Body Image and Female Sexual Functioning and Behavior: A Review

Knowledge in the research fields of body image and sexuality has significantly increased in the last decade. In this review, data from 57 studies were compiled for a review of empirical evidence regarding the association between sexuality and body image among healthy women. The overall conclusion is that body image issues can affect all domains of sexual functioning. Cognitions and self-consciousness seem to be key factors in understanding the complex relationships between women's body image and sexuality. Body evaluations and cognitions not only interfere with sexual responses and experiences during sexual activity, but also with sexual behavior, sexual avoidance, and risky sexual behavior.

[1]  P. Nobre,et al.  Sexual Dysfunctional Beliefs Questionnaire: An instrument to assess sexual dysfunctional beliefs as vulnerability factors to sexual problems , 2003 .

[2]  J. Simpson,et al.  Individual differences in sociosexuality: evidence for convergent and discriminant validity. , 1991, Journal of personality and social psychology.

[3]  J. Wincze,et al.  An inventory for the measurement of female sexual arousability: The SAI , 1976, Archives of Sexual Behavior.

[4]  W. Snell.  Multidimensional Sexual Self-Concept Questionnaire , 2010 .

[5]  C. Meston.  The effects of state and trait self-focused attention on sexual arousal in sexually functional and dysfunctional women. , 2006, Behaviour research and therapy.

[6]  L. Kogan,et al.  Satisfaction with Body Image and Peer Relationships for Males and Females in a College Environment , 2001 .

[7]  D. Byrne,et al.  Erotophobia‐erotophilia as a dimension of personality , 1988 .

[8]  W. Snell,et al.  The sexuality scale: An instrument to measure sexual‐esteem, sexual‐depression, and sexual‐preoccupation , 1989 .

[9]  A. Clayton,et al.  The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. , 1997, Psychopharmacology bulletin.

[10]  Susan Bordo.  Unbearable Weight: Feminism, Western Culture, and the Body , 1993 .

[11]  J. Pinto-Gouveia,et al.  Dysfunctional sexual beliefs as vulnerability factors for sexual dysfunction , 2006, Journal of sex research.

[12]  L Rapoport,et al.  Evaluation of a modified cognitive–behavioural programme for weight management , 2000, International Journal of Obesity.

[13]  Lina A. Ricciardelli,et al.  Self-Esteem and Negative Affect as Moderators of Sociocultural Influences on Body Dissatisfaction, Strategies to Decrease Weight, and Strategies to Increase Muscles Among Adolescent Boys and Girls , 2001 .

[14]  B. Fredrickson,et al.  Objectification Theory: Toward Understanding Women's Lived Experiences and Mental Health Risks , 1997 .

[15]  S. Stewart,et al.  Body image and sexual problems in young women with breast cancer , 2006, Psycho-oncology.

[16]  L. Wild,et al.  Associations among adolescent risk behaviours and self-esteem in six domains: Self-esteem and adolescent risk behaviours , 2004 .

[17]  C. Meston,et al.  The association between sexual satisfaction and body image in women. , 2010, The journal of sexual medicine.

[18]  B. Træen,et al.  Body evaluation and coital onset: a population-based longitudinal study. , 2011, Body image.

[19]  R. Basson,et al.  The Female Sexual Response: A Different Model , 2000, Journal of sex & marital therapy.

[20]  L. M. Ward,et al.  Cycles of shame: Menstrual shame, body shame, and sexual decision‐making , 2005, Journal of sex research.

[21]  M. Clark,et al.  Perceived changes in sexual functioning and body image following weight loss in an obese female population: a pilot study. , 1997, Journal of sex & marital therapy.

[22]  J. Cioe,et al.  An Evaluation of the Relationship between Body Image and Sexual Avoidance , 2011, Journal of sex research.

[23]  M. Leary,et al.  The Measurement of Social Physique Anxiety , 1989 .

[24]  V. Schick,et al.  Genital Appearance Dissatisfaction: Implications for Women's Genital Image Self-Consciousness, Sexual Esteem, Sexual Satisfaction, and Sexual Risk , 2010, Psychology of women quarterly.

[25]  C. M. Davis,et al.  Handbook of Sexuality-Related Measures , 1998 .

[26]  J. L. Burns,et al.  Factor analysis of the Condom Use Self-Efficacy Scale among multicultural college students. , 2000, Health education research.

[27]  T. Pruzinsky.  The Beauty Myth: How Images of Beauty Are Used Against Women , 1993 .

[28]  J. Heiman,et al.  Affective and physiological sexual response patterns: the effects of instructions on sexually functional and dysfunctional men. , 1983, Journal of psychosomatic research.

[29]  S. Sanders,et al.  Turning On and Turning Off: A Focus Group Study of the Factors That Affect Women's Sexual Arousal , 2004, Archives of sexual behavior.

[30]  Janet Shibley Hyde,et al.  A meta-analytic review of research on gender differences in sexuality, 1993-2007. , 2010, Psychological bulletin.

[31]  C. Fichten,et al.  Sexual Self-Efficacy Scale for Female Functioning , 2010 .

[32]  L. Derogatis,et al.  The DSFI: a multidimensional measure of sexual functioning. , 1979, Journal of sex & marital therapy.

[33]  M. Meana,et al.  Gender differences in the content of cognitive distraction during sex , 2006, Journal of sex research.

[34]  Sarah K. Murnen,et al.  Are Feminist Women Protected from Body Image Problems? A Meta-analytic Review of Relevant Research , 2009 .

[35]  S. Bartky.  Femininity and Domination: Studies in the Phenomenology of Oppression , 1990 .

[36]  R. Rosen,et al.  The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores , 2005, Journal of sex & marital therapy.

[37]  K. O’grady,et al.  Development of a sex anxiety inventory. , 1980, Journal of consulting and clinical psychology.

[38]  J. Bancroft,et al.  The varied nature of women's sexuality: Unresolved issues and a theoretical approach , 2011, Hormones and Behavior.

[39]  T. F. Cash,et al.  "Baring the Body in the Bedroom": Body Image, Sexual Self-Schemas, and Sexual Functioning among College Women and Men , 2004 .

[40]  D. Barlow.  Causes of sexual dysfunction: the role of anxiety and cognitive interference. , 1986, Journal of consulting and clinical psychology.

[41]  L. Bernhard.  Sexuality and Sexual Health Care for Women , 2002, Clinical obstetrics and gynecology.

[42]  J. Hyde,et al.  The Objectified Body Consciousness Scale , 1996 .

[43]  E. Reissing,et al.  Young Women's Sexual Adjustment: The Role of Sexual Self-Schema, Sexual Self-Efficacy, Sexual Aversion and Body Attitudes , 2005 .

[44]  B. Andersen,et al.  A psychometric analysis of the sexual arousability index. , 1989, Journal of consulting and clinical psychology.

[45]  S. Horne,et al.  The Use of Self-Pleasure: Masturbation and Body Image Among African American and European American Women , 2003 .

[46]  L. Heinberg,et al.  The Physical Appearance Comparison Scale (PACS) , 1991 .

[47]  M. Wiederman,et al.  Body Image and Sexual Functioning , 2012 .

[48]  V. Mock.  Body Image in Women Treated For Breast Cancer , 1993, Nursing research.

[49]  B. Gorzalka,et al.  Spectatoring and the relationship between body image and sexual experience: Self‐focus or self‐valence? , 1997 .

[50]  H. Dittmar.  The Costs of Consumer Culture and the “Cage Within”: The Impact of the Material “Good Life” and “Body Perfect” Ideals on Individuals” Identity and Well-Being , 2007 .

[51]  M. Gerrard,et al.  The pinney sexual satisfaction inventory , 1987 .

[52]  Rowland S. Miller,et al.  Development of the Sexual Awareness Questionnaire: Components, reliability, and validity , 1991 .

[53]  Candace S. Brown,et al.  The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. , 2000, Journal of sex & marital therapy.

[54]  J. Pinto-Gouveia,et al.  Sexual modes questionnaire: Measure to assess the interaction among cognitions, emotions, and sexual response , 2003, Journal of sex research.

[55]  R. Pauls,et al.  Effects of pregnancy on female sexual function and body image: a prospective study. , 2008, The journal of sexual medicine.

[56]  Tina M. Penhollow,et al.  Predictors of Sexual Satisfaction: The Role of Body Image and Fitness , 2008 .

[57]  T. Brown,et al.  Body-image disturbances in adolescent female binge-purgers: a brief report of the results of a national survey in the U.S.A. , 1989, Journal of child psychology and psychiatry, and allied disciplines.

[58]  L. A. Peplau,et al.  Body Image Satisfaction in Heterosexual, Gay, and Lesbian Adults , 2009, Archives of sexual behavior.

[59]  C. Purdon,et al.  Non‐erotic thoughts: Content and relation to sexual functioning and sexual satisfaction , 2006, Journal of sex research.

[60]  E. Robinson,et al.  Body satisfaction and sexual health behaviors among New Zealand secondary school students , 2012 .

[61]  N. L. Dove,et al.  Cognitive distraction and women's sexual functioning. , 2000, Journal of sex & marital therapy.

[62]  K. Dion,et al.  Appearance anxiety as a dimension of social-evaluative anxiety: Exploring the ugly duckling syndrome. , 1990 .

[63]  D. Barlow,et al.  Cognitive and affective processes in female sexual dysfunctions , 2005 .

[64]  J. Thompson,et al.  The sociocultural attitudes towards appearance scale-3 (SATAQ-3): development and validation. , 2004, The International journal of eating disorders.

[65]  B. Fredrickson,et al.  A Mediational Model Linking Self-Objectification, Body Shame, and Disordered Eating , 1998 .

[66]  E. Sandra Byers,et al.  Sexual satisfaction in long-term heterosexual relationships: The interpersonal exchange model of sexual satisfaction , 1995 .

[67]  E. Byers,et al.  The Relationships Among Body Image, Body Mass Index, Exercise, and Sexual Functioning in Heterosexual Women , 2006 .

[68]  J. Fortenberry,et al.  The Female Genital Self-Image Scale (FGSIS): results from a nationally representative probability sample of women in the United States. , 2011, The journal of sexual medicine.

[69]  C. Meston,et al.  The impact of body awareness on sexual arousal in women with sexual dysfunction. , 2007, The journal of sexual medicine.

[70]  R. DiClemente,et al.  Body image and African American females' sexual health. , 2002, Journal of women's health & gender-based medicine.

[71]  C. Tang,et al.  Assessment of Sexual Functioning for Chinese College Students , 1997, Archives of sexual behavior.

[72]  Rachel M. Calogero,et al.  Potential implications of the objectification of women's bodies for women's sexual satisfaction. , 2009, Body image.

[73]  J. Daniluk.  The Meaning and Experience of Female Sexuality: A Phenomenological Analysis , 1993 .

[74]  D. F. Hurlbert.  The role of assertiveness in female sexuality: a comparative study between sexually assertive and sexually nonassertive women. , 1991, Journal of sex & marital therapy.

[75]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[76]  Elizabeth Aura McClintock.  Handsome Wants as Handsome Does: Physical Attractiveness and Gender Differences in Revealed Sexual Preferences , 2011, Biodemography and social biology.

[77]  S. Shields,et al.  The Body Esteem Scale: multidimensional structure and sex differences in a college population. , 1984, Journal of personality assessment.

[78]  Rachel M. Calogero,et al.  Sexual Self-Esteem in American and British College Women: Relations with Self-Objectification and Eating Problems , 2009 .

[79]  Sarah K. Murnen,et al.  The effect of experimental presentation of thin media images on body satisfaction: a meta-analytic review. , 2002, The International journal of eating disorders.

[80]  Judith A. Hall.  Nonverbal sex differences: Accuracy of communication and expressive style. , 1990 .

[81]  L. Wild,et al.  Associations among adolescent risk behaviours and self-esteem in six domains. , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[82]  S. A. Vasilenko,et al.  Body image and first sexual intercourse in late adolescence. , 2011, Journal of adolescence.

[83]  J. Jemmott,et al.  Increasing condom-use intentions among sexually active black adolescent women. , 1992, Nursing research.

[84]  A. Berenson,et al.  Body image and risky sexual behaviors: an investigation in a tri-ethnic sample. , 2005, Body image.

[85]  J. van Lankveld,et al.  The interaction of state and trait aspects of self-focused attention affects genital, but not subjective, sexual arousal in sexually functional women. , 2008, Behaviour research and therapy.

[86]  L. Berman,et al.  Genital Self-Image as a Component of Sexual Health: Relationship Between Genital Self-Image, Female Sexual Function, and Quality of Life Measures , 2003, Journal of sex & marital therapy.

[87]  J. Rosen,et al.  Development of a Body Image Avoidance Questionnaire , 1991 .

[88]  P. Trapnell,et al.  Development and validation of a five-factor sexual satisfaction and distress scale for women: the Sexual Satisfaction Scale for Women (SSS-W). , 2005, The journal of sexual medicine.

[89]  Judy C. Chang,et al.  Exploring the Relationship Among Weight, Race, and Sexual Behaviors Among Girls , 2009, Pediatrics.

[90]  A. Kiefer,et al.  Body Concerns In and Out of the Bedroom: Implications for Sexual Pleasure and Problems , 2007, Archives of sexual behavior.

[91]  D. Ben-Tovim,et al.  The development of the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ), a new measure of women's attitudes towards their own bodies , 1991, Psychological Medicine.

[92]  E. Laan,et al.  Genital vascular responsiveness and sexual feelings in midlife women: psychophysiologic, brain, and genital imaging studies , 2004, Menopause.

[93]  Julie M. Albright,et al.  Sex in America Online: An Exploration of Sex, Marital Status, and Sexual Identity in Internet Sex Seeking and Its Impacts , 2008, Journal of sex research.

[94]  I. Goldstein,et al.  Women's Sexual Function and Dysfunction: Study, Diagnosis and Treatment , 2005 .

[95]  S. Grogan.  Body Image: Understanding Body Dissatisfaction in Men, Women and Children , 1998 .

[96]  John Sabini,et al.  Subjective and Objective Measures of Attractiveness and Their Relation to Sexual Behavior and Sexual Attitudes in University Students , 2007, Archives of sexual behavior.

[97]  Nichole L. Wood-Barcalow,et al.  The Body Appreciation Scale: development and psychometric evaluation. , 2005, Body image.

[98]  N. Donaghue.  Body satisfaction, sexual self-schemas and subjective well-being in women. , 2009, Body image.

[99]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[100]  P. Koch,et al.  “Feeling frumpy”: The relationships between body image and sexual response changes in midlife women , 2005, Journal of sex research.

[101]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[102]  K. Lyness,et al.  Body Image and Sexual Satisfaction , 2007 .

[103]  S. Moore,et al.  Adolescent self‐efficacy, self‐esteem and sexual risk‐taking , 1991 .

[104]  J. Thompson,et al.  Sexual Experiences among College Women: The Differential Effects of General versus Contextual Body Images on Sexuality , 2006 .

[105]  M. McCabe,et al.  Relationships Between Men’s and Women’s Body Image and Their Psychological, Social, and Sexual Functioning , 2005 .

[106]  M. Wiederman.  Women's body image self‐consciousness during physical intimacy with a partner , 2000 .

[107]  D. Buss,et al.  Evolutionary Psychology and Feminism , 2011 .

[108]  C. Meston,et al.  Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder , 2003, Journal of sex & marital therapy.

[109]  Karen L. Blair,et al.  Women's Sexual Satisfaction as a Predictor of Well-Being in Same-Sex Versus Mixed-Sex Relationships , 2010, Journal of sex research.

[110]  Pamela Davis,et al.  Body image , 2007, BMJ : British Medical Journal.

[111]  T. Roberts,et al.  Mere Exposure: Gender Differences in the Negative Effects of Priming a State of Self-Objectification , 2004 .

[112]  M. Faith,et al.  The role of body image in sexually avoidant behavior , 1993, Archives of sexual behavior.

[113]  P. Jern,et al.  Sexual Body Image and Its Correlates: A Population-Based Study of Finnish Women and Men , 2011 .

[114]  Bernard S. Gorman,et al.  The extended satisfaction with life scale: Development and psychometric properties , 1996 .

[115]  Shaowen Bardzell,et al.  An assessment of body appreciation and its relationship to sexual function in women. , 2012, Body image.

[116]  G. Colditz,et al.  The persistent impact of breast carcinoma on functional health status , 2000, Cancer.

[117]  D. Williamson,et al.  Development of a simple procedure for assessing body image disturbances. , 1989 .

[118]  A. Bradford,et al.  The Association Between Body Esteem and Sexual Desire Among College Women , 2009, Archives of sexual behavior.

[119]  B. Andersen,et al.  Men's sexual self-schema. , 1994, Journal of personality and social psychology.

[120]  Meghan M. Gillen,et al.  Does Body Image Play a Role in Risky Sexual Behavior and Attitudes? , 2006 .

[121]  L. Steinberg,et al.  The sexual desire inventory: development, factor structure, and evidence of reliability. , 1996, Journal of sex & marital therapy.

[122]  J. Lankveld,et al.  The Sexual Self-Consciousness Scale: Psychometric Properties , 2008, Archives of sexual behavior.

[123]  Carmen Peota,et al.  Body work. , 2007, Minnesota medicine.

[124]  D. DuBois.  Early adolescent self-esteem: A developmental–ecological framework and assessment strategy. , 1996 .

[125]  C. Graham.  New Developments for the Journal of Sex Research: Updates From the Incoming Editor , 2009, Journal of sex research.

[126]  M. A. Thompson,et al.  Development and validation of a new body-image assessment scale. , 1995, Journal of personality assessment.

[127]  T. F. Cash,et al.  The impact of body image experiences: development of the body image quality of life inventory. , 2002, The International journal of eating disorders.

[128]  L. Mâsse,et al.  Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behavior in adolescents. , 1999, Health education research.

[129]  R. Baumeister,et al.  Gender differences in erotic plasticity: the female sex drive as socially flexible and responsive. , 2000, Psychological bulletin.

[130]  J. Carvalho,et al.  Predictors of women's sexual desire: the role of psychopathology, cognitive-emotional determinants, relationship dimensions, and medical factors. , 2010, The journal of sexual medicine.

[131]  C. Byrd-Bredbenner,et al.  A comparison of the anthropometric measurements of idealized female body images in media directed to men, women, and mixed gender audiences , 2003 .

[132]  T. F. Cash,et al.  Body-image disturbances and self-discrepancy theory: expansion of the Body-Image Ideals Questionnaire , 1995 .

[133]  Stacey Tantleff-Dunn,et al.  The Physical Appearance Comparison Scale , 1991 .

[134]  M. Wiederman,et al.  Body size, physical attractiveness, and body image among young adult women: Relationships to sexual experience and sexual esteem , 1998 .

[135]  Thomas F. Cash,et al.  Development of the Appearance Schemas Inventory: A new cognitive body-image assessment , 1996, Cognitive Therapy and Research.

[136]  M. Tiggemann,et al.  The role of self-objectification in women's sexual functioning. , 2008 .

[137]  J. Heiman,et al.  Relating Body Image to Psychological and Sexual Functioning in Child Sexual Abuse Survivors , 1998, Journal of Traumatic Stress.

[138]  M. Pinquart.  Ambivalence in Adolescents' Decisions about Having Their First Sexual Intercourse , 2010, Journal of sex research.

[139]  M. Probst,et al.  The Body Attitude Test for Patients with an Eating Disorder: Psychometric Characteristics of a New Questionnaire , 1995 .

[140]  D. Neumark-Sztainer,et al.  Weight-Related Issues and High-Risk Sexual Behaviors Among College Students , 2005, Journal of American college health : J of ACH.

[141]  A. Kearney-Cooke,et al.  Effect of body image and self-image on women's sexual behaviors. , 2000, The International journal of eating disorders.

[142]  G. Denny,et al.  Correlates of sexual satisfaction in marriage. , 1998 .

[143]  E. Laan,et al.  The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): Psychometric Properties within a Dutch Population , 2006, Journal of sex & marital therapy.