Sexual expression and the COVID-19 pandemic: The future of sexual intimacy after the COVID-19 pandemic.

Humans, as social beings, rely on interaction in order to survive and "flourish". By nature, they are "weak" and when in solitary, their freedom is jeopardized. Connecting with others, intimacy, physical contact, and the sense of belonging are core needs, and once recognized as such, they ultimately serve one's freedom. In this context, social interaction serves as a fundamental factor for survival. The creation of bonds improves one's position in the evolutionary process, and paves the way towards the ultimate "goal" of existence. The COVID-19 pandemic and the measures to control its spread have disrupted every aspect of human activity. Social, academic, cultural, business, and economic activities have been drastically modified.1 The conscious experience of the threat of life has been a ubiquitous "dramatic reminder of human vulnerability". The environment became unintelligible, death was "present" at all times. People tried to find a new meaning of life and discover a new sense of self-worth. The triggered vulnerability, the isolation from friends and relatives that to date validated one's self-esteem, the unprecedented obstacles with respect to career goals, and unexpected job losses affected the global view of things.1 The restrictive measures and the resulting urgent vaccination created "dystopian" conditions, under which deriving pleasure became a luxury. Scientific data have shown that social distancing has led to high levels of psychological distress. Primary research conducted during the social restrictions as well as subsequent meta-analytical studies have revealed increased irritability, emotional instability, and ultimately an increase in emotional and anxiety disorders' prevalence.2 Undoubtedly, mental and sexual health share a strong and bidirectional relationship.3 International health organizations emphasize the positive impact of a healthy sexual life on psychological well-being. Sexual well-being can serve - along with other factors - as a protective measure against the development of psychopathology, while stable sexual activity acts as a safeguard for well-being in general. The negative relationship between psychological symptoms and sexual gratification has been repeatedly documented by research, highlighting the impact of anxiety on sexual desire, arousal, and overall satisfaction with sexual life.4 Given this relationship and the increased emotional vulnerability during the pandemic, one might wonder how this reciprocal path has been affected. Physical intimacy, one of the basic expressions of the connection between partners, could not remain unaffected. During the first year of the pandemic and the restrictive measures, it became difficult for partners to meet. Due to the measures and discouragement of gatherings, a strong fear of infection gradually developed and avoidance behaviors emerged. In some countries, there were recommendations for physical-sexual interactions' limitation, and use of masks in intimate situations.5 The end result of these circumstances was that one in three individuals demonstrated such fear that they completely avoided engaging in sexual contact with the person they desired, even in cases they cohabited.6 The anxiety and reduced quality of life seemed to affect sexual function, especially aspects related to sexual desire and arousal. The fear and anxiety caused by the constant threat to life deprived individuals of the ability to derive satisfaction from intimate relationships, guiding sexual expression towards a safer "self-centered" orientation. As a result, self-gratification through masturbation increased for both single individuals as well as for stable, cohabiting partners.7 On the other hand, the newly formed living conditions served as a "vehicle' in an attempt to search for new paths towards pleasure. People, as in every past crisis, needed to "reinvent" themselves in order to adapt. Given that every sexual contact is a multi-sensory experience as well as a means of psychological discharge, they searched for or even created new paths that led to sexual release. The concept of "virtual sexuality" emerged even more strongly than it did before the pandemic. The pre-existing use of digital sexual content, which priorly simply facilitated individual sexual practices, took another form. The use of interactive technologies allowed people to create and share - in most cases for the first time - their personal erotic content.8 The internet emerged as an effective substitute for the discharge of sexual desire for people not in a stable romantic relationship, while for those with a stable partner in some cases facilitated their relationships, but for most of them prolonged behaviors of fear and avoidance of intimacy. The human need for connection, love, flirting, and sexual expression cannot be eliminated. The questions that arise whether the changes that have occurred are permanent, whether the need for real-life, physical contact has decreased, and whether the ways through which people connect with others have been permanently modified. It is possible that sexual intimacy is now conceptualized and experienced as something different, and perhaps the pandemic is a causal factor and a strong catalyst for a predetermined change of course with respect to close relationships. In any case, the clinical significance of the dynamic interaction between sexual factors and psychological well-being must be understood in depth. As mental health professionals, we must take into account the altered or new aspects of sexual expression, and with scientific rigor and respect for human nature, we should keep highlighting the unbreakable bond between sexuality and quality of life. We must recognize the timeless human need for intimacy and meaningful, stable connections, irrespective of threatening factors and uncertainty caused by conditions such as the recent pandemic.