting for testing results.

In your case, if you live with your partner and they are not symptomatic, I would consider their exposure risk: Are they leaving the house? If so, is it to work in a situation with a higher exposure risk? Or if it’s simply to grocery shop, do they take steps to mitigate exposure, like social distancing and practicing good hand hygiene?

And, of course, remember that they could be asymptomatic and still infected.

Furthermore, sex is not the only household activity that could expose you. Unfortunately we don’t know where to rank it, in terms of risk, compared with other activities that happen under the same roof.

What about sharing a meal, considering many of us likely spray droplets when we eat? What about sitting on the same couch watching a funny movie and laughing, which also sprays droplets?

If you are at higher risk because of pre-existing conditions, I would consider these factors and then discuss them with your doctor so you can decide what makes the most sense for you given your health conditions and your living situation. Everyone should pay extra attention to house hygiene — cleaning surfaces after use — as well as hand hygiene, as these actions may help reduce transmission between members of the household.

The more hygiene and distancing measures you can put in place, the lower your risk of transmission.

I heard this advice regarding social distancing and the hygiene measures and it stuck with me: If you feel as if you are doing too much, then you are probably doing it correctly. It’s hard when no one has the answers, but it’s important to acknowledge that uncertainty.


Dr. Jen Gunter is an obstetrician and gynecologist in California. She is the author of the “The Vagina Bible” and writes The Cycle, a column on women’s health that appears regularly in Styles.

Source: NY times

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