341 Archivio Italiano di Urologia e Andrologia 2021; 93, 3 ORIGINAL PAPER No conflict of interest declared. the World Health Organization (WHO) declared it a pan- demic on March 11, 2020 (2). The WHO generated a global epidemiological situation report based on the national data received from each country and Turkey was reported as having the highest number of cases in the European region (33% of all cases in Europe, 194.476 new cases total, and 2.306 new cases per 1 million pop- ulation) (3). The first COVID-19 case in Turkey was iden- tified on the same day the WHO declared the global pan- demic. Several measures limiting individual and social life were quickly implemented by the Turkish government. People have been living with these limitations, and the accompanying physical, psychological, economic, and social effects, for a long time. It was inevitable that sexual health, defined by the WHO as the physical, emotional, mental, and social well-being of an individual, would also be affected during this period (4). Quarantine measures and some of the limitations in daily life imposed during the recent Severe Acute Respiratory Syndrome (SARS), H1N1 influenza, Middle East Respiratory Syndrome (MERS), and Ebola epidemics have been report- ed to negatively affect sexual life (5). The COVID-19 pan- demic has significantly affected the quality of life, with neg- ative effects on interpersonal relationships, community life, and sexual health (6). A few studies have evaluated the effects of the COVID-19 pandemic on sexual life during the first months of the pandemic; however they mostly focused on investigating sexual behaviors rather than sexual func- tion, and presented various opinions (7, 8). The effects of this prolonged pandemic, which has reshaped all our lives, on sexual behavior patterns and sexual function are not yet known. In this study, we evaluated the medium-term effects of the COVID-19 pandemic on sexual function and behaviors in men with heterosexual partners. MATERIALS AND METHODS Study design In this cross-sectional study, men were asked to complete a 34-item online questionnaire, which took approximately 20 minutes, consisting of multiple-choice and open-ended questions evaluating their sexual function and behaviors between November 06 and December 06, 2020. The ques- tionnaire, which was created using a Turkish online survey Objective: To evaluate the long-term effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual functions and behavior in men with hetero- sexual partners. Materials and methods: A total of 602 participants completed an online questionnaire, shared via social networks, between November 20 and December 20, 2020. Pre-pandemic sexual intercourse frequency, International Erectile Dysfunction Index (IIEF-15) score, intravaginal ejaculatory latency time (IELT), premature ejaculation diagnostic tool (PEDT) score, and activi- ties during sexual intercourse were compared to the ones during the pandemic. In addition, the effects of various variables on participants’ sexual functions were evaluated and analyzed according to age groups. Results: The mean number of weekly sexual intercourse during the pandemic was 1.7+1.7, which was significantly lower than in the pre-pandemic period (p < 0.001). The ED score was signifi- cantly lower during the pandemic (p < 0.001) compared to the pre-pandemic period, however orgasmic function (p = 0.016), sexual intercourse satisfaction (p < 0.001), general satisfaction (p < 0.001), and PEDT scores (p = 0.004) were significantly higher. There was no significant difference in IELT before and during the pandemic (p = 0.391). Full-time employment and low education level were risk factors for developing ED and PE. The negative affect of the pandemic on sexual life was most prominent in the > 65 age group. Although kissing, oral and anal sex, and face-to-face sex positions decreased during the pandemic in all age groups, kissing and face-to-face sex posi- tions remained the most preferred sexual behavior pattern (p = 0.002). There was no reduction in risky sexual behavior in the majority of the participants. Conclusions: At the end of one year with COVID-19, a decrease in erectile function and an increase in PE incidence were observed in men. Despite this, there was an increase in sexual desire and satisfaction. Although there were some changes in sexual behavior, the majority of pre-pandemic habits continued. KEY WORDS: Coronavirus disease 2019 (COVID-19); Erectile dysfunction; Premature ejaculation; Sexual behavior; Mid-term effect. Submitted 1 March 2021; Accepted 21 April 2021 INTRODUCTION Coronavirus disease 2019 (COVID-19) caused by the SARS CoV-2 virus first appeared in Wuhan, China, in December 2019 (1). It quickly spread across the globe, and finally Male sexual functions and behaviors in the age of COVID-19: Evaluation of mid-term effects with online cross-sectional survey study Erhan Ates, Hakan Gorkem Kazici, Ahmet Emre Yildiz, Saparali Sulaimanov, Arif Kol, Haluk Erol Aydin Adnan Menderes University School of Medicine, Department of Urology, Aydin, Turkey. DOI: 10.4081/aiua.2021.3.341 Summary