Femininity Ideology and Sexual Health in Young Women: A focus on Sexual Knowledge, Embodiment, and Agency

ABSTRACT

Traditional femininity ideology is associated with diminished sexual agency in women; yet we know little about its connection to sexual knowledge or experiences of one's body during sex. This study examined how femininity ideology related to sexual health knowledge, body comfort during sex, condom self-efficacy, and sexual assertiveness in college-age women. Femininity ideologies were related to decreased sexual-risk knowledge and lowered body esteem during sex. Femininity ideologies were also related to decreased sexual assertiveness and condom use self-efficacy. Results highlight the importance of understanding the association between femininity ideologies and sexual knowledge acquisition as an aspect of sexual agency, as well as sexual embodiment, in addition to the more commonly studied sexual self-efficacy and assertiveness.

KEYWORDS:

• Femininity ideology
• sexual knowledge
• embodiment
• sexual health
• sexual agency
• college-aged women

Although healthy sexuality is frequently cited as a central aspect of women's physical and psychological well-being (Aggleton & Campbell, 2000; Tolman, 1999), achieving sexual health is not straightforward. Sexual health can be broadly defined as, “a state of physical, emotional, mental, and social well-being in relation to sexuality … [including] the possibility of having pleasurable and safe sexual experiences” (World Health Organization [WHO], n.d.). This definition includes sexual rights, such as the rights to avoid sexual coercion, feel and express desire (Aggleton & Campbell, 2000; Fine, 1988), and “seek, receive and impart information related to sexuality [sexual knowledge]” (WHO, n.d.). Understanding women's sexual health requires understanding gender roles and gendered relationships of power (Amaro & Raj, 2000; Amaro, Raj, & Reed, 2001; Tolman, Striepe, & Harmon, 2003; WHO, n.d.), including femininity ideologies. Indeed, evidence demonstrates that traditional femininity ideologies may be detrimental to women's sexual health and has linked these ideologies to lower sexual self-efficacy, satisfaction, and assertiveness (e.g., Tolman, 1994, 1999, 2002; Tolman, Impett, Tracy, & Michael, 2006; Tolman & Porche, 2000). However, little is known about how these ideologies relate to other aspects of women's sexual health, such as their sexual knowledge or their experiences of their bodies during sex. Accordingly, the current study sought to address this gap by investigating associations between femininity ideology and multiple aspects of young women's sexuality, including aspects of sexual agency commonly studied (i.e., sexual self-efficacy), and lesser-studied components such as sexual knowledge and sexual embodiment (women's feelings about their bodies during sexual encounters).

Sexual Health During Emerging Adulthood

During emerging adulthood women navigate a number of important developmental tasks, including exploring new identities, establishing independence, and managing their sexuality (Erikson, 1968; Sugar, 1993). For young women in college, these tasks are often negotiated in a context of newfound independence that might allow for increased opportunities for healthy sexual exploration (Adams & Fitch, 1982; Konik & Stewart, 2004). Yet these freedoms do not come without risk. Data show that one fourth of young women age 19 to 24 in the United States are diagnosed with at least one common sexually transmitted infection (Centers for Disease Control and Prevention [CDC], 2008). In 2006, young women age 15 to 19 had the highest rates of gonorrhea, and those age 20 to 24 had the second highest rates, compared to other age/sex groups (CDC, 2006). Moreover, in 2001, women age 18 to 24 had the highest rates of unintended pregnancies (Finer & Henshaw, 2006). These findings underscore the urgency to uncover factors that shape not only how young women make sexual decisions, but what they know about disease and pregnancy prevention.

One factor investigated as a potential contributor to sexual risk taking and sexual health has been women's gender ideologies. According to feminist theory, femininity ideologies can be defined as ideas, norms, and restrictions about what constitutes “normal,” acceptable, and ideal womanhood. Traditional femininity ideologies emphasize women's passivity, compliance, concern for others, and agreeableness (Amaro, 1995; Fox, 1977; Tolman et al., 2006). Femininity ideologies are believed to become especially significant during girls’ transition to womanhood, as gender roles become more salient and intensified (Galambos, Almeida, & Petersen, 1990). Several negative effects of femininity ideology have been identified in adolescent girls as they transition to young adulthood, including a loss of “voice” or an inability to connect with and communicate one's needs and desires (e.g., Brown, 1998), lowered self-esteem, and increased depression (Tolman et al., 2006). As girls become women they are increasingly taught that their needs and desires are secondary to others’, and the internalization of these ideologies comes at a cost to young women's well-being.

Femininity Ideology and Sexual Agency

In the sexual arena, femininity ideologies translate to a heterosexual sexual “script” in which traditional women do not initiate sexual relationships or assert their needs and desires and are not knowledgeable about sex (Greene & Faulkner, 2005). Indeed, one of their main roles in these scripted encounters is as sexual gatekeeper and passive partner—a role that requires little sexual knowledge—and assumes sexual innocence, along with sexual availability (Byers, 1996; Gagnon, 1990). As such, feminist theorists (e.g., Bartky, 1990; Brownmiller, 1984; Foreman, 1977) have argued that femininity is a form of “alienation,” and that traditional notions of feminine sexuality, and the objectification of women (Fredrickson & Roberts, 1997), estrange women from their own sense of self and sexuality and make it difficult for them to negotiate safe and pleasurable sexual encounters. Thus, because gender norms have traditionally linked femininity with sexual passivity, ignorance, and objectification, concern has been raised for how acceptance of these norms interferes with women's sexual agency and subsequent sexual health (Tolman, 1994, 1999, 2002; Tolman et al., 2006; Tolman & Porche, 2000; Tolman, Spencer, Rosen-Reynoso, & Porche, 2003).

Sexual Self-Efficacy and Sexual Assertiveness

Perhaps the two most commonly studied aspects of sexual agency are sexual self-efficacy and sexual assertiveness. Sexual self-efficacy encompasses women's belief in their ability to engage in behaviors aimed at preventing unwanted pregnancy and sexually transmitted infections (STIs), including using contraception, or requiring their partners to do so (Rostosky, Dekhtyar, Cupp, & Anderman, 2008). Sexual assertiveness is the ability to refuse unwanted sex and to communicate with one's partner about what pleases one sexually. Research conducted in the 1980s found consistent links between high endorsement of traditional gender-role beliefs and women's diminished sexual health, including decreased comfort with discussing and using contraceptives and condoms (MacCorquodale, 1984; Walfish & Myerson, 1980), and with asserting one's own sexual desires (Koblinsky & Palmeter, 1984), and increased incidence of teenage pregnancy (Ireson, 1984).

Offering additional support are findings from qualitative studies that show that femininity ideologies are related to decreased sexual self-efficacy and sexual assertiveness (Caron, Davis, Halteman, & Stickle, 1993; Crawford, Kippax, & Waldby, 1994; Faulkner & Mansfield, 2002; Gavey & McPhillips, 1999). Across studies, women who adhered to traditional beliefs about their passive role during sex were also less likely than other women to provide and use condoms during sexual encounters. Women's reported experiences of sexual encounters seemed to indicate that holding traditional beliefs about women's sexual roles is related to their sexual health behaviors. For example, Crawford et al. (1994) found that women reported ignoring or minimizing their own sexual desires in sexual encounters, explaining that men's sexual needs either overshadowed their own, or came first (see also Tolman, 1994).

More recently, quantitative analyses have tested younger women and have used newer measures of gender ideology. Tolman (1999) found that eighth-grade girls who expressed stronger endorsement of conventional beliefs about femininity (assessed using a Self-in-Relationship subscale, a Relationship-with-Body subscale, and a measure of traditional attitudes towards women) reported feeling decreased sexual agency (including the ability to refuse unwanted sex or require a partner to use a condom). These girls also more strongly endorsed heterosexual romance conventions that required them to maintain romantic relationships at the cost of their own needs. Testing girls age 16 to 19, Impett, Schooler, and Tolman (2006) demonstrated that greater inauthenticity in relationships and body objectification predicted a diminished ability to practice safer sex and refuse unwanted sex. Testing college undergraduates, Shearer, Hosterman, Gillen, and Lefkowitz (2005) found that women who expressed more traditional views toward marital roles also expressed less positive expectations toward enjoying sex with condoms and perceived greater barriers to using condoms. Each of these findings indicates that femininity ideologies have significant effects on young women's ability to be sexually assertive and practice safer sex.

Femininity Ideology and Sexual Knowledge

One important aspect of sexual health is having appropriate knowledge about the workings of the female reproductive system and of how one can prevent unwanted pregnancies and STIs. Yet our understanding of the connections between gender roles and sexual knowledge is sparse. Traditional expectations of femininity and the female sexual role characterize women as passive sexual gatekeepers (Byers, 1996; Gagnon, 1990; Grauerholz & Serpe, 1985). Within this paradigm, women do not need to—and indeed should not—be knowledgeable about sex; they simply need to say no. As a result, we may expect that young women who internalize traditional gender ideologies may not be as likely to seek out important information on sexuality, as it does not fit with their prescribed role as passive recipients of sexual interest and desire. However, to our knowledge, there is no empirical research examining the connection between sexual knowledge and gender role ideologies.

There is some evidence that young women are actually more sexually knowledgeable than young men, although these same data indicate that young people generally lack adequate knowledge about their bodies, STIs, or pregnancy prevention (Baldwin, Whitely, & Baldwin, 1990; Weinstein, Walsh, & Ward, 2008; Winn, Rocker, & Coleman, 1998). There is also some evidence that sexual health knowledge can be beneficial for many aspects of women's sexual functioning, although most of this research has focused specifically on HIV/AIDS knowledge and condom use. Here, links between HIV/AIDS knowledge and condom use are positive but weak and often inconsistent (for meta-analysis review, see Sheeran, Abraham, & Orbell, 1999). Looking more specifically at college-age women, however, we do see some support, with findings linking knowledge to safer sex practices, more consistent condom use, greater condom use self-efficacy, more positive attitudes toward condoms, and stronger condom-use intentions (e.g., Bazargan, Kelly, Stein, Husaini, & Bazargan, 2000; Burazeri, Roshi, & Tavanxhi, 2004; Davis, Sloan, MacMaster, & Kilbourne, 2007; Hollar & Snizek, 1996). In a recent study, Weinstein and colleagues (2008) found that sexual health knowledge was linked to increased sexual assertiveness in young women, indicating that it may be an important aspect of sexual health beyond condom use. We therefore predict that beliefs about femininity will be related to sexual knowledge, such that women who offer stronger support of traditional femininity ideologies will hold less knowledge.

Femininity Ideology and Sexual Embodiment

In addition to being knowledgeable about their bodies, a key aspect of sexual health for women is comfort with their bodies during sex, or sexual embodiment. Physical bodies are often deeply involved in sexual encounters. We may be partially or fully naked and feel exposed in ways that are different from other areas of daily life. For these reasons, body image concerns are argued to play an important role in sexual pleasure and sexual functioning (e.g., Fredrickson & Roberts, 1997; Masters & Johnson, 1970; Wiederman, 2000). Researchers argue that if people are distracted by concerns about their physical appearance, they may be unable to relax and focus on their own sexual pleasure. Evidence supports this assertion, linking greater body self-consciousness during sex to lower levels of sexual pleasure and arousability, sexual assertiveness, sexual functioning, sexual experience, sexual self-esteem, and condom-use self-efficacy, and higher levels of sexual avoidance, ambivalence in sexual decision making and sexual risk taking (Sanchez & Kiefer, 2007; Schooler, Ward, Merriwether, & Caruthers, 2005; Wiederman, 2000; Yamamiya, Cash, & Thompson, 2006).

If evidence suggests that being concerned about one's appearance may interfere with sexual functioning, then this may be a particularly significant problem for women because concern about appearance is a core and defining feature of femininity. According to objectification theory (Fredrickson & Roberts, 1997), girls and young women develop in a cultural milieu that values and judges them based on their physical appearance. As a result, girls internalize and reproduce within their own self-schemas this objectified perspective and come to experience their bodies more as observers than as actors, focusing on how their bodies look on the outside rather than on how they feel or function. This core dimension of femininity is reflected in many new measures of femininity ideology, including the Objectified Relationship with Body subscale of the Adolescent Femininity Ideology Scale (Tolman & Porche, 2000), and the Thinness and Invest in Appearance subscales of the Conformity to Feminine Norms Inventory (Mahalik et al., 2005).

However, although body concerns during sex affects women's sexual health, and although body concerns are a core aspect of femininity ideology, we still do not know if women's views toward femininity affect their body comfort during sex. Are women who endorse traditional gender ideologies also more likely to feel uncomfortable with their bodies during sex? To help answer this question, we turn to evidence linking femininity ideology with body attitudes, more broadly. Here, findings indicate that endorsing more traditional gender ideologies is associated with lower body comfort and satisfaction (Cash, Ancis, & Strachan, 1997; Forbes, Adams-Curtis, Rade, & Jaberg, 2001; Gillen & Lefkowitz, 2006). Conversely, greater endorsement of feminist principles is associated with decreased investment in a thin body ideal and decreased investment in physical appearance (Hurt et al., 2007). Indeed, a recent meta-analysis (Murnen & Smolack, 2009) found that feminist identity was related to more positive attitudes toward one's body and was negatively associated with a drive for thinness and disordered eating. Together, these findings indicate that gender role ideologies are related to how women feel about their bodies in general. Extrapolating from this, we anticipated that femininity ideology would contribute to women's attitudes towards their bodies during sexual encounters.

The Current Study

Although we may wish to believe that as they age adolescent women not only become better able to advocate for themselves sexually, but also more knowledgeable about, and likely to engage in, safer sex practices, research has not borne out these predictions (CDC, 2006, 2008; Dunne et al., 2007; Finer & Henshaw, 2006; Wyatt & Riederle, 1994). What role might beliefs and expectations about femininity and female sexuality play in shaping these aspects of women's sexual health? The current study built upon previous research and examined the connections between femininity ideology and sexual agency and embodiment in a group of contemporary undergraduate women. We sought to replicate previous findings concerning sexual efficacy and assertiveness, and to expand the focus to include sexual knowledge and measures of sexual embodiment. We hypothesized that women higher in femininity ideology would report lower levels of sexual knowledge, less sexual assertiveness, and less sexual self-efficacy. We further hypothesized that they would be less comfortable with their bodies during sex and in front of sexual partners.

METHOD

Participants

Participants were young women drawn from a mixed-sex sample of 580 undergraduates at a midwestern university, who were part of a larger study on sexuality. The current analyses focus on all 397 young women from the larger group (68.6%). Although more than one half of the participants were White (67.3%), the sample also included women of Asian (14.4%), African American (7.8%), Latina (6.0%), and Arab American (4.5%) descent. Participants ranged in age from 17 to 25 years (M = 19.67 years). The sample was predominantly heterosexual, with 95.9% describing themselves as either “exclusively heterosexual” or “predominantly heterosexual.” Please note that we ran analyses excluding the 4% of the sample that did not identify as heterosexual (given that there is reason to believe that femininity ideology may be experienced differently by heterosexual, bisexual and lesbian women; Nestle, 1992). However because this did not alter the findings (not surprising given the small number of sexual minority women in the sample), we included all participants (bisexual, lesbian, and heterosexual) in the results presented below. Overall, participants were from well-educated homes. Mothers’ mean education was 15.93 years (SD = 2.28; i.e., they had almost completed a college degree), and fathers’ mean education was 17.06 years (SD = 2.90). Six percent of the sample reported that they were raised in a single-parent home. Participant's body mass index (BMI) was also calculated, using their self-reported height and weight. Average BMI for the sample was 22 (SD = 3.65).

Measures

Femininity ideology

Two scales were used to assess femininity ideology: the Attitudes towards Women Scale for Adolescents (AWSA; Galambos, Peterson, Richards, & Gitelson, 1985) and the Inauthentic Self in Relationships scale (ISR), a subscale of the Femininity Ideology Scale (Tolman & Porche, 2000). The AWSA is a 12-item, modified (for adolescents), version of the original Attitudes Towards Women Scale (Spence & Helmreich, 1978). This Likert-type scale requires participants to indicate, using a 4-point scale, how much they agree with each statement concerning appropriate male/female behavior, roles, and capabilities (1 = strongly agree, 4 = strongly disagree). Examples included statements such as, “[o]n the average, women are as smart as men” and “[i]t is all right for a woman to ask a man out on a date.” Scores were computed so that higher scores indicated a greater endorsement of traditional attitudes towards women and men, α = .78. Participants also completed the 10-item ISR, which measures the degree to which women report ignoring their own needs to satisfy other people, such as friends. Participants were asked to indicate how much they agreed with each statement on a 6-point scale (1 = strongly disagree, 6 = strongly agree), and means were computed such that higher scores indicated greater inauthentic voice (α = .72). Sample items included statements such as, “I worry that I make others feel bad if I am successful” and “I wish I could say what I feel more often than I do.” Both scales have demonstrated reliability and have been used with similar samples in the past (e.g., Smiler, Ward, Caruthers, & Merriwether, 2005). The scales were significantly correlated with each other (r = .17, p < 0.01; N = 389).

Sexual-risk knowledge

Sexual-risk knowledge was assessed using 11 items from the 15-item Sexual Knowledge Scale (Joseph, Sawyer, & Desmond, 1995). Four of the items were dropped because they were deemed too technical to assess general sexual knowledge. This measure assesses knowledge about HIV/AIDS and pregnancy prevention, and female reproductive health. Sample items include, “latex condoms provide more effective protection against HIV/AIDS than natural, sheepskin condoms” and “the middle of a women's menstrual cycle is a safe time to have sex and avoid pregnancy.” Participants were asked to check “True,” “False,” or “Not sure” for each statement. A correct answer received a score of 1, whereas an incorrect answer or “not sure” received a score of 0; a total score was summed for each participant (because this scale was scored 0/1, no alphas were run).

Sexual agency

We used two measures to assess sexual agency: a measure of condom-use self-efficacy and a measure of sexual assertiveness. Condom-use self-efficacy was assessed using The Sexual Self-efficacy Scale (Rosenthal, Moore, & Flynn, 1991). The original measure is a 20-item instrument, consisting of three subscales. Only the 5-item subscale evaluating the ability to purchase and use condoms was administered to participants in the current study. These items asked participants to indicate their ability on a 1–5 scale (very uncertain to absolutely certain) to do activities such as “discuss using condoms and/or other contraceptives with a potential partner,” or “carry condoms around with you ‘in case.’” Mean scores on this subscale were computed for each participant (α = .82); higher scores indicated greater self-efficacy. Participants also completed The Hurlbert Index of Sexual Assertiveness (Hurlbert & Apt, 1991), which is a 25-item measure that uses a 5-point scale (0 = never, 4 = all of the time) to indicate how assertive individuals are in their sexual relationships. A not applicable option was also included for each item. Sample items include, “I speak up for my sexual feelings” and “I find myself doing sexual things I do not like” (reverse scored). Mean scores were computed for each participant (α = .78), and higher scores indicated greater sexual assertiveness.

Sexual body comfort

Two scales assessed participants’ feelings about their bodies in sexual situations. The first measure was The Body Image Self Consciousness Scale (BISC; Wiederman, 2000). This 15-item measure assesses women's concern with their body's appearance to their partner during sexual intimacy. Items include statements such as, “[d]uring sex, I (would) prefer to be on the bottom so my stomach appears flat,” to which participants indicated their agreement on a 6-point scale (0 = never, 5 = always). Mean scores were computed across all 15 items (α = .96), and higher scores indicated more body consciousness. The second measure was a subscale of six items from the female version of the Body Comfort/Body Modesty Scale (Merriwether & Ward, 2002). The full 29-item measure evaluates how comfortable individuals are with their bodies across a range of situations: intimate (e.g., “being naked in front of your partner”), nonintimate (e.g., “having a doctor touch your breasts during a breast exam”), private/personal (e.g., “touching your own genitals for pleasure”), and social (e.g. “undressing … in front of other women”). The measure uses a 9-point Likert-type scale, that ranges from 0 (never done & actively avoid) to 7 (totally comfortable), with 8 indicating not sure; never done yet (please note that all responses indicating “not sure; never done yet” were excluded from the current analyses). For the purposes of the present analyses, only the six items concerning intimate situations with a sexual partner (e.g. “being naked in front of your partner”) were used (α = .85), and higher scores indicated greater comfort.

Religiosity

The following three items, each completed using a 5-point scale, assessed participants’ religiosity: “how religious are you,” “how often do you attend services,” and “how often do you pray” (1 = never, 5 = very regularly, usually once a week). A mean religiosity score was computed across all three items (α = .89). Religiosity was included as a control because religious beliefs and practices may shape experiences of sexuality.

Current relationship status

Participant's current relationship status was assessed by asking them to respond to one question, “Which of the following descriptions best represents the type of dating or sexual relationships you are having now?” All participants could choose among eight possible responses that included, “casual dating, playing the field, nonsexual” or “exclusive, committed boyfriend-girlfriend sexual relationship.” Reponses were sorted into two categories: not in a committed relationship (46% of sample; including those who indicated they were not interested in any kind of relationship and those who were in any kind of dating or sexual relationships that involved no commitment), and in a committed relationship (54% of sample; including both sexual and nonsexual committed dating relationships). Because relationship status may be associated with sexual agency or embodiment (e.g., Sanchez & Broccoli, 2008), we included it as a potential control variable.

Procedure

All students enrolled in an introductory psychology and an introductory developmental psychology course were invited to complete an extensive packet of survey measures as one of several extra credit options. The survey included measures inquiring about sexual and body attitudes, mass media use, gender beliefs, alcohol use, and sexual health. Surveys were distributed in class, and participants completed the measures on their own and returned them a week later (the return rate was 79%). The survey took approximately 3 hours to complete.

TABLE 1 Descriptive Statistics of Predictor and Outcome Variables

	Scale
	Range	M	SD	Min.	Max.
Femininity ideology
Attitudes towards women	1–4	1.57	0.33	1.00	2.75
Inauthentic self in relationships	1–6	3.12	0.63	1.30	5.00
Sexual risk knowledge	0–11	7.30	2.11	0.00	11.00
Sexual agency
Sexual assertiveness	0–4	2.48	0.69	.33	3.92
Condom self-efficacy	1–5	3.98	0.87	1.00	5.00
Sexual body comfort
Body image self-consciousness	0–5	1.65	1.09	0.00	5.00
Body comfort/body modesty Partner subscale
	0–8	4.34	1.86	0.00	8.00
Religiosity	1–5	3.17	1.12	1.00	5.00
Note. N = 366–397.

RESULTS

Preliminary Analyses

Descriptive statistics for the independent and dependent variables are listed in Table 1. Participants in the sample generally reported low scores on AWSA and ISR scales. Participants were moderately knowledgeable about female reproductive health (on average they scored about 66% on the knowledge questionnaire). They also tended to score moderately on the measures of condom self-efficacy and sexual assertiveness. Participants expressed relatively low levels of body self-consciousness during sex (below the midpoint), and they reported being moderately comfortable with their partners in intimate situations (slightly above the midpoint). Intercorrelations for our dependent variables are shown in Table 2. Confirming the results of Weinstein et al. (2008), we see many potential benefits of sexual knowledge, which was associated with greater sexual assertiveness, condom self-efficacy, and body comfort, and with diminished self-consciousness during sex. Moreover, all variables were significantly intercorrelated, adding some support to our conceptualization of these as aspects of the larger construct of sexual health.

TABLE 2 Intercorrelations of Outcome Variables

	1	2	3	4
1. Sexual risk knowledge
2. Sexual assertiveness	.27***
3. Condom self-efficacy	.34***	.50***
4. Body image self-consciousness	−.24***	−.49***	−.36***
5. Sexual body comfort	.17**	.24***	.19***	−.23***
Note. N = 365–384.
**p ≤ 0.01, ***p ≤ 0.001.

To investigate potential control variables, we ran a series of zero-order correlations between our dependent variables and the following demographic factors: age, religiosity, BMI, and mother and father's educations level. BMI and parents’ education did not significantly correlate with our dependent variables. Older women reported more condom self-efficacy, r(380) = .11, p = .03, and less body self-consciousness during sex, r(376) = −.14, p = .01. Women who were more religious held less sexual-risk knowledge, r(384) = −.22, p < 0.001), and reported lower condom self-efficacy, r(380) = −.21, p < 0.001, and sexual assertiveness, r(364) = −.15, p = .003. We also ran independent sample t tests to explore potential differences between those women in committed relationships versus those who were not in committed relationships on each of the dependent variables. Women who were currently in committed sexual relationships reported more condom self-efficacy, t(336) = −3.69, p < 0.001, and sexual assertiveness, t(323) = −3.94, p < 0.001, and less body self-consciousness during sex, t(332) = 4.86, p < 0.001. Based on these analyses, age, religiosity, and current relationship status were used as controls in all hierarchical regression analyses. We did not include ethnicity as a control variable, given the relatively small numbers of any ethnic categories except White women.

Testing the Main Research Questions

We next ran hierarchical regressions for the four outcomes of interest: sexual-risk knowledge, sexual assertiveness, condom self-efficacy, and sexual comfort (the Body Image Consciousness Scale and the partner subscale of the Body Modesty/Body Comfort Scale). The two main predictors were the femininity ideology measures (the AWSA and the ISR). We entered the three demographic control variables together in the first block of each regression (mean religiosity, age, and current relationship status); the main femininity ideology predictors were entered as a second block to determine how much of the remaining variance they accounted for.

Results supported nearly all of our hypotheses (Table 3). As expected, women who expressed greater endorsement of traditional gender role attitudes (AWSA) reported less sexual-risk knowledge, less condom self-efficacy, and were less sexually assertive. Also as predicted, women who were higher in inauthentic self held lower levels of sexual-risk knowledge, sexual assertiveness, and condom self-efficacy and reported higher levels of body self-consciousness during sex and less comfort with their body around sexual partners. The only null results were that holding traditional attitudes toward women was unrelated to body self-consciousness during sex or comfort with one's body around sexual partners.

TABLE 3 Five Hierarchical Regressions Predicting Women's Sexual Risk Knowledge, Agency, and Body Comfort

	β
	Sexual Risk	Sexual	Condom	Body Image	Sexual Body
	Knowledge	Assertiveness	Self-Efficacy	Self-Consciousness^a	Comfort
Predictors
Step 1
Age	.11*	.06	.07	−.08	−.06
Religiosity	−.21**	−.18*	−.23***	.06	–.09
Current relationship	.09	.22***	.20***	–.26***	.06
Adjusted R ^2	.06	.07	.09	.07	.00
Step 2
Attitudes toward women (AWSA)	−.19***	−.10*	−.19***	.03	−.07
Inauthentic self (ISR)	−.15**	−.31***	−.20***	.34***	−.12*
Change in R ^2	+.07	+.11	+.09	+.11	+.02
Adjusted R ^2	.12	.18	.17	.18	.02
F	9.93	14.92	14.60	15.52	2.48
p	.000	.000	.000	.000	.03
Note. N = 364–388. Standardized betas reported. Higher scores on Body Imagine Self-Consciousness Scale indicated less comfort with body during sex.
*p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001.

Each regression equation was statistically significant, and our two femininity ideology predictors, along with our control variables, explained 12% of the variance in sexual-risk knowledge scores, 18% of the variance in sexual assertiveness, 17% of the variance in condom self-efficacy, 18% of the variance in body self-consciousness during sex, and 2% of the variance concerning body comfort with an intimate partner.

DISCUSSION

Sexual health requires young women to navigate complex and multifaceted roles and opportunities: seeking out and understanding knowledge about their bodies, advocating for their protection and their pleasure, and maintaining a positive sense of one's body during sex and with an intimate partner. Emerging research shows that the messages women receive about femininity can have significant connections to their sexual health and sexual agency. We sought to replicate this work and to expand our assessment of sexual health to include sexual-risk knowledge and sexual embodiment.

Our results indicated that femininity ideology is indeed negatively associated with women's sexual agency and their experiences of sexual embodiment. Specifically, women who endorsed more traditional gender roles showed decreased sexual health knowledge, and lowered confidence in their ability to advocate for themselves sexually. Women who silence themselves to preserve relationships with others showed a similar pattern and also indicated less comfort with their bodies during sex.

These findings replicate existing results documenting connections between femininity ideologies and condom self-efficacy and assertiveness. More importantly, we provide evidence that femininity ideologies are related to another important component of sexual agency: sexual knowledge. Women who endorse traditional femininity ideologies are less knowledgeable about reproductive health and about disease and pregnancy prevention. Given the relation between sexual knowledge and sexual assertiveness (Weinstein et al., 2008), our results are a first step in building a more complete model of gender ideologies and overall sexual health. Sexual knowledge is a key aspect of sexual health and is considered a sexual right (WHO, n.d.). However, women who endorse traditional femininity ideologies seem not to be accessing, or making use of, sexual-risk knowledge. This lack of knowledge threatens young women's sexual health. Furthermore, decreased sexual knowledge may reinforce traditional gender scripts in which young women remain sexually uninformed and passive. This association also raises questions about the role that beliefs about gender play not only in how young women access sexual health knowledge independently, but also in whether they retain knowledge learned in the classroom or other venues for sexual health education.

Another addition to the literature is our focus on women's feelings about their bodies specifically during sex. As expected, we found that women who endorse traditional femininity beliefs are also more self-conscious and less comfortable with their bodies during sex. Body self-consciousness undermines sexual pleasure and sexual functioning. It negatively affects sexual assertiveness (Schooler et al., 2005; Wiederman, 2000; Yamamiya et al., 2006) and is related to increased sexual avoidance and ambivalence in sexual decision making as well as emotional disengagement during sex (Wiederman, 2000; Yamamiya et al., 2006). Although these findings have important implications for disease and pregnancy prevention, other research programs highlight the negative effects of body self-consciousness on sexual pleasure and functioning (Masters & Johnson, 1970; Sanchez & Kiefer, 2007; Steer & Tiggemann, 2008). Our current findings underscore the fact that femininity ideologies may diminish women's ability to remain agentic and to fully enjoy the physical experience of their own bodies during sex. If women who keep silent about their own needs to maintain important relationships are more likely to be disengaged from, and self-conscious about, their bodies during sex, then they may also be more likely to suffer from sexual dysfunction. Our findings suggest that such a pathway may be worth exploring further.

Although the results obtained with our two measures of femininity ideology were similar, there were some differences. Moreover, the two measures were correlated, but not so strongly as to indicate that they are measuring the exact same construct. This modest correlation, in addition to the two measures’ sometimes diverging contributions to our outcome variables, indicates that it may be important to use multiple measures to capture the complexity of femininity ideologies. For example, future studies may want to include a measure of self-objectification as a component of femininity ideologies, as other researchers have previously done (this argument is by no means new, see Impett et al., 2006).

Whereas these findings highlight certain risks associated with endorsement of femininity ideologies, it is also the case that variability persists. Because these constructions are widespread, may be deeply ingrained, and may be appealing to some women, we may wish to consider how some young women adhere to certain norms of femininity yet also manage to retain sexual agency and feel good about their bodies during sex. This seems particularly important given that popular writers (e.g., Baumgardner & Richards, 2000; Wood, 2004), and research (Cole & Zucker, 2007) found that femininity is sometimes considered to be compatible with feminism. Examining the potentially positive intersections of feminine and feminist identities/beliefs may be fruitful; when women adhere to traditional ideas of femininity, what might help mitigate the negative effects of such adherence? Other researchers (Schick, Zucker & Bay-Cheng, 2008) remind us that there are alternatives to traditional femininity ideologies and that these alternatives have beneficial sexual outcomes for young women and should also be further examined.

Limitations

Although our findings suggest relations between femininity ideologies and sexual agency and embodiment, there are several important factors that we did not include in the current analyses. First, although we did attempt to capture some of the multifaceted nature of femininity ideology, there are other important attitudinal and belief structures missing from the current analysis. Body/self objectification seems to be one such important factor; for example, it may be the women who are particularly high in self-objectification would have lower sexual body comfort, even when they do not endorse traditional femininity ideologies. Similarly, self- or body esteem might also moderate the relationships between ideologies and sexual assertiveness and sexual body comfort; high self- or body esteem may either mitigate or reverse some of the negative effects of traditional femininity ideologies. Other important factors might include ideas of compulsory heterosexuality and attitudes toward appearance norms for women. Because expectations of heterosexuality are a central aspect of femininity (Rich, 1980; Tolman et al., 2003), women's beliefs about heterosexuality should perhaps be included in measures of femininity ideology. This may be particularly important when assessing femininity ideologies in lesbian or bisexual women. Furthermore, future research may want to include broader measures of sexual knowledge, such as anatomical knowledge or knowledge of general sexual functioning, as well as measures of sexual self-efficacy that look at the degree to which women feel comfortable using other forms of STI/contraceptive protection in sexual encounters.

Although we believe that women's knowledge and attitudes about sex are important in their own right, we did not ask them about their actual behavior. It is important to know not only how participants feel or what they know, but also what they are doing with those feelings and that knowledge. The lack of inclusion of these behavioral variables may also help explain the relatively modest, though significant, variance we were able to explain in our models. More complex models will likely yield a more complete picture of women's sexual health, and future examinations might also want to capture the degree to which attitudes, beliefs, and behaviors about sexuality are congruent.

The current set of analyses did not differentiate between participants who identified as heterosexual and those who did not. Such analyses were not possible, with the small number of sexual minority women in our sample. However, femininity may have very different meanings and outcomes for lesbian and bisexual women (Nestle, 1992). Future studies will also want to replicate these findings among samples that are more ethnically diverse, especially because expectations of femininity do differ somewhat across culture, class, and ethnic background (Archer, Halsall, & Hollingworth, 2007; Bay-Cheng, Zucker, Stewart, & Pomerleau, 2002; Cole & Zucker, 2007).

A final limitation was the study's cross-sectional design, which did not allow us to test causality, and our use of self-report measures. Future studies may want to extend this research using longitudinal and experimental approaches.

Future Directions

The current research presents evidence that sexual-risk knowledge and sexual embodiment are two areas that deserve additional attention within the literature on gender ideologies and sexual health. Given that both factors are important aspects of sexual health, we argue that they should be more often included as important outcomes or mediating variables in future sexual health models. For example, we still do not understand the mechanism by which femininity ideologies link with sexual knowledge. Do women who are more traditional come from backgrounds where they are simply exposed to less sexual health education; are they somehow more resistant to the messages they receive, seeing them as incompatible with traditional roles for women; or do they not feel comfortable seeking out sexual health information? Or, viewing the association from the other side, is it possible that women with little sexual health knowledge are more open to accepting traditional gender ideologies? Longitudinal research is needed to begin to tease out the causal directions of these relations. We also do not fully understand why sexual embodiment was related to only one of our measures of femininity ideology. Does this indicate that the multiple “strands” of femininity ideology exert independent effects? Moreover, what are the long-term outcomes of increased body surveillance during sex, and their implications for pleasure and desire?

Future research may also wish to examine how femininity ideologies change across the life span, how they may exert different influences at different times, or how the effects might differ among sexual and ethnic minorities. As women age, they are more likely to settle into monogamous long-term relationships. Our findings indeed suggest that women in committed relationships may feel more sexually agentic. Furthermore, some research has indicated that romantic relationships shape how women perceive their bodies in positive ways (Ambwani & Strauss, 2007). However, we cannot rule out that agentic or assured women are more likely to settle into committed relationships in the first place, or that there may be some kind of reciprocal effect. Overall, the findings of the current study suggest that more complex models could be developed to include sexual knowledge and sexual embodiment as key features of women's sexual health.

Acknowledgments

We gratefully acknowledge Abby Stewart for helpful comments on drafts of this manuscript