STUDY OF CHANGES IN SEXUAL BEHAVIOR IN COUPLES FACING DIGITAL TECHNOLOGIES

Digital technologies are popular means of exchanging, communicating, and accessing information, and their use has been increasing in recent years. Studies of changes in society's behavior are observed because of the new way of communicating and relating. To evaluate the sexual behavior of couples during the period of social isolation imposed by the pandemic and the frequent use of Digital Technologies (DTs), an online cross-sectional survey was carried out to obtain information on sexual behavior and the use of TDs. A total of 1,357 individuals were interviewed using the Google Forms tool, of which 616 were eligible to participate in the survey. According to the data obtained, DTs were used by 24.02% of the study participants, and a change in sexual behavior was observed in this group that has the habit of using DTs. The logistic regression analysis verified an association between the variables that predicted significant and positive changes in the sexual behavior of individuals, which points to a tendency towards change in sexual behavior given the greater use of DTs.


RESUMEN
Las tecnologías digitales son medios populares de intercambio, comunicación y acceso a la información, y su uso ha ido en aumento en los últimos años.Se observan estudios de cambios en el comportamiento de la sociedad debido a la nueva forma de comunicarse y relacionarse.Para evaluar el comportamiento sexual de las parejas durante el período de aislamiento social impuesto por la

INTRODUCTION
Digital Technologies (DTs) are popular means of exchange, communication, and access to information (Moreno-Guerrero et al. 2020).Through the use of digital devices, Internet, and social media the human behavior have changed (Gonçalves et al. 2020).The use of social networks allows immediate communications and facilitates research.Voice messages, videos or images enables new contacts and virtual meetings that relationships and face-to-face meetings (Guedes et al. 2016) may replace.
Mutual interaction is essential for social living between humans (Brandt et al. 2022).Prosocial behavior shows protective effects on physical and mental health.Social exclusion can affect personal well-being.Therefore, social isolation is a factor of distress and has been associated with mental disorders such as mood disorders, psychosis, and chemical, emotional, and technological dependence (Wijaya et al. 2022;Brandt et al. 2022;Bzdok;Dunbar 2022).
Technological dependence causes serious public health problems, such as impairment in an individual's daily activities (Cárdenas Garza et al. 2022).The excess of connectivity and information has been linked to several mental disorders, mainly stress, anxiety, and depression (White 2023).In addition, this excess worsens feelings of fear, insecurity, and loneliness (Gonçalves et al. 2020).Studies between technological addiction and psychiatric comorbidities are bidirectional, also showing that technology dependents are more likely to suffer from anxiety and depression and vice versa (Cai et al. 2021).
For the last three years, humans were under global stress.An infection caused by the novel coronavirus (SARS-CoV-2) began in 2019 and a few months later was declared a pandemic by the World Health Organization (WHO) (Melca et al. 2021;Cai et al. 2021).In avoidance the transmission of COVID-19, some restrictive "social distancing" measures have been adopted (Gonçalves et al. 2020), and people had to stay at home.Then, the risk of new contaminations and the consequences lead to social reclusion.After this time of reclusion, in May 2023, WHO downgrades the COVID pandemic and affirms that the disease is no longer an emergency (CDC 2023).
During the restrictive measures, people had to spend more time together.In this period, WHO has also recommended practicing sexual abstinence, so monogamous relationships have been suggested.Extramarital sex has been contraindicated because apart from the direct and respiratory transmission, other ways of spreading the virus are oral-fecal and sexual.Individuals that used to practice friendly, polyamorous, or casual sex had to change these patterns (Cipriano et al. 2020;Döring 2020;Lopes et al. 2020).
However, some individuals' libido has not entered lockdown mode.In this context, sexual relations need to be rethought, and DTs appear to be a coping strategy (Lopes et al. 2020).DTs are electronic tools, systems, devices, and data resources.Examples feature social media, online games, and cellphones.The use of digital devices fosters new forms of sexual interaction and relations.With social media like Facebook, dating apps, and sites such as Pornhub, these combinations have fostered the development of new sexual behaviors (Sfoggia;Kowacs 2014;Courtice;Shaughnessy 2017).This survey aimed to evaluate the sexual behavior of couples during the pandemic and the use of DTs.

METHODOLOGY
The study used an online cross-sectional survey with the Google Forms platform as the principal evaluation method.Google Forms is a free, cloud-based tool used to design and develop web-based questionnaires that collect data from individuals through personalized quizzes and surveys (Vasantha Raju;Harinarayana 2016;Gavin 2019).This survey is scientifically important because it gathers unbiased data from a representative sample of respondents.From 7th to 21st July 2020, 1.357 individuals answered this survey after receiving links via e-mail, WhatsApp, or Facebook messages.
Reminders were sent via messaging software, and the invitation letter started with the current survey's title.All data were collected over the Internet.There were no missing data because all questions were mandatory, so incomplete questionnaires could not be submitted.
Inclusion criteria: age 19 to 70 years, residents Rio de Janeiro, Brazil, and individuals that were married or living with a partner regardless of marital status (in stable unions or living together romantically).Exclusion criteria: single marital status, defined for the study's purpose as unmarried, divorced, separated, or widowed, age under 19 years, or failure to provide informed consent.
WhatsApp: Participants were randomly selected via WhatsApp in family and friend groups, and the link was replicated in other groups.The survey was sent randomly.The survey's title in the message was "Use of Technologies and Sexual Behavior in Social Distancing," and the link was sent to participants.
Facebook: Participants were recruited through a Facebook advertisement from July 9 to July 16, 2020.According to the platform guidelines, the advertisement included a headline, main text, and a suitably sized image.The advertisement appeared in Facebook user's news feeds because it was Statistical analysis was performed with the descriptive analysis of participants' sociodemographic, cultural, and psychological data.A Chi-square test was applied to compare the group of participants who stated that they did not use technological resources for sexual activity during the COVID-19 pandemic and the group that reported using such resources for sexual activity.Odds ratio analysis was performed using the binary logistic regression model.The model was evaluated by loglikelihood, deviation, z-statistics, Hosmer-Lemeshow R2N, Cox-Snell measures (RL2), and Nagelkerke R2CS, following the Akaike information criterion (AIC) (Lopes et al. 2020).The SPSS software was used in these analyses.

RESULTS
A total of 616 married individuals participated in the survey.The majority were women (n=404, 5.6%), the rest were men (n=180, 29.2%) and others (n = 32, 5.2%).The largest concentration of participants was 31-40 years (39.7%),followed by the 41-50-year age group (25.5%).The sample was predominantly middle-aged with high educational attainment, and 57.6% had university degrees (Table 1).Logistic regression analysis at a 5% significance level was used for variables that predicted significant and positive changes in the sexual behavior of married individuals during the pandemic.The following odds ratios were obtained: 5.06 for the male gender, 1.98 for impact on sexual behavior due to social distancing in the pandemic, 7.55 for the use of social networks during the pandemic, 3.08 for the use of erotic content, 3.00 for the use of DTs for sexual satisfaction, and 1.56 for greater ease in reaching orgasm with the use of erotic toys/porn videos.(Table 3)

DISCUSSION
The excessive use of DT has been linked to physical and mental disorders, as depression with or without suicidal ideation, anxiety, substance abuse, lack of sleep, increased aggressivity, cognitive impairment, and social isolation (Mboya et al. 2020).Social isolation is a cause of distress and is also associated with a range of mental disorders (Noguera Novoa et al. 2023).As a mechanism of copying DT have been used to support humans against feelings of loneliness and social isolation (Brandt et al.

2022).
Nowadays, with the advancement of technology digital intimacy has become more present.The term refers to emotional connection, sexual or not, maintained through DT without physical contact.
Digital intimacy can occur through text or voice messages, video calls, online dating, and other forms of social media interaction.This kind of interaction is sometimes preferable because of the possibility of anonymity, capacity for self-exploration, and the discovery of the identity, interest, and desires (Be known therapy, 2023).However, most of the time, relations created by the DT are superficial and brief.
The abundance of choices and excessive exposure to others lead to excessive pressure, feeling of judgment, a sense of disconnection and loneliness (Paestry, 2023).
In couples, the technologies provide positive and negative consequences.In strengthening the relationships technology can improve communication in couples through being in touch with the partner no matter the distance and enhancing access to information by advice and counselling in the relationships.Technology also can make the marriage worse.The feeling of neglection and resentment can appear when a partner spends too much time using digital devices.Another aspect is the emergence of jealousy and mistrust.Also, as a way of straining couples, internet addiction, mainly pornography creates tension, and conflicts and diminishes sexual interest in the partner (Conradie, 2023).
Sexual activity brings pleasure and intimacy to the couple and contributes to physical and mental health (Cabello et al. 2020).The restrictive measures during quarantine raised academic interest in sexual behavior (Döring 2020).Couples have to spend more time together with social distancing in the lockdown (Li et al. 2020;Döring, 2020).In this context, DTs appear to have provided a way to mitigate the impact of anxiety caused by social distancing.
Although there is relative gender equality in the use of DTs, women appear to enjoy the technology more and have more depression rates (Falek et al. 2022).The principal purpose for women to use DT are research, while men use DTs for entertainment.Most participants in this survey were women (n=404) who used DTs.These findings are consistent with those of Ansari and Baumeister (Baumeister et al. 2001), who reported that women used more messaging and mobile devices and accessed more social networks.Women also spend more time than men surfing the web.The longer a person uses DT, the more likely to become addicted to the Internet and, consequently, to have a mental disorder (Mboya et al. 2020).
Women also develop more online friendships than men (Harris and Aboujaoude 2016).When to think more about sex and seek more sex eagerly, and mobile devices can be a source of pleasure, entertainment, and porn access (Baumeister 2001;Anshari et al. 2016).
The likelihood of answering an online survey depends on age, gender, and schooling.For example, women, married individuals, and elders are the most accessible participants (Sjetne et al. 2019).However, according to age, older people (in their seventies or older) have more difficulty engaging in online surveys (Meier;Tunger 2018).These findings also appeared in this survey.Most respondents were women 30 to 50 years of age with high educational attainment.Schooling plays an important role: higher education tends to be associated with less easygoing attitudes (Anshari et al. 2016).In this context, more educated individuals may be more prone to using DTs, as shown in the survey, to entertainment and cope with this personality trait.
During the COVID-19 pandemic, some couples have experienced breaks in their routine and spent more time together.Like this survey, several studies have shown changes in couples´ sexual behaviors (Cabello et al. 2020;Li et al. 2020;Döring, 2020).To cope with social distancing and sexual monotony and to mitigate stress, some married people have turned to digital resources such as chats, nude photos, audio, and phone calls with sexual material, as shown in this study.
DTs have also been used to improve sexual activity and reach sexual satisfaction (Cabello et al. 2020).Due to social distancing, people have had to find creative ways to spend time; one way has been consuming pornography.Pornography (porn) is a common practice among people, increasing pleasure in general, and not used only for masturbation.Sexual arousal and enhancing sexual pleasure are the principal motivations for watching porn.During the pandemic, porn has been used to cope with boredom and psychological distress and relieve negative feelings and anxiety.An increase in porn consumption has thus been observed during the pandemic (Zattoni et al. 2021).Meanwhile, it is essential to note that excessive consumption of porn can hurt the brain and may increase sexual violence (Döring, 2020).
Digital technologies are becoming intimate and impacting intimacy.The present study showed that people who use DTs achieve a greater sexual satisfaction.The hypothesis is that DTs diminish inhibition and favor sexual self-disclosure.Another theory is that using DTs during sex provides different behavioral, physical, emotional, and cognitive experiences, creating a more fulfilling, affirmative, and rewarding kind of sex (Lomanowska;Guitton 2016;Ibarra et al. 2020).According to this survey, the use Although several studies have shown that internet addiction (IA) can lead to academic, workplace, and social impairment (Cárdenas Garza et al. 2022), it is still not considered a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).Excessive use of digital media has been related to mental disorders, mainly stress, anxiety, and depression (Anshari et al. 2016).There have been three main hypotheses: depression or depressive symptoms may predict internet addiction (Anand et al. 2018;Balhara et al. 2021), depression is the major comorbid disorder with IA (Carli et al. 2013;Gedam et al. 2016Gedam et al. , 2017)), and IA increases the odds of depression (Ching et al. 2017;Boonvisudhi;Kuladee 2017).Some studies have shown that internet addiction correlates with anxiety (Capetillo-Ventura; Juárez-Treviño 2015; Gedam et al. 2017), but only one study has found an association with ADHD (Shi;Du 2019).
Psychiatric disorders appear to contribute to changes in sexual behavior.Sexual activity favors psychological well-being because it improves mood and diminishes anxiety, especially during confinement in the pandemic.Individuals who enjoy sexual satisfaction have better mental health outcomes (Cabello et al. 2020).Thus, more than 58% of participants may have altered their sexual behavior due to psychiatric disorders.Anxiety and depression are also common factors in impaired sexual activity.They may be responsible for erectile dysfunction and premature ejaculation in men or lack of libido, hypoactive sexual desire, and inability to achieve orgasm in women (Harris; Aboujaoude 2016).In the current survey, people may have used DTs more to achieve orgasm, perhaps again due to their psychiatric disorders.These findings suggest that psychiatric disorders may make people more prone to use DTs to relieve their symptoms and that DTs are a way to cope with psychiatric symptoms, besides contributing to more satisfying sexual experiences.

RECOMENDATIONS
The survey results show a change in people's sexual behavior through digital devices.DTs seem to support an alternative sexual activity because they explore couples' sexual fantasies and lower individuals' inhibitions.There is little scientific data on how the internet impacts the sexual behavior of people with TDs.Therefore, further studies are needed to obtain more data on sexual activity and TDs.
It is also relevant to know how DTs act on psychiatric disorders, increasing or decreasing psychiatric comparing sexual behavior and the use of digital devices during the COVID-19 pandemic, being a man presents a significant factor.They also access dating apps more frequently, probably because men tend of social media during the pandemic has contributed to changes in sexual behavior.The use of dating apps has allowed a new form of relationships, presented a variety of possible matches, and brought people closer during the pandemic.Men use more of dating apps and engage more in casual sex(Castro;Barrada 2020); this was corroborated by the survey´s results, in which men increased the change in their sexual behavior during the pandemic by more than five times and the use of social networks by more than three times.The main stated purpose for dating apps has been entertainment, and multiple matches have probably reduced the likelihood of lasting interpersonal relations, an ideal situation for casual sex.Thus, less commitment has translated into more entertainment for these individuals.More than 58% of the group that used DTs in this survey had a history of prior mental diagnosis, compared to 50.4% who had a prior diagnosis and did not use such technologies.DT seems to be the second leading cause of disability among psychiatric disorders(Paul et al. 2021).Besides, evidence suggests that social distancing increases the incidence of depression and anxiety and can exacerbate preexisting mental disorders(Zubair et al. 2023).Anxiety, depression, and ADHD were the most prevalent disorders in this study.

Table 1 :
Sociodemographic Characteristics Statistics The Chi-square test was applied to compare the group of technology users and the control group.As shown in Table2, the dependent variables were age, gender, schooling, use of digital resources for sexual interaction, the purpose of use of apps, history of mental disorders, whether social distancing during the pandemic had affected sexual behavior, use of social networks, and search for films or series with sexual content during social distancing.Statistical significance was set at 5%.

Table 2 :
Chi-square test among sociodemographic, cultural, and psychological variables and use of technologies during the COVID-19 pandemic in Brazil

Table 3 :
Significant factors in married couples´ sexual behaviors related to use of digital devices during the COVID-19 pandemic, according to binary logistic regression analysis