Body Image and Female Sexual Functioning and Behavior: A Review

Abstract

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.

Notes

Note. For both the modified version of Section 3 of the Derogatis Sexual Functioning Inventory (DSFI) and the modified version of the DSFI (Column 4), see Derogatis and Melisaratos (1979). AOR = Adjusted Odds Ratio; BISQ = Body Image Self-consciousness Questionnaire; BMI = body mass index; CSA = childhood sexual abuse; OR = odds ratio; STI = sexually transmitted infection; VPA = vaginal pulse amplitude. Body image measures: AAS = Appearance Anxiety Scale (Dion, Dion, & Keelan, 1990); ABDs = Appearance-Based Distraction subscale of the Cognitive Distraction During Sexual Activity Scale (Dove & Wiederman, 2000); AE–MBSRQ = Appearance Evaluation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); AO–MBSRQ = Appearance Orientation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); ASI = Appearance Schemas Inventory (Cash & Labarge, 1996); AS–BIQ = Attractiveness Scale of the Body Image Questionnaire (Strauss & Richter-Appelt, 1996); BWBAQ = Ben-Tovim Walker Body Attitudes Questionnaire (Ben-Tovim & Walker, 1991); BAQ = Body Attitude Questionnaire (Story, 1998); BAS = Body Appreciation Scale (Avalos, Tylka, & Wood-Barcalow, 2005); BASS = Body Areas Satisfaction Scale (Brown, Cash, & Lewis, 1989); BASS–MBSRQ = Body Areas Satisfaction Scale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); BAQ = Body Attitude Questionnaire (Story, 1998); BCBM = Body Comfort/Body Modesty Measure (Merriwether & Ward, 2002); BCS–BIBS = Body Concealment Scale of the Body Image Behavior Scales (Davison & McCabe, 2005); BC–OBCS = Body Control subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996); BD–EDI–2 = Body Dissatisfaction subscale of the Eating Disorder Inventory–Second Edition (Garner, 1991); BES = Body Esteem Scale (weight concern, physical condition, and sexual attractiveness dimensions; Franzoi & Shields, 1984); BESAQ = Body Exposure during Sexual Activities Questionnaire (Cash, 2004); BIA = Body Image Assessment (Williamson, Davis, Bennett, Goreczny, & Gleaves, 1989); BIAQ = Body Image Avoidance Questionnaire (Rosen, Srebnik, Saltzberg, & Wendt, 1991); BIB–SDBQ = Body Image Beliefs Dimension of the Sexual Dysfunctional Beliefs Questionnaire (Nobre, Pinto-Gouveia, & Gomes, 2003); BI–DSFI = Body Image subscale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); BIQ = Body Image Ideals Questionnaire (Szymanski & Cash, 1995); BII–BIBCQ = Body Image Importance subscale of the Body Image and Body Change Questionnaire (Ricciardelli & McCabe, 2001); BIQLI = Body Image Quality of Life Inventory (Cash & Fleming, 2002); BIS—BIBCQ = Body Image Satisfaction subscale of the Body Image and Body Change Questionnaire (Ricciardelli & McCabe, 2001); BISC = Body Image Self-Consciousness scale (Wiederman, 2000); BI–SEQ = Body Image subscale of the Self-Esteem Questionnaire (DuBois, Felner, Brand, Phillips, & Lease, 1996); BIS–BIBS = Body Improvement Scale of the Body Image Behavior Scales (Davison & McCabe, 2005); BRSS = Body and Relationship Satisfaction Survey (Hoyt & Kogan, 2001; based on the Body Satisfaction Scale: Berscheid, Walster, & Bohrnstedt, 1973); BSh–OBCS = Body Shame subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996); BSu–OBCS = Body Surveillance subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996); CDRS = Contour Drawing Rating Scale (Thompson & Gray, 1995); DT–EDI–2 = Drive for Thinness subscale of the Eating Disorder Inventory–Second Edition (Garner, 1991); FGSIS = Female Genital Self-Image Scale (Herbenick et al., 2011); FE–MBSRQ = Fitness Evaluation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); FO–MBSRQ = Fitness Orientation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); GBDS = General Body Dissatisfaction subscale of the Body Attitude Test (Probst, Vandereycken, Van Coppenolle, & Vanderlinden, 1995); GSS–PSSI = General Sexual Satisfaction and Satisfaction with Partner subscales of the Pinney Sexual Satisfaction Inventory (Pinney, Gerrard, & Denney, 1987); GISC = Genital Image Self-Consciousness scale (Schick et al., 2010; modified version of the BISC scale: Wiederman, 2000); GSIS = Genital Self-Image Scale (Berman et al., 2003); HE–MBSRQ = Health Evaluation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); HO–MBSRQ = Health Orientation Subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); IO–MBSRQ = Illness Orientation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); IG–SATAQ–3 = Internalization-General subscale of the Social Attitudes Toward Appearance Questionnaire–Third Edition (Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004); LSBIT–SMQ = Low Self Body Image Thoughts Dimension of the Sexual Modes Questionnaire (Nobre & Pinto-Gouveia, 2003); NETCQ = Non-Erotic Thought Content Questionnaire (Purdon & Holdaway, 2006); OP–MBSRQ = Overweight Preoccupation subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); PACS = Physical Appearance Comparison Scale (Thompson, Heinberg, & Tantleff, 1991); PAS = Physical Attractiveness Scale (Davison & McCabe, 2005); PSCSQ = Physical Self-Consciousness during Sex Questionnaire (Cash et al., 2004); SP–PSSI = Satisfaction with Partner subscale of the Pinney Sexual Satisfaction Inventory (Pinney et al., 1987); SW–MBSRQ = Self-classified Weight subscale of the Multidimensional Body–Self Relations Questionnaire (Cash, 1994a, 2000); SE–SSCS = Sexual Embarrassment Dimension of the Sexual Self-Consciousness Scale (van Lankveld, Geijen, & Sykora, 2007); SR–RB = sexual risk behavior items of a self-report risk questionnaire (Wild et al., 2004); SSF–SSCS = sexual self-focus dimension of the Sexual Self-Consciousness Scale (van Lankveld et al., 2007); SIBID = Situational Inventory of Body Image Dysphoria (Cash, 1994b); SPAS = Social Physique Anxiety Scale (Hart, Leary, & Rejeski, 1989); VAS = Vulva Appearance Satisfaction Scale (Schick et al., 2010; modified version of the Body Satisfaction Scale: Rapport, Clark, & Wardle, 2000). Sexuality measures: AfS–DSFI = Affect Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); AS = Ambivalence Scale (Pinquart, 2009); AS–DSFI = Attitude Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); BIQLI; BRSS; BSFQ = Brief Sexual Functioning Questionnaire (Wenniger & Heiman, 1998); CSFQ = Changes in Sexual Functioning Questionnaire (Clayton, McGarvey, & Clavet, 1997); CCS = Communication about Condoms Scale (Barkley & Burns, 2000); CRUS = Confidence in Refusing an Unsafe Sexual Encounter (Wingood et al., 2002); DS–DSFI = Drive Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); DSD–SDI = Dyadic Sexual Desire Factor of the Sexual Desire Inventory–Second Edition (Spector, Carey, & Steinberg, 1996); FS–DSFI = Fantasy Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); FSDS = Female Sexual Distress Scale (Derogatis, 2001); FSFI = Female Sexual Functioning Index (desire, arousal, lubrication, orgasm, satisfaction, and pain dimensions; Rosen et al., 2000); FTSEQ = First-Time Sexual Experience Questionnaire (Yamamiya et al., 2006); GMSEX = Global Measure of Sexual Satisfaction–Revised (Lawrance & Byers, 1995); GSSI–DSFI = Global Sexual Satisfaction Index of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); HISA = Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991); HIV–A = HIV Anxiety (Wingood et al., 2002); MRS–MSSCQ = Motivation to Avoid Risky Sex subscale of the Multi Dimensional Sexual Self-Concept Questionnaire (Snell, 1995); OC = Orgasm Consistency (Dove & Wiederman, 2000); OG–SAI = Oral/Genital subscale of the Sexual Arousability Index (Andersen, Broffitt, Karlsson, & Turnquist, 1989); PD–DSFI = Psychological Distress Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); POS = Perceived control Over Sexuality (Wingood et al., 2002); SSE = Precautions subscale of the Sexual Self-Efficacy scale (Rosenthal, Moore, & Flynn, 1991); SAI = Sex Anxiety Inventory (Janda & O'Grady, 1980); SAISAI = Sexual Arousability Inventory and Sexual Anxiety Inventory (Hoon, Hoon, & Wincze, 1976); SA–SAQ = Sexual Assertiveness subscale of the Sexual Awareness Questionnaire (Snell, Fisher, & Miller, 1991); SAS = Sexual Aversion Scale (sexual avoidance, sexual anxiety, self-consciousness, sexual inadequacy, fear of sexually transmitted infections, and childhood sexual trauma dimensions; Katz, Gipson, Kearl, & Kriskovich, 1989); SDBQ = Sexual Dysfunctional Beliefs Questionnaire (sexual conservatism, sexual desire and pleasure as a sin, age-related beliefs, body image beliefs, motherhood primacy, and denying affection primacy domains; Nobre et al., 2003); SDSS = Sexual Double Standard Scale (Muehlenhard & Quackenbush, 1996); SE = Sexual Experience (Kissing and Petting experience, Oral Sex experience, and Vaginal Intercourse Experience subscales; Schooler et al., 2005); SE–MSSCQ = Sexual Esteem Scale of the Multidimensional Sexual Self-Concept Questionnaire (Snell, 1995); SES–DSFI = Sexual Experience Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); SFQ = Sexual Functioning Questionnaire (Lawrance & Byers, 1992); SI–DSFI = Sexual Information subscale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); SI–SAI = Sexual Intercourse subscale of the Sexual Arousability Index (Andersen et al., 1989); SHF = Sexual History Form (Creti et al., 1998); SOS = Sexual Opinion Survey (Fisher, Byrne, White, & Kelley, 1988); SOS–MSSCQ = Sexual Optimism Scale of the Multidimensional Sexual Self-Concept Questionnaire (Snell, 1995); SOQ = Self-Objectification Questionnaire (Noll & Fredrickson, 1998); SRBBS = Sexual Risk Behavior Beliefs and Self-efficacy scales (Basen-Engquist et al., 1996); SSES–F = Sexual Self-Efficacy Scale for Female functioning (Bailes et al., 1998); SSS = Sexual Satisfaction Scale (Dove & Wiederman, 2000); SS–ESLS = Sexual Satisfaction subscale of the Extended Satisfaction with Life Scale (Alfonso, Allison, Rader, & Gorman, 1996); SSSW = Sexual Satisfaction Scale for Women (contentment, communication, compatibility, interpersonal concern, and personal concern dimensions; Meston & Trapnell, 2005); SSS–DSFI = Sexual Satisfaction Scale of the Derogatis Sexual Functioning Inventory (Derogatis, 1975); SSS–MSSCQ = Sexual Satisfaction Scale of the Multidimensional Sexual Self-Concept Questionnaire (Snell, 1995); SSSS = Sexual Self-Schema Scale (Andersen & Cyranowski, 1994); SSES–MSSCQ = Sexual Self-Efficacy Scale of the Multidimensional Sexual Self-Concept Questionnaire (Snell, 1995); SSe = sexual self-esteem (measured by a modified version of Rosenberg's Global Self-Esteem Scale; Calogero & Thompson, 2009a); SSE–SS = sexual Self-Esteem subscale of the Sexuality Scale (Snell & Papini, 1989); SOI = Sociosexual Orientation Inventory (Simpson & Gangestad, 1991); SSAS = Subjective Sexual Arousal Scale (mental sexual arousal, physical sexual arousal, and sexual desire dimensions; Heiman & Rowland, 1983).