The impact of working in a COVID hospital on sexual functioning in male nurses: A study from North India.

INTRODUCTION: The COVID-19 pandemic has spread to almost all the countries and regions in the world. The fear of getting infected while serving COVID patients and the stress due to separation from family during the quarantine period may impact over sexual functioning of healthcare workers (HCWs).
METHODOLOGY: The study protocol was approved by the institutional ethics committee. This was a nonfunded, cross-sectional, observational study. All participants provided written informed consent. This study was carried out in a multispecialty tertiary teaching hospital in North India. The participants were drawn from married and living with partner male nurses. Sexual functioning was assessed using the changes in sexual functioning questionnaire short-form (CSFQ-14).
RESULTS: The study found that the prevalence of global sexual dysfunction was significantly higher in male nurses who had completed their rotations in the COVID hospital when compared to those who had not. There were no statistically significant differences between the groups on sociodemographic profiles and the profile of their spouses. DISCUSSION: HCWs working in COVID situations are known to suffer from stress, depression, and anxiety. This may impact the sexual functioning of the HCWs, especially when they have been in an infectious environment and the marital dyad may have doubts of the transmission of the infection.
CONCLUSION: Male nurses who have worked in a COVID care setting are likely to report higher levels of sexual dysfunction. Copyright:

The COVID-19 pandemic has spread to almost all the countries and regions in the world. There has been a disproportionate psychosocial impact of COVID-19 on healthcare workers (HCWs).[1] Many studies have shown that there is an increased prevalence of psychological morbidity in the form of anxiety and depressive symptoms.[1] As coronaviruses and COVID-19 are not known to have any direct impact on psychological functioning, it is presumed that much of this morbidity is explainable based on the stress of working in a COVID environment.[23] This stress could be due to various factors such as the fear of death and disease, the stigma associated with COVID-19, and the fear of spreading the infection to family members among others.[4]

It is known that psychosocial stress concerning the working environment may impact sexual functioning.[5] Working in a COVID care setting is likely to represent significant stress and may impact sexual functioning. As per current evidence, COVID-19 is unlikely to have any direct impact on sexual functioning. Sexual dysfunction that is observed in these individuals is likely to be due to psychosocial distress.[6] There is some previous evidence to suggest that stress at the workplace (non-COVID environment) can impact sexual functioning in both men and women.[78] Thus, HCW who has worked in a COVID environment may experience an impact on sexual functioning. A review of literature in this area suggested that while there are studies that have assessed sexual functioning in various populations, the impact of working in a COVID environment on sexual functioning in HCWs has not been studied.[910]

This study was conducted to assess sexual functioning in a population of HCWs who had worked in a COVID hospital in North India.

METHODOLOGY

The study protocol was submitted and approved by the institutional ethics committee. This was a nonfunded, cross-sectional, observational study. All participants provided written informed consent.

Setting

This study was carried out in a multispecialty tertiary teaching hospital in North India. A separate wing of the hospital has been designated a COVID hospital for the district. This is staffed by all categories of the HCWs of the hospital. The usual schedule followed in the COVID hospital is that HCW is withdrawn from their usual place of work and sent to work in the COVID hospital for 1 week which is followed by a period of quarantine of 5 days. During the period of work in COVID hospital and quarantine, the HCWs stay at a designated accommodation provided by the hospital and are not allowed to meet family members, and movement is restricted. At the end of the quarantine, HCW are tested for COVID-19 and on being tested negative are allowed to go back to their families and workplace.

Participants

The participants were drawn from married and living with partner male nurses. One group (cases) had been posted in the COVID hospital, had completed quarantine, and had tested negative. Assessments were done 2–4 weeks after their being tested negative for COVID-19 and allowed to go back to their usual places of work and accommodation. The control population consisted of married male nurses who had not yet been posted to the COVID hospital. There were 100 participants in each group.

Instruments

We used a sociodemographic profile sheet for recording sociodemographic details. Sexual functioning was assessed using the changes in sexual functioning questionnaire short-form (CSFQ-14).[11] This is a commonly used instrument for assessing global sexual dysfunction in a variety of clinical situations. We also assessed the participants for depressive symptoms using the patient health questionnaire-9 (PHQ-9).[12] Both of these are self-rated instruments.

Procedure

Male nurses who had completed their COVID hospital rotation, had mandatory quarantine, and had been tested negative were approached for participation in the study. The controls were also approached for participation. All those who provided written informed consent were assessed on the three instruments mentioned above. We recruited 100 participants in each group. Data were analyzed statistically. Confidentiality was assured.

RESULTS

The mean age of the respondents was 32.02 years (standard deviation [SD] = 3.99) in the COVID group and 32.32 years (SD = 4.07) in the non-COVID group. There were no statistically significant differences between the groups on sociodemographic profiles and the profile of their spouses. There was no reported physical comorbidity in the participants and their partners in the two study groups.

Table 1 presents the scores on the CFSQ-14 and PHQ-9 in the two groups.

Table 1

The scores on the changes in sexual functioning questionnaire-14 and patient health questionnaire-9 in the two groups

Variables	Mean±SD		95% CI (P)
	HCW posted at COVID-19 areas, Group 1	HCW posted at places other than COVID-19 areas, Group 2
Pleasure	4.2±0.9	4.5±0.8	−0.4-0.0 (0.07)
Sexual frequency	8.1±1.1	8.4±1.1	−0.6-0.0 (0.07)
Sexual interest	11.4±1.6	11.7±1.3	−0.6-0.1 (0.24)
Sexual arousal	12.6±1.7	13.0±1.6	−0.8-0.1 (0.10)
Sexual orgasm	12.2±2.0	12.7±1.8	−1.0-0.1 (0.08)
Global sexual dysfunction	48.5±6.1	50.2±4.5	−3.1-−0.1 (0.02)
PHQ score	6.7±4.5	5.2±3.6	0.2-2.5 (0.01)

PHQ – Patient health questionnaire; HCW – Healthcare workers; COVID – Coronavirus disease; SD – Standard deviation

The prevalence of global sexual dysfunction (score <48) was 31 in the COVID group and 16 in the non-COVID group (P << 0.05). The prevalence of moderate and above severity of depressive symptomatology (PHQ score >10) was 24 in the COVID group and 11 in the non-COVID group (P = 0.01). The severity of depression was found to be inversely correlated with the CSFQ-14 score in both groups (overall Pearson's correlation coefficient = −0.48, P << 0.05).

DISCUSSION

Male sexual dysfunction is often associated with systemic illnesses and depression.[13] There is also evidence that stress may impact sexual functioning and marital satisfaction.[14] HCWs working in COVID situations are known to suffer from stress, depression, and anxiety.[15] This may impact the sexual functioning of the HCWs, especially when they have been in an infectious environment and the marital dyad may have doubts about the transmission of the infection. This study was planned to examine the above question by assessing sexual dysfunction in male nurses who have been working in a COVID hospital.

We found that the prevalence of global sexual dysfunction was significantly higher in male nurses who had completed their rotations in the COVID hospital when compared to those who had not. Further, the COVID hospital group had a small significantly higher mean score on global sexual dysfunction. This mean global score was inversely correlated with the severity of depression. The prevalence of depressive morbidity was higher in the COVID hospital group.

While our study was not designed to assess the direction and causality of these phenomena, it is possible that working in a COVID hospital may be associated with sexual dysfunction due to psychological distress as indicated by the depressive symptoms. The possible reasons for psychological morbidity may be the working environment characterized by the danger of infection, morbidity, and mortality in patients, the physical discomfort of wearing personal protective equipment, and staying away from family during the rotation and quarantine. It is also possible that after return from quarantine, the possibility of infection may persist in some and lead to a reduction in or abstinence from sexual activity. Our study suggests that more research is needed into the sexual health, marital adjustment, and emotional impact of working in a COVID environment among HCW.

The study has certain limitations; first, purposive sampling was used to get the sample size which can add bias in the results, which limits it for projections. Second, the study was done exclusively in male nursing officers, which do not determine the sexual dysfunction perspective of female nursing officers.

As health systems globally are overwhelmed by coronavirus disease 2019 (COVID-19), health workers must be protected as “every country's most valuable resource.” Measures to support the enormous psychological burden faced by frontline health workers worldwide are urgently needed.

CONCLUSION

Male nurses who have worked in a COVID care setting are likely to report higher levels of sexual dysfunction.This may have a bearing on their overall functioning and psychological health. Impairment in sexual functioning should be factored into wellness initiatives for this group of personnel.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.