Abstract
Restriction measures enacted during the COVID-19 pandemic had severe effects on male sexual and reproductive health. We aimed to investigate the real-life impact and perception of sexual function in 2020 in Italy, as the first Western country experiencing a national lockdown by measuring relative search volume for keywords pertaining to sexual health and behaviors provided by Google Trends and sales data for pro-erectile treatments. No significant change was observed for erectile dysfunction and premature ejaculation. Interest towards most phosphodiesterase type 5 inhibitors decreased significantly during lockdown (e.g., sildenafil, p = 0.0002; tadalafil p = 0.0016), then reverted to pre-lockdown levels (e.g., sildenafil, p < 0.0001; tadalafil p < 0.0001), mirroring a concomitant sales decrement (p = 0.0292). A subsequent recovery to previous levels at the end of the social confinement was also found (e.g., after vs. before lockdown, sildenafil, p = 0.8459; tadalafil p = 0.1166). During lockdown, interest towards pornography significantly increased during restrictions (p = 0.0053) and remained high (after vs. before lockdown, p = 0.0004), whereas interest towards paid and casual sex declined (p = 0.0015 and p = 0.049, respectively), then reverted to previous levels (after vs. before lockdown, p = 0.3969 and 0.8373, respectively). During the first Italian lockdown, we observed a transient but measurable decrease of sexual health-seeking behaviors and changes in sexual behaviors, with unknown impact for sexual medicine and public health.
Highlights
The same findings were confirmed by using tadalafil and its most common brand name as keywords: queries during lockdown were decreased compared to before (p = 0.0007 and p = 0.0016, respectively) and after lockdown (p = 0.0012, p < 0.0001), but no significant change was found comparing search volume from before lockdown and after lockdown (p = 0.1004 and p = 0.1166)
We report that general interest towards erectile dysfunction (ED) and premature ejacfound for queries for sildenafil and tadalafil, using either the molecule or the most common ulation (PE) did not change during lockdown, but a significant, U-shaped trend was found brand name
The decrease in Google queries for pro-erectile medications together with the sales reduction is a clear sign of reduced health-seeking behaviors in Italy, possibly because of lockdown rather than of a reduced prevalence of sexual dysfunctions that have been found to be significantly increased [22] in the same context
Summary
Was the first Western country to be struck by COVID-19, with the first cases being reported since February, 2020 [1]. From these initial cases, the pandemic quickly spread throughout all of the country [2], and a lockdown, i.e., a nationwide community containment restricting the population from moving except for well-defined reasons [3], was enforced between 9 March and 3 May 2020. While potentially able to minimize potential exposure, lockdowns bear negative consequences on a personal and social level. The pandemic itself, with the fear for the new infection; the constriction in small apartments; the feeling of isolation; the
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