In the wake of conflicting studies on whether or not COVID-19 is present in semen, researchers from three Boston hospitals have released sexual health guidelines describing the riskiest behavior, and offering some unusual advice about when to wear masks. The guidelines, published in the Annals of Internal Medicine, note that any type of in-person sexual activity is a COVID-19 risk factor given the limited data on sexual transmission, and the knowledge that SARS-CoV-2 can spread through saliva, mucus, aerosolized particles or, although less common, by touching the eyes, nose and mouth after touching an infected surface.
The sex-positive study ranks habits from the safest to the riskiest through the CDC’s social distancing model. Sexual abstinence and masturbation are the safest moves, followed by phone or video sex (which comes with its own risks, the authors warn) and sleeping with a live-in partner, if neither has been exposed or is asymptomatic. Sexual activity with a person other than those with whom you’re quarantining is considered the riskiest behavior — and the researchers recommend wearing a face mask in that case.
“We recognize that it may come as an unusual recommendation, but wearing a mask during intercourse with someone from outside the home may reduce risk, as may a range of other strategies, including showering, hand-washing and cleaning surfaces where the virus may reside following sex,” Dr. Jack Turban, lead author and resident physician in psychiatry at Massachusetts General Hospital and McLean Hospital said in an interview with Yahoo Life, adding, “Unfortunately, the virus is easily spread via respiratory particles, making kissing a higher-risk behavior than other intimate acts,”
Despite the risk associated with this type of intimacy, the study encourages doctors to be nonjudgmental when asking patients about their sex lives. “Luckily, public health experts are starting to pay attention to the fact that abstinence-only recommendations are unlikely to be successful and may lead to worse outcomes,” says Turban.
Major health organizations recommend the use of face masks to prevent passing on respiratory droplets that could spread SARS-CoV-2, the virus that causes COVID-19. But while face masks may help mitigate risks for non-live-in sexual partners, experts say it’s not a perfect solution — and note that anyone engaging in sexual activity may be putting themselves at risk. “We’re not saying, ‘Wear a mask and don’t worry,’” Dr. Kenneth Mayer, professor of medicine at Harvard Medical School and one of the authors of the study, states, “More that if you [wear one], you’ll decrease risk.” The study notes that research is mixed on whether or not COVID-19 is present in semen, with one study from China finding virtually zero evidence that it is and another finding the opposite. “Until this is better understood, it would be prudent to consider semen potentially infectious,” the authors wrote.
Dr. Alex Keuroghlian, director of both the National LGBT Health Education Center at the Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program, says that sex may be a hazard for the foreseeable future. “The risks of physical contact among persons not in quarantine with one another will remain very real in the absence of adequate vaccination across the population.” The report results, of course, are not meant as a prescriptive list of sexual do’s and don’ts; rather it provides recommendations for how to slow the spread of SARS-CoV-2. The researchers say couples will have to decide what they’re comfortable doing behind closed doors. “The major takeaway from this paper is that risk lies on a spectrum,” says Turban. “Abstinence is the safest recommendation to prevent the spread of the virus, but for many people this will not be attainable. Sex with those from outside the home is higher risk than sex with those residing in the home, and is one way to decrease risk.”
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