Review 1: "The Sexual Experience of Italian Adults During the COVID-19 Lockdown"

RR:C19 Evidence Scale rating by reviewer:

• Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review:

This study provides a descriptive picture of the self-reported sexual behaviors, experiences and attitudes of Italian adults during the COVID-19 lockdown. As the authors note, the lockdown measures that were enacted across the world have diverse potential implications for sexuality and sexual behavior; they limited much in-person activity, but also brought cohabitating partners into constant proximity and set the stage for discussions about new sexual behaviors and expressions.

The sample consists of 465 adults who responded to an open-ended questionnaire about their sexual activity, desire, masturbation behaviors, use of sexual aids, and awareness after the lockdown ended. They also completed a Sexual Modes Questionnaire (SMQ) instrument asking about the frequency with which certain images or thoughts occurred and their emotional and sexual responses to them. The guiding hypothesis was that the lockdowns would impact sexual behaviors. More specifically, the authors expected that psychological distress would impact interest in sex, that limitations on in-person contact would decrease sexual encounters, that there may be increases in the use of sex toys, and that the lockdown would change desire. Using quantitative and qualitative analytic approaches, the authors find that sexual thoughts and responses during lockdown differed by gender and disability status. Respondents reported a variety of effects of lockdown on their sexual attitudes and behaviors. The authors conclude that sexual experiences in lockdown were largely positive, but highlight the sexual vulnerabilities of disabled persons. The adults in their study did report being psychologically distressed during the pandemic, but many also reported gaining new sexual freedoms and insights.

Although each of the four initial predictions is not distinctly answered, the authors’ conclusions were broadly well-supported by the data. Study participants clearly described the lockdown measures as impacting their sexual attitudes, thoughts, and behaviors in diverse ways, which are overall thoughtfully reported and discussed. It is important to note, however, that the authors do not present data on sexual behaviors/attitudes before the pandemic-related lockdown measures. Thus, the self-reported changes and reflections about lockdown effects are subject to recall biases. Another issue is that it is difficult to distinguish which of the many effects of the COVID19 pandemic—including the lockdown itself, feelings of distress and anxiety, a lack of access to health care and childcare, and losses of income and material resources—impact what attitudes and behaviors. A further limitation is that the sample was not randomly selected. It is not apparent from the current text exactly who would have come across the social media links to the survey, but there are clear sociodemographic patterns in those that responded (i.e., younger, female, and well-educated persons). Adults who elect to respond to such detailed surveys about sexual behaviors may also have more liberal attitudes about sex, additionally impacting the findings. While results for disabled persons are interesting, their small numbers mean they should be interpreted cautiously. Conclusions cannot be drawn about older adults and nonheterosexual persons. It is sometimes difficult to interpret the findings based on the SMQ because such a wide range of thoughts/statements are included, the context in which they are introduced is not explicit, and specific item numbers are mentioned without giving their content.

The figure and supplemental tables, which may have been separate files, did not appear in the document I received, so I cannot comment on these.

These considerations qualify the conclusions somewhat, but do not undermine the important contributions of this study. One significant strength is that the study incorporates both qualitative and quantitative data, a commendable strategy to capture a multifaceted and complex category of life experiences and represent it empirically. The literature review is thorough and informative, and the authors appropriately highlight the specific contributions of their study. The findings add to our understanding of the many profound ways that the COVID-19 pandemic affected our personal lives and interpersonal relationships, and suggest that these experiences may have longterm implications for how individuals approach sex. More broadly, the study offers insight to the sometimes surprising ways that a period of social isolation can affect relationships to sex and sexuality.