how did they do reasearch? based on attached image 1852INTRODUCTIONThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was recognized in January 2020 as the agent responsiblefor the coronavirus disease (COVID-19), whose worldwide out-break led to the declaration of a global pandemic by the WorldHealth Organization (WHO) on March 11, 2020.¹ In responseto the COVID-19 pandemic, governments across the globe haveimplemented strict measures limiting physical interpersonal con-tact to reduce the spread of the virus. Human sexual behavior islikely affected by such measures, which has raised concern amongsexual health experts regarding the negative outcomes the pan-demic may have on sexual health.² Specifically, sexual health |pro-fessionals are concerned about increases in sexual dysfunctionand relationship conflict, as well as a negative impact on access tosexual healthcare.³ In addition, there is concern that quarantinemeasures and increases in relationship conflict may lead to anincrease in intimateviolence.partnerPreliminary evidence has supported some of these experts'concerns. For instance, one recent national survey in the UnitedStates found that 34% of individuals in a relationship reportedrelationship conflict due to COVID-19, and couples with moreconflict also reported greater decrease in solitary and partneredsexual activities. Another survey of married individuals in theUnited States found that 32% of respondents reported COVID-19 was straining their marriage. However, 74% also reportedfeeling the pandemic was strengthening their relationship, andthe impact on sexual frequency was mixed, with 32% reportingan increase and 20% reporting a decrease. Interestingly, a recentlongitudinal survey found that stress related to COVID-19 pre-dicted both increased relationship satisfaction as well as decreasedsex drive and sexual activity at both the within-person andbetween-person levels.8Other preliminary evidence, from both the United States andother countries, has suggested that additional changes to sexualbehavior are occurring, such as decreased casual sex,¹0 andincreased use of pornography and sexting/cybersex. 12 The pan-demic may also facilitate experimentation with new ways of relat-ing to others socially as well as sexually. For example, Lehmilleret al¹² found that engaging in novel sexual activities during thepandemic (such as new sexual positions, sharing fantasies, orusing technology) was protective against the pandemic's deleteri-ous effects on sexual satisfaction.Nevertheless, there remain few studies examining the impact ofthe COVID-19 pandemic on sexual health in the United States,and many studies have methodological deficiencies including smallconvenience samples that overrepresent or are limited to certaindemographics such as women LGBTQ+ individuals 9,12,13 ormarried couples. In addition, studies published to date werelargely conducted in the first few months of the pandemic whenlockdown measures were just starting to take effect.Since the public health response to this pandemic alsorequires attention to sexual health as a fundamental pillar ofGleason et alphysical and mental well-being, the aim of this study is toanalyze the impact of COVID-19 on the sexual behaviors,sexual functioning, and intimate partner violence in theUnited States. This study adds to the findings of previousresearch by collecting a large national convenience sampleand examining a wide variety of sexual behaviors severalmonths into the pandemic. During this period (October2020), individuals and government had been given numerousmonths to adapt to the novel circumstances, and many statesin the United States had eased lockdown restrictions aftersummer surges in COVID-19 cases had subsided. Thus, col-lecting data in this period provides the opportunity toobserve how COVID-19 continued to impact sexual behav-iors after several months. Given the exploratory nature ofthis study and the limited prior research, specific a priorihypotheses were not generated. Rather, this study aimed toanswer the question: How has the COVID-19 pandemicimpacted the frequency of various partnered and solitary sex-ual behaviors, sexual functioning and satisfaction, relationshipsatisfaction, and intimate partner violence?METHODSParticipantsApproval for this study was obtained from [sponsor insti-tution's] IRB. Participants were recruited from the AmazonMechanical Turk (Mturk) platform. This platform allows ver-ified workers to accept tasks from requesters in exchange forpayments to their Mturk accounts. A total of 1,474 surveyswere started. Of these, 177 surveys were incomplete, 33 wereeliminated due to participants taking the survey twice, 250surveys were rejected due to incorrect responses to the atten-tion check questions, and 23 were excluded from analysisbecause no sexual behaviors were reported. This resulted in asample of 1,051 participants from 48 U.S. states. Fulldescriptive statistics for participant demographics are listed inTable 1.ProcedureMturk workers were recruited to complete the survey andwere compensated $5 USD after completion of a valid survey.After giving consent, participants were asked questions abouthow frequently they engaged in various sexual behaviors beforeand after the start of the COVID-19 pandemic. When consider-ing their behavior before and after the start of the pandemic,they were asked to use the reference date of March 11, 2020 asthe start of the pandemic, as this was the date the World HealthOrganization declared COVID-19 a pandemic. Participantsthen completed the other study measures and demographicsquestions.J Sex Med 2021;18:1851-1862

The study "Impact of COVID-19 on Sexual Behaviors, Sexual Functioning, and Intimate Partner Violence…

INTRODUCTION The severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) was recognized in January 2020 as the agent responsible for the coronavirus disease (COVID-19), whose worldwide out- break led to the declaration of a global pandemic by the World Health Organization (WHO) on March 11, 2020. In response to the COVID-19 pandemic, governments across the globe have implemented strict measures limiting physical interpersonal con- tact to reduce the spread of the virus. Human sexual behavior is likely affected by such measures, which has raised concern among sexual health experts regarding the negative outcomes the pan- demic may have on sexual health. Specifically, sexual health pro- fessionals are concerned about increases in sexual dysfunction and relationship conflict, as well as a negative impact on access to sexual healthcare. In addition, there is concern that quarantine measures and increases in relationship conflict may lead to an increase in intimate partner violence. 4.5 Preliminary evidence has supported some of these experts' concerns. For instance, one recent national survey in the United States found that 34% of individuals in a relationship reported relationship conflict due to COVID-19, and couples with more conflict also reported greater decrease in solitary and partnered sexual activities. Another survey of married individuals in the United States found that 32% of respondents reported COVID- 19 was straining their marriage. However, 74% also reported feeling the pandemic was strengthening their relationship, and the impact on sexual frequency was mixed, with 32% reporting an increase and 20% reporting a decrease. Interestingly, a recent longitudinal survey found that stress related to COVID-19 pre- dicted both increased relationship satisfaction as well as decreased sex drive and sexual activity at both the within-person and between-person levels. 9,10 Other preliminary evidence, from both the United States and other countries, has suggested that additional changes to sexual behavior are occurring, such as decreased casual sex" and increased use of pornography and sexting/cybersex. ¹2 The pan- demic may also facilitate experimentation with new ways of relat- ing to others socially as well as sexually. For example, Lehmiller et al ¹2 found that engaging in novel sexual activities during the pandemic (such as new sexual positions, sharing fantasies, or using technology) was protective against the pandemic's deleteri- ous effects on sexual satisfaction. Nevertheless, there remain few studies examining the impact of the COVID-19 pandemic on sexual health in the United States, and many studies have methodological deficiencies including small convenience samples that overrepresent or are limited to certain demographics such as women¹2 LGBTQ+ individuals,12,13 or married couples. In addition, studies published to date were largely conducted in the first few months of the pandemic when lockdown measures were just starting to take effect. Since the public health response to this pandemic also requires attention to sexual health as a fundamental pillar of physical and mental well-being, the aim of this study is to analyze the impact of COVID-19 on the sexual behaviors, sexual functioning, and intimate partner violence in the United States. This study adds to the findings of previous research by collecting a large national convenience sample and examining a wide variety of sexual behaviors several months into the pandemic. During this period (October 2020), individuals and government had been given numerous months to adapt to the novel circumstances, and many states in the United States had eased lockdown restrictions after summer surges in COVID-19 cases had subsided. Thus, col- lecting data in this period provides the opportunity to observe how COVID-19 continued to impact sexual behav- iors after several months. Given the exploratory nature of this study and the limited prior research, specific a priori hypotheses were not generated. Rather, this study aimed to answer the question: How has the COVID-19 pandemic impacted the frequency of various partnered and solitary sex- ual behaviors, sexual functioning and satisfaction, relationship satisfaction, and intimate partner violence? METHODS Participants Approval for this study was obtained from [sponsor insti- tution's] IRB. Participants were recruited from the Amazon Mechanical Turk (Mturk) platform. This platform allows ver- ified workers to accept tasks from requesters in exchange for payments to their Mturk accounts. A total of 1,474 surveys were started. Of these, 177 surveys were incomplete, 33 were eliminated due to participants taking the survey twice, 250 surveys were rejected due to incorrect responses to the atten- tion check questions, and 23 were excluded from analysis because no sexual behaviors were reported. This resulted in a sample of 1,051 participants from 48 U.S. states. Full descriptive statistics for participant demographics are listed in Table 1. Procedure Mturk workers were recruited to complete the survey and were compensated $5 USD after completion of a valid survey. After giving consent, participants were asked questions about how frequently they engaged in various sexual behaviors before and after the start of the COVID-19 pandemic. When consider- ing their behavior before and after the start of the pandemic, they were asked to use the reference date of March 11, 2020 as the start of the pandemic, as this was the date the World Health Organization declared COVID-19 a pandemic. Participants then completed the other study measures and demographics questions.