ScienceSpiegeloog 406: The Unknown

Christiaan Hamaker Prize – Winning Thesis: The Female Orgasm and Body Dissatisfaction

By September 21, 2020 No Comments

The Christiaan Hamaker prize is awarded to the best propedeautic thesis in the psychology bachelor at the University of Amsterdam every year. 

The Female Orgasm and Body Dissatisfaction

Mona Klau
University of Amsterdam

 

Gender equality is a fundamental human right and western societies are making progress in achieving parity, yet one divergence is still to overcome: the orgasm gap. This literature review investigated the relation between the female orgasm and body dissatisfaction. Two aspects of body dissatisfaction in the context of sexology were assessed, namely the relation between the female orgasm and subjective body dissatisfaction as well as genital body dissatisfaction, expecting a negative relation on both facets. This negative relation between the female orgasm and both, subjective body dissatisfaction and genital body dissatisfaction was confirmed. The findings indicate substantial value behind enhancing body satisfaction and orgasm capacity for improving gender equality, sexual as well as mental well-being.

The Relation between the Female Orgasm and Body Dissatisfaction

   Many aspects of gender inequality have improved in society in recent years, yet one key factor has not received its appropriate attention to further enhance gender equality: the female orgasm (World Association for Sexual Health, 2014). The orgasm gap still very much exists today, proven by women revealing fewer orgasms than men with whom they have sex (Frederick, St. John, Garcia, & Lloyd, 2017) as well as by rates as high as 20-50% of all women having difficulty reaching orgasm or are not able to do so at all (Santana et. al, 2019). Due to this high prevalence of orgasm difficulty and dysfunction, it is vital from a sexual health as well as clinical perspective to find treatment methods and ways to reduce the gender gap.
     In fact, previous research has shown that body image is an important aspect influencing female sexual activity and initiation of sex (Ackard, Kearney-Cooke, & Peterson, 2000). Women who experience more negative feelings about their body display declined levels of sexual satisfaction (Træen, Markovic, & Kvalem, 2016). Indeed, even though it continues to be claimed that sexual pleasure in females can be achieved without an orgasm, it is found to be the most essential predictor of women’s sexual satisfaction (Kontula, 2009; cited by Kontula & Miettinen, 2016). In regard to dissatisfaction with one’s own body, the etiology is multi-faceted, many of which may have sociocultural origins. In fact, it has been revealed that females experience an increased pressure to live up to the current unrealistic appearance ideal (Dondzilo, Rieger, Jayawardena, & Bell, 2018), reflecting itself in the dramatic growth in numbers of cosmetic surgery (Duenwald, 2004; cited by Sanchez & Kiefer, 2007). Parallel to this increased preoccupation with beauty and physical improvement, previous research has ascertained a further trend among women, namely the decreasing ability to orgasm (Kontula & Miettinen, 2016). Objectification theory suggests a possible mechanism connecting both movements, physical perceptions and intimate experiences. Self-objectification proposes that females are acculturated to regard themselves primarily in relation to appearance and to internalize an observer’s perspective as the primary view of their own physical self, thereby constantly consciously monitoring their body (Fredrickson & Roberts, 1997). The resulting self-conscious habitual monitoring preoccupies most of attentional and cognitive ability, impairing sexual functioning and satisfaction.

Altogether, previous research shows an existing relation between body image and sexual experiences. Especially body dissatisfaction was shown to be linked to decreased sexual satisfaction, whereby the single most important predictor of sexual satisfaction was demonstrated to be the female orgasm. Considering two major trends that have been found to increasingly exist among women, enhanced preoccupation with physical appearance and decreased orgasm capacity, objectification theory provides a possible underlying mechanism which likely connects these. Being cognitively distracted due to body dissatisfaction and constant self-monitoring may interfere with sexual experiences, such as the orgasm. Therefore, one might argue that these shifts do not solely happen parallel to each other, but may indeed be connected, a detrimental relation which is yet unexplored. Based on the negative relation between body dissatisfaction and sexual satisfaction, orgasm being an important predictor of sexual satisfaction as well as increased pressure to improve one’s bodily appearance and decreased orgasm capacity, a negative association between the female orgasm and body dissatisfaction is expected. This review seeks to provide the respective answer to the relation between the female orgasm and body dissatisfaction.                                                     When addressing body dissatisfaction in the context of sexology, both the subjective degree of satisfaction with one’s own bodily appearance and the attitude toward one’s genitalia must be taken into consideration. The female orgasm may be related to subjective body dissatisfaction, the negative assessment of the own bodily attractiveness (Koch, Mansfield, Thurau, & Carey, 2005) as well as to genital body dissatisfaction, the adverse evaluation of the appearance and the lack of acceptance of one’s genitals (Herbenick et al., 2011). Both reflecting on different aspects affecting body dissatisfaction, this review will consider the relationship between the female orgasm and both, subjective body dissatisfaction and genital body dissatisfaction. The association will first be discussed in the light of subjective body dissatisfaction. Considering the relationship between the female orgasm and subjective body dissatisfaction, a negative association is expected. Afterwards the review looks at the relation between genital body dissatisfaction and the female orgasm, as it addresses body parts of unique relevance in the context of sexology. Examining the link between the female orgasm and genital body dissatisfaction, a negative association is expected.

The Relation between the Female Orgasm and Subjective Body Dissatisfaction

      Since body dissatisfaction can be formed by various factors, it is important to consider different aspects of physical appearance concerns. A considerable element contributing to body dissatisfaction is subjective body dissatisfaction, the negative assessment of one’s own physical image (Koch et al., 2005). Previous research unveiled that negative evaluative thoughts and feelings towards an individual’s own body appearance is an important predictor of unhealthy bodily behaviors, decreased self-esteem and reduced pleasure in daily activities (Komarnicky, Shakoon-Sparling, Milhausen, & Breuer, 2019). Objectification theory proposes that increased cognitive distraction caused by a negative subjective body image, misattributes attention away from sexual pleasure (Fredrickson & Roberts, 1997). On the other hand, positive body perceptions were found to be directly related to sexual experiences (Faith & Schare, 1993). Based on previous research and the self-objectification theory, this review hypothesizes that subjective body dissatisfaction and the female orgasm are negatively related. Thus, the following section discusses the association between the female orgasm and subjective body dissatisfaction. Quinn-Nilas, Benson, Milhausen, Buchholz and Goncalves (2016) studied the relation between the female orgasm and body image self-consciousness. The study was instrumentalized on 88 female university students whereby participants were on average 20.8 years old. Body image self-consciousness, negative perceptions and thoughts about the own body during a sexual experience, was determined using the Body Image Self-Consciousness Scale; BISC (Wiederman, 2000). The BISC consisted of 15 items that were answered on a 6-point likert scale. Propositions were numbered from 0 (never) to 5 (always). Scores ranged from 0 to 75 with higher scores indicating greater body image self-consciousness. An example of an item is: ‘During sexual activity it is (would be) difficult not to think about how unattractive my body is’. The female orgasm was assessed using the Female Sexual Functioning Index; FSFI (Rosen, Brown, Heiman, & Leib, 2000). The FSFI consisted of 3 items investigating the female orgasm, that were answered on a 6-point likert scale. Scores ranged from 0 (no sexual activity) to 5 (almost always or always) with higher scores displaying heightened orgasm capacity. An example of an item is: ‘Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?’. Participants with higher BISC scores depicted lower FSFI scores. Hence, it was concluded that the female orgasm and body image self-consciousness are negatively related. The above study was 

conducted within primarily university students. However, there are a number of factors that contribute specifically to the difficulties young women have in functioning sexually which can lead to a deviating relation between subjective body dissatisfaction and the female orgasm. These aspects entail a shorter history of sexual experiences to gain insight from, as well as restricted sexual communication abilities (Abel & Fitzgerald, 2006). Orgasm frequency is found to be lower in younger women (Boroditsky, Fisher, & Bridges, 1999; cited by Salisbury & Fisher, 2013) which might represent a factor influencing the relation between subjective body dissatisfaction and the female orgasm. Therefore, the next study will investigate the association within women of a wider age range. Sanchez and Kiefer (2007) examined the relation between the female orgasm and body shame. The study consisted of 198 women with an age range from 17 to 71 years old. Body shame, the perceived failure to do the cultural body ideal justice and a subsequent feeling of worthlessness, was assessed using the Objectified Body Consciousness Scale; OBC (McKinley & Hyde, 1996). The OBC entailed 8 items that were answered on an 8-point likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Scores ranged from 8 to 64 with higher scores indicating more severe body shame. An example of an item is: ‘When I cannot control my weight, I feel like something must be wrong with me’. The female orgasm was evaluated by asking two questions. ‘How often do you reach orgasm during sexual activity with your partner?’ and ‘How often do you have difficulty reaching orgasm with your partner?’ (Kiefer, Sanchez, Kalinka, & Ybarra, 2006). The two items were answered on a 5-point likert scale from 1 (never, 0% of the time) to 5 (always, 100% of the time), whereby the first question was coded in reverse. Scores ranged from 2 to 10 with higher scores signifying lower orgasm capacity. Participants scoring higher on OBC depicted greater scores on the two questions assessing orgasm capacity. Hence, it was concluded that the female orgasm and body shame are negatively related.
     The above study approached the level of content with one’s appearance solely through the presence of an excess of negative perceptions. However, subjective body dissatisfaction cannot be merely addressed by considering a surplus of negative beliefs and evaluations about one’s own body. Grasping a whole picture of subjective body dissatisfaction, a lack of positive appraisal must be examined as well. Indeed, social sciences have demanded a shift from restoring adverse characteristics towards expanding and enhancing positive properties as prevention (Seligman & Csikszentmihalyi, 2000). Subjective body dissatisfaction should thus be additionally 

displayed in a deficiency of positive evaluations. Therefore, the next study addressed subjective body dissatisfaction by looking at body appreciation.
     Satinsky, Reece, Dennis, Sanders and Bardzell (2012) studied the relation between the female orgasm and lack of body appreciation. The study was computed on 247 women aged 18 to 58 years old. Lack of body appreciation, a deficiency in holding favorable opinions of one’s body and the failure to accept one’s appearance notwithstanding the shape or size, was determined by using the Body Appreciation Scale; BAS (Avalos, Tylka, & Wood-Barcalow, 2005). The BAS comprised 13 items that were approached on a 5-point likert scale ranging from 1 (never) to 5 (always). Scores ranged from 13 to 65 with lower scores depicting diminished body appreciation. An example of an item is: ‘I feel good about my body’. The female orgasm was assessed using the FSFI (Rosen et al., 2000). Participants with lower BAS scores revealed lower FSFI scores. Hence, it was concluded that the female orgasm and a lack of body appreciation are negatively related.                  In conclusion, the female orgasm and subjective body dissatisfaction are negatively related. All studies reflected on different types of subjective body dissatisfaction thereby forming a coherent picture of the construct as a whole. In more detail, since subjective body dissatisfaction is multidimensional, it can be assessed from various kinds of appearance concerns. Body image self-consciousness disclosed a negative relationship with the female orgasm within a study primarily including university students. It determines women’s subjective bodily dissatisfaction during a sexual experience thus representing a behavior specific body image concern. Eliminating possible age-related influences, a study with wider age range demonstrated a negative link between body shame and the female orgasm. Additionally, approaching subjective body dissatisfaction from a deficiency of positive evaluations, a lack of body appreciation illustrated a negative association with the female orgasm. Body shame as well as lack of body appreciation reflect on more general adverse feelings and negative cognitive appraisals of one’s appearance or the absence of the respective positive equivalents, regardless of behavior or situation. Thus, both display an affective and evaluative kind of body image concern, which is why all studies assessed different types of subjective body dissatisfaction. Hence, these findings on behavioral as well as affective and evaluative body image concerns altogether display a negative relation between the female orgasm and subjective body dissatisfaction.

Accordingly, the initially expected negative relationship between subjective body dissatisfaction and the female orgasm can be supported. However, the above studies reflected on body dissatisfaction purely from the perspective of subjective body dissatisfaction. No specific body parts were addressed. Nevertheless, discontent with the overall body does not necessarily indicate dissatisfaction with individual features of one’s appearance (Berscheid, Walster, & Borhnstedt, 1973; cited by Schick, Calabrese, Rima, & Zucker, 2010). The vulva, being one of the most eroticized female body parts in western culture, can be a body part that occupies a unique position for women during sexual activity (Braun, 2005; cited by Schick et al., 2010). Hence, the following section will consider another facet of body dissatisfaction that might be particularly prominent for women in the context of sexology, addressing the genital body dissatisfaction.

The Relation between the Female Orgasm and Genital Body Dissatisfaction

     Having taken subjective body dissatisfaction as an aspect of body dissatisfaction into consideration, another substantial factor in the frame of sexology is the genital body dissatisfaction. Genital body discontent entails dismissive appraisals of the appearance as well as negative emotions and beliefs towards one’s own genitals (Herbenick et al., 2011). Women tend to develop a distorted view of their genitals due to depictions of unrealistic female genitalia in media (Schick et al., 2010). Objectification theory proposes that objectifying one’s genitals leads to self-consciousness and preoccupation with appearance which in return may distract attention in the context of sexual activity (Fredrickson & Roberts, 1997). Indeed, a more negative genital perception was found to be related to higher sexual distress during sexual activity (Berman, Berman, Miles, Pollets, & Powell, 2003). On the other hand, positive genital self-image was proven to be linked to sexual enjoyment as well as esteem (Morrison, Bearden, Ellis, & Harriman, 2005; cited by Schick et al., 2010). Based on previous research and the self-objectification theory, this review hypothesizes a negative association between genital body dissatisfaction and the female orgasm. Therefore, the section below looks at the relation between the female orgasm and genital body dissatisfaction. Goodman, Fashler, Miklos, Moore and Brotto (2011) studied the relation between the female orgasm and the physical genital image. The study incorporated 33 women seeking vulvovaginal aesthetic (VVA) surgery to

modify the physical properties of the genitals, whereby the average age was 35.40 years old.The physical genital image, the purely objective appearance of the genitals, was assessed by differentiating between before and after the procedure, by assuming a less negative physical genital image after the surgery. This measurement of the physical genital image was carried out this way based on the fact that women’s dissatisfaction with the own appearance of the vulva is an essential cause of the emergence of VVA surgery, as well as that the procedure fundamentally promises an improvement of the aesthetic image. The female orgasm was determined before the surgery, one month later and lastly six to nine months after, using the FSFI (Rosen et al., 2000). Results revealed no increase in FSFI scores when comparing FSFI scores before the surgery to both, one month and six to nine months follow-up scores. Thus, it was concluded that there is no relation between the female orgasm and the physical genital image.
      Genital body dissatisfaction can be rooted in a range of aspects. The above study addressed an important part of this array possible devoting to the discontent, the purely physical properties of the genitals. However, the objective genital appearance does not cover the entire scope of genital body dissatisfaction. With VVA promising increased pleasure due to purely physical appearance modification (Goodman et al., 2011) it sheds light into an important aspect of the relation between genital body dissatisfaction and sexual functioning. It reveals that it might not be the physical characteristics that are linked to the female orgasm. Displeasure with one’s genitals might also stem from feelings and beliefs about the sexual body parts instead of the actual physical image. Therefore, in order to grasp the entire spectrum of the genital body dissatisfaction, the discontent must be addressed from a psychological perspective, one’s deviant emotions and beliefs towards the genitals.                                                                    Ålgars et al. (2011) studied the relation between the female orgasm and genital self-image. The study was instrumentalized on 6201 female participants from Finland, aged 18 to 49 years old. The genital self-image, the subjective evaluation of the own genitals, was investigated using the body image subscale of the Derogatis Sexual Functioning Inventory; DSFI (Derogatis & Melisaratos, 1979). The body image subscale of the DSFI contained 15 items that were responded to on a 5-point likert scale ranging from 1 (disagree) to 5 (agree) with lower scores indicating a more negative genital self-image. An example of an item is: ‘I am pleased with the way my vagina looks’. The female orgasm was appraised using the FSFI (Rosen et al., 2000). Respondents with lower scores on the body image subscale of the DSFI were found to have lower FSFI scores. Hence, it was concluded that there is a positive relation between the female orgasm and genital self-image.

    The above study was conducted within a Finnish population sample. However, Finland is more advanced regarding gender equality than most other countries, showing social advancements for women in aspects such as politics and paid work (Kontula & Miettinen, 2016). Due to Finland’s unique social progress, a different sample must be taken into consideration to be able to generalize the demonstrated relation between the female orgasm and genital body dissatisfaction.                     Herbenick et al. (2011) studied the relation between the female orgasm and the genital self-image. The study entailed 2056 American women aged 18 to 60 years old. The genital self-image was assessed using the Female Genital Self Image Scale; FGSIS (Herbenick et al., 2011). The FGSIS comprised 7 items that were attended on a 4-point likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Scores ranged from 7 to 28 with lower scores expressing a more adverse genital self-image. An example of an item is: ‘I am satisfied with the appearance of my genitals’. The female orgasm was evaluated using the FSFI (Rosen et al., 2000). Participants with lower FGSIS scores displayed lower FSFI scores. Thus, it can be concluded that there is a positive relation between the female orgasm and the genital self-image.
    In conclusion, there is a negative relation between genital body dissatisfaction and the female orgasm. Genital body dissatisfaction can arise from a variety of sources, whereby the most crucial distinction can be made between displeasure due to the physical genital image, the actual properties of the genitals and discontent due to the genital self-image, women’s feelings and convictions towards their own genitals. Dissatisfaction with the genital body might therefore be possibly improved by an actual aesthetic reshaping of the genitals or by repairing women’s adverse perceptions and attitudes towards them. In order to determine genital body dissatisfaction from its entire spectrum, this review first looked at the physical genital image to examine whether the objective appearance is associated with the female orgasm. The physical genital image within women undergoing vulvovaginal aesthetic (VVA) surgery revealed to be in no relation to the female orgasm. In considering the subjective part of the genital body dissatisfaction, the genital self-image was first investigated within a Finnish population study, showing a positive association with the female orgasm. Additionally, a nationally representative sample in the United States illustrated a positive relationship between the genital self-image and the female orgasm. This positive association simultaneously entails that a negative genital self-image, a fundamental cause of genital body dissatisfaction, is linked to diminished orgasm capacity. Hence, the initially expected negative relation of the female orgasm and genital body dissatisfaction can be supported in  relation to the 

genital self-image, however not the physical genital image.

Conclusion

       There is a negative relation between body dissatisfaction and the female orgasm. In light of subjective body dissatisfaction and genital body dissatisfaction encompassing two distinct and defining factors of body dissatisfaction in the context of sexology, the female orgasm depicted to be associated with both. Subjective body dissatisfaction being contributed to by various types of discontent, body image self-consciousness demonstrated to be negatively related to the female orgasm within a university sample. Adjusting for age related influences, body shame showed a negative link to the female orgasm. Forasmuch as subjective body dissatisfaction not being solely determined by the presence of negative evaluations but also by an absence of positive appraisals, lack of body appreciation displayed a negative relationship with the female orgasm. In consideration of this review’s context of sexology, genital body dissatisfaction subsequently illustrated no association between the physical genital image and the female orgasm. Since genital body dissatisfaction can further be rooted in negative feelings and beliefs toward the genitals, the genital self-image was highlighted within a Finnish sample as well as a sample from the United States. Both uncovered a positive relation between the genital self-image and the female orgasm. Consequently, the expected negative link between body dissatisfaction and the female orgasm can be supported. In more detail, the hypothesized negative relation between the female orgasm and subjective body dissatisfaction can be accepted. Additionally, the negative relation between the female orgasm and genital body dissatisfaction can be supported regarding the genital self-image yet not the physical genital image. Despite the negative relation found between body dissatisfaction and the female orgasm, the studies addressed in this review, except from one, evaluated the female orgasm by means of the FSFI, which is based on self-reports. This review takes a stand on socialization as a mechanism behind the relation between the female orgasm and body dissatisfaction yet overlooks the risk of self-reported answers possibly being influenced by traditional sexual scripts. Western scripts depict female gender roles on the basis of behavioral restrictions and personal control. A woman must not appear too keen for sexual activity, since this eagerness might raise concern about her character as well as femininity. Instead she must control her urges (Wiederman, 2005). It is the sexual double standard, the concept that people are judged differently with regard to the same actions based on their gender, for why women are stigmatized for various sexual behaviors (Rudman, Fetterold, & Sanchez, 2013).

Due to these stigmata against female pleasure, women’s sexual behavior reports could be distorted. Therefore, further research must approach the female orgasm by means of physiological measurements to ensure for no discordance between women’s self-reported orgasmic responses and actual physiological reactions.
     In addition, all of the above studies were conducted within heterosexual samples. Results cannot be generalized since a whole part of the population is not considered at this point. Deviating mechanisms might be at play within different sexual orientations. It was found that heterosexual women orgasm less frequently than lesbian women (Van Rees, Spiering, & Laan, 2016). Indeed, the largest orgasm gap when comparing gender occurs during penile-vaginal intercourse (Salisbury & Fisher, 2013), nevertheless it is still the most commonly reported sexual behavior among heterosexual couples (Herbenick et al., 2010). However, clitoral stimulation has been found to be the primary source of the female orgasm, whereas the normative script of vaginal-penile intercourse includes the least amount of clitoral stimulation (Fisher, 1973; cited by Salisbury & Fisher, 2013). Knowledge about the clitoris was illustrated to be linked to orgasm frequency, with more knowledge existing in women than in men (Wade, Kremer, & Brown, 2005). Therefore, orgasm might play different roles in different sexual orientations. This must be addressed in further exploration in order to gain a broader knowledge of the interplay between the female orgasm and body dissatisfaction.                   In conclusion, the female orgasm and body dissatisfaction have proven to be related. In a broader context, the knowledge of this association can be used to incredibly benefit society in relation to sexual and psychological disorders as well as gender equality.

References

See below

The Female Orgasm and Body Dissatisfaction

Mona Klau
University of Amsterdam

Abstract

Gender equality is a fundamental human right and western societies are making progress in achieving parity, yet one divergence is still to overcome: the orgasm gap. This literature review investigated the relation between the female orgasm and body dissatisfaction. Two aspects of body dissatisfaction in the context of sexology were assessed, namely the relation between the female orgasm and subjective body dissatisfaction as well as genital body dissatisfaction, expecting a negative relation on both facets. This negative relation between the female orgasm and both, subjective body dissatisfaction and genital body dissatisfaction was confirmed. The findings indicate substantial value behind enhancing body satisfaction and orgasm capacity for improving gender equality, sexual as well as mental well-being.

The Relation between the Female Orgasm and Body Dissatisfaction

   Many aspects of gender inequality have improved in society in recent years, yet one key factor has not received its appropriate attention to further enhance gender equality: the female orgasm (World Association for Sexual Health, 2014). The orgasm gap still very much exists today, proven by women revealing fewer orgasms than men with whom they have sex (Frederick, St. John, Garcia, & Lloyd, 2017) as well as by rates as high as 20-50% of all women having difficulty reaching orgasm or are not able to do so at all (Santana et. al, 2019). Due to this high prevalence of orgasm difficulty and dysfunction, it is vital from a sexual health as well as clinical perspective to find treatment methods and ways to reduce the gender gap.
     In fact, previous research has shown that body image is an important aspect influencing female sexual activity and initiation of sex (Ackard, Kearney-Cooke, & Peterson, 2000). Women who experience more negative feelings about their body display declined levels of sexual satisfaction (Træen, Markovic, & Kvalem, 2016). Indeed, even though it continues to be claimed that sexual pleasure in females can be achieved without an orgasm, it is found to be the most essential predictor of women’s sexual satisfaction (Kontula, 2009; cited by Kontula & Miettinen, 2016). In regard to dissatisfaction with one’s own body, the etiology is multi-faceted, many of which may have sociocultural origins. In fact, it has been revealed that females experience an increased pressure to live up to the current unrealistic appearance ideal (Dondzilo, Rieger, Jayawardena, & Bell, 2018), reflecting itself in the dramatic growth in numbers of cosmetic surgery (Duenwald, 2004; cited by Sanchez & Kiefer, 2007). Parallel to this increased preoccupation with beauty and physical improvement, previous research has ascertained a further trend among women, namely the decreasing ability to orgasm (Kontula & Miettinen, 2016). Objectification theory suggests a possible mechanism connecting both movements, physical perceptions and intimate experiences. Self-objectification proposes that females are acculturated to regard themselves primarily in relation to appearance and to internalize an observer’s perspective as the primary view of their own physical self, thereby constantly consciously monitoring their body (Fredrickson & Roberts, 1997). The resulting self-conscious habitual monitoring preoccupies most of attentional and cognitive ability, impairing sexual functioning and satisfaction.

Altogether, previous research shows an existing relation between body image and sexual experiences. Especially body dissatisfaction was shown to be linked to decreased sexual satisfaction, whereby the single most important predictor of sexual satisfaction was demonstrated to be the female orgasm. Considering two major trends that have been found to increasingly exist among women, enhanced preoccupation with physical appearance and decreased orgasm capacity, objectification theory provides a possible underlying mechanism which likely connects these. Being cognitively distracted due to body dissatisfaction and constant self-monitoring may interfere with sexual experiences, such as the orgasm. Therefore, one might argue that these shifts do not solely happen parallel to each other, but may indeed be connected, a detrimental relation which is yet unexplored. Based on the negative relation between body dissatisfaction and sexual satisfaction, orgasm being an important predictor of sexual satisfaction as well as increased pressure to improve one’s bodily appearance and decreased orgasm capacity, a negative association between the female orgasm and body dissatisfaction is expected. This review seeks to provide the respective answer to the relation between the female orgasm and body dissatisfaction.                               When addressing body dissatisfaction in the context of sexology, both the subjective degree of satisfaction with one’s own bodily appearance and the attitude toward one’s genitalia must be taken into consideration. The female orgasm may be related to subjective body dissatisfaction, the negative assessment of the own bodily attractiveness (Koch, Mansfield, Thurau, & Carey, 2005) as well as to genital body dissatisfaction, the adverse evaluation of the appearance and the lack of acceptance of one’s genitals (Herbenick et al., 2011). Both reflecting on different aspects affecting body dissatisfaction, this review will consider the relationship between the female orgasm and both, subjective body dissatisfaction and genital body dissatisfaction. The association will first be discussed in the light of subjective body dissatisfaction. Considering the relationship between the female orgasm and subjective body dissatisfaction, a negative association is expected. Afterwards the review looks at the relation between genital body dissatisfaction and the female orgasm, as it addresses body parts of unique relevance in the context of sexology. Examining the link between the female orgasm and genital body dissatisfaction, a negative association is expected.

 

The Relation between the Female Orgasm and Subjective Body Dissatisfaction

      Since body dissatisfaction can be formed by various factors, it is important to consider different aspects of physical appearance concerns. A considerable element contributing to body dissatisfaction is subjective body dissatisfaction, the negative assessment of one’s own physical image (Koch et al., 2005). Previous research unveiled that negative evaluative thoughts and feelings towards an individual’s own body appearance is an important predictor of unhealthy bodily behaviors, decreased self-esteem and reduced pleasure in daily activities (Komarnicky, Shakoon-Sparling, Milhausen, & Breuer, 2019). Objectification theory proposes that increased cognitive distraction caused by a negative subjective body image, misattributes attention away from sexual pleasure (Fredrickson & Roberts, 1997). On the other hand, positive body perceptions were found to be directly related to sexual experiences (Faith & Schare, 1993). Based on previous research and the self-objectification theory, this review hypothesizes that subjective body dissatisfaction and the female orgasm are negatively related. Thus, the following section discusses the association between the female orgasm and subjective body dissatisfaction.

   Quinn-Nilas, Benson, Milhausen, Buchholz and Goncalves (2016) studied the relation between the female orgasm and body image self-consciousness. The study was instrumentalized on 88 female university students whereby participants were on average 20.8 years old. Body image self-consciousness, negative perceptions and thoughts about the own body during a sexual experience, was determined using the Body Image Self-Consciousness Scale; BISC (Wiederman, 2000). The BISC consisted of 15 items that were answered on a 6-point likert scale. Propositions were numbered from 0 (never) to 5 (always). Scores ranged from 0 to 75 with higher scores indicating greater body image self-consciousness. An example of an item is: ‘During sexual activity it is (would be) difficult not to think about how unattractive my body is’. The female orgasm was assessed using the Female Sexual Functioning Index; FSFI (Rosen, Brown, Heiman, & Leib, 2000). The FSFI consisted of 3 items investigating the female orgasm, that were answered on a 6-point likert scale. Scores ranged from 0 (no sexual activity) to 5 (almost always or always) with higher scores displaying heightened orgasm capacity. An example of an item is: ‘Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?’. Participants with higher BISC scores depicted lower FSFI scores. Hence, it was concluded that the female orgasm and body image self-consciousness are negatively related. The above study was conducted within primarily university students. However, there are a number of factors that contribute specifically to the difficulties young women have in functioning sexually which can lead to a deviating relation between subjective body dissatisfaction and the female orgasm. These aspects entail a shorter history of sexual experiences to gain insight from, as well as restricted sexual communication abilities (Abel & Fitzgerald, 2006). Orgasm frequency is found to be lower in younger women (Boroditsky, Fisher, & Bridges, 1999; cited by Salisbury & Fisher, 2013) which might represent a factor influencing the relation between subjective body dissatisfaction and the female orgasm. Therefore, the next study will investigate the association within women of a wider age range.

    Sanchez and Kiefer (2007) examined the relation between the female orgasm and body shame. The study consisted of 198 women with an age range from 17 to 71 years old. Body shame, the perceived failure to do the cultural body ideal justice and a subsequent feeling of worthlessness, was assessed using the Objectified Body Consciousness Scale; OBC (McKinley & Hyde, 1996). The OBC entailed 8 items that were answered on an 8-point likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Scores ranged from 8 to 64 with higher scores indicating more severe body shame. An example of an item is: ‘When I cannot control my weight, I feel like something must be wrong with me’. The female orgasm was evaluated by asking two questions. ‘How often do you reach orgasm during sexual activity with your partner?’ and ‘How often do you have difficulty reaching orgasm with your partner?’ (Kiefer, Sanchez, Kalinka, & Ybarra, 2006). The two items were answered on a 5-point likert scale from 1 (never, 0% of the time) to 5 (always, 100% of the time), whereby the first question was coded in reverse. Scores ranged from 2 to 10 with higher scores signifying lower orgasm capacity. Participants scoring higher on OBC depicted greater scores on the two questions assessing orgasm capacity. Hence, it was concluded that the female orgasm and body shame are negatively related.

     The above study approached the level of content with one’s appearance solely through the presence of an excess of negative perceptions. However, subjective body dissatisfaction cannot be merely addressed by considering a surplus of negative beliefs and evaluations about one’s own body. Grasping a whole picture of subjective body dissatisfaction, a lack of positive appraisal must be examined as well. Indeed, social sciences have demanded a shift from restoring adverse characteristics towards expanding and enhancing positive properties as prevention (Seligman & Csikszentmihalyi, 2000). Subjective body dissatisfaction should thus be additionally displayed in a deficiency of positive evaluations. Therefore, the next study addressed subjective body dissatisfaction by looking at body appreciation.

    Satinsky, Reece, Dennis, Sanders and Bardzell (2012) studied the relation between the female orgasm and lack of body appreciation. The study was computed on 247 women aged 18 to 58 years old. Lack of body appreciation, a deficiency in holding favorable opinions of one’s body and the failure to accept one’s appearance notwithstanding the shape or size, was determined by using the Body Appreciation Scale; BAS (Avalos, Tylka, & Wood-Barcalow, 2005). The BAS comprised 13 items that were approached on a 5-point likert scale ranging from 1 (never) to 5 (always). Scores ranged from 13 to 65 with lower scores depicting diminished body appreciation. An example of an item is: ‘I feel good about my body’. The female orgasm was assessed using the FSFI (Rosen et al., 2000). Participants with lower BAS scores revealed lower FSFI scores. Hence, it was concluded that the female orgasm and a lack of body appreciation are negatively related.

    In conclusion, the female orgasm and subjective body dissatisfaction are negatively related. All studies reflected on different types of subjective body dissatisfaction thereby forming a coherent picture of the construct as a whole. In more detail, since subjective body dissatisfaction is multidimensional, it can be assessed from various kinds of appearance concerns. Body image self-consciousness disclosed a negative relationship with the female orgasm within a study primarily including university students. It determines women’s subjective bodily dissatisfaction during a sexual experience thus representing a behavior specific body image concern. Eliminating possible age-related influences, a study with wider age range demonstrated a negative link between body shame and the female orgasm. Additionally, approaching subjective body dissatisfaction from a deficiency of positive evaluations, a lack of body appreciation illustrated a negative association with the female orgasm. Body shame as well as lack of body appreciation reflect on more general adverse feelings and negative cognitive appraisals of one’s appearance or the absence of the respective positive equivalents, regardless of behavior or situation. Thus, both display an affective and evaluative kind of body image concern, which is why all studies assessed different types of subjective body dissatisfaction. Hence, these findings on behavioral as well as affective and evaluative body image concerns altogether display a negative relation between the female orgasm and subjective body dissatisfaction.

   Accordingly, the initially expected negative relationship between subjective body dissatisfaction and the female orgasm can be supported. However, the above studies reflected on body dissatisfaction purely from the perspective of subjective body dissatisfaction. No specific body parts were addressed. Nevertheless, discontent with the overall body does not necessarily indicate dissatisfaction with individual features of one’s appearance (Berscheid, Walster, & Borhnstedt, 1973; cited by Schick, Calabrese, Rima, & Zucker, 2010). The vulva, being one of the most eroticized female body parts in western culture, can be a body part that occupies a unique position for women during sexual activity (Braun, 2005; cited by Schick et al., 2010). Hence, the following section will consider another facet of body dissatisfaction that might be particularly prominent for women in the context of sexology, addressing the genital body dissatisfaction.

 

The Relation between the Female Orgasm and Genital Body Dissatisfaction

     Having taken subjective body dissatisfaction as an aspect of body dissatisfaction into consideration, another substantial factor in the frame of sexology is the genital body dissatisfaction. Genital body discontent entails dismissive appraisals of the appearance as well as negative emotions and beliefs towards one’s own genitals (Herbenick et al., 2011). Women tend to develop a distorted view of their genitals due to depictions of unrealistic female genitalia in media (Schick et al., 2010). Objectification theory proposes that objectifying one’s genitals leads to self-consciousness and preoccupation with appearance which in return may distract attention in the context of sexual activity (Fredrickson & Roberts, 1997). Indeed, a more negative genital perception was found to be related to higher sexual distress during sexual activity (Berman, Berman, Miles, Pollets, & Powell, 2003). On the other hand, positive genital self-image was proven to be linked to sexual enjoyment as well as esteem (Morrison, Bearden, Ellis, & Harriman, 2005; cited by Schick et al., 2010). Based on previous research and the self-objectification theory, this review hypothesizes a negative association between genital body dissatisfaction and the female orgasm. Therefore, the section below looks at the relation between the female orgasm and genital body dissatisfaction. Goodman, Fashler, Miklos, Moore and Brotto (2011) studied the relation between the female orgasm and the physical genital image. The study incorporated 33 women seeking vulvovaginal aesthetic (VVA) surgery to modify the physical properties of the genitals, whereby the average age was 35.40 years old. The physical genital image, the purely objective appearance of the genitals, was assessed by differentiating between before and after the procedure, by assuming a less negative physical genital image after the surgery. This measurement of the physical genital image was carried out this way based on the fact that women’s dissatisfaction with the own appearance of the vulva is an essential cause of the emergence of VVA surgery, as well as that the procedure fundamentally promises an improvement of the aesthetic image. The female orgasm was determined before the surgery, one month later and lastly six to nine months after, using the FSFI (Rosen et al., 2000). Results revealed no increase in FSFI scores when comparing FSFI scores before the surgery to both, one month and six to nine months follow-up scores. Thus, it was concluded that there is no relation between the female orgasm and the physical genital image.

      Genital body dissatisfaction can be rooted in a range of aspects. The above study addressed an important part of this array possible devoting to the discontent, the purely physical properties of the genitals. However, the objective genital appearance does not cover the entire scope of genital body dissatisfaction. With VVA promising increased pleasure due to purely physical appearance modification (Goodman et al., 2011) it sheds light into an important aspect of the relation between genital body dissatisfaction and sexual functioning. It reveals that it might not be the physical characteristics that are linked to the female orgasm. Displeasure with one’s genitals might also stem from feelings and beliefs about the sexual body parts instead of the actual physical image. Therefore, in order to grasp the entire spectrum of the genital body dissatisfaction, the discontent must be addressed from a psychological perspective, one’s deviant emotions and beliefs towards the genitals.               

     Ålgars et al. (2011) studied the relation between the female orgasm and genital self-image. The study was instrumentalized on 6201 female participants from Finland, aged 18 to 49 years old. The genital self-image, the subjective evaluation of the own genitals, was investigated using the body image subscale of the Derogatis Sexual Functioning Inventory; DSFI (Derogatis & Melisaratos, 1979). The body image subscale of the DSFI contained 15 items that were responded to on a 5-point likert scale ranging from 1 (disagree) to 5 (agree) with lower scores indicating a more negative genital self-image. An example of an item is: ‘I am pleased with the way my vagina looks’. The female orgasm was appraised using the FSFI (Rosen et al., 2000). Respondents with lower scores on the body image subscale of the DSFI were found to have lower FSFI scores. Hence, it was concluded that there is a positive relation between the female orgasm and genital self-image.    

     The above study was conducted within a Finnish population sample. However, Finland is more advanced regarding gender equality than most other countries, showing social advancements for women in aspects such as politics and paid work (Kontula & Miettinen, 2016). Due to Finland’s unique social progress, a different sample must be taken into consideration to be able to generalize the demonstrated relation between the female orgasm and genital body dissatisfaction.                 

      Herbenick et al. (2011) studied the relation between the female orgasm and the genital self-image. The study entailed 2056 American women aged 18 to 60 years old. The genital self-image was assessed using the Female Genital Self Image Scale; FGSIS (Herbenick et al., 2011). The FGSIS comprised 7 items that were attended on a 4-point likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Scores ranged from 7 to 28 with lower scores expressing a more adverse genital self-image. An example of an item is: ‘I am satisfied with the appearance of my genitals’. The female orgasm was evaluated using the FSFI (Rosen et al., 2000). Participants with lower FGSIS scores displayed lower FSFI scores. Thus, it can be concluded that there is a positive relation between the female orgasm and the genital self-image.

      In conclusion, there is a negative relation between genital body dissatisfaction and the female orgasm. Genital body dissatisfaction can arise from a variety of sources, whereby the most crucial distinction can be made between displeasure due to the physical genital image, the actual properties of the genitals and discontent due to the genital self-image, women’s feelings and convictions towards their own genitals. Dissatisfaction with the genital body might therefore be possibly improved by an actual aesthetic reshaping of the genitals or by repairing women’s adverse perceptions and attitudes towards them. In order to determine genital body dissatisfaction from its entire spectrum, this review first looked at the physical genital image to examine whether the objective appearance is associated with the female orgasm. The physical genital image within women undergoing vulvovaginal aesthetic (VVA) surgery revealed to be in no relation to the female orgasm. In considering the subjective part of the genital body dissatisfaction, the genital self-image was first investigated within a Finnish population study, showing a positive association with the female orgasm. Additionally, a nationally representative sample in the United States illustrated a positive relationship between the genital self-image and the female orgasm. This positive association simultaneously entails that a negative genital self-image, a fundamental cause of genital body dissatisfaction, is linked to diminished orgasm capacity. Hence, the initially expected negative relation of the female orgasm and genital body dissatisfaction can be supported in  relation to the genital self-image, however not the physical genital image.

 

Conclusion

       There is a negative relation between body dissatisfaction and the female orgasm. In light of subjective body dissatisfaction and genital body dissatisfaction encompassing two distinct and defining factors of body dissatisfaction in the context of sexology, the female orgasm depicted to be associated with both. Subjective body dissatisfaction being contributed to by various types of discontent, body image self-consciousness demonstrated to be negatively related to the female orgasm within a university sample. Adjusting for age related influences, body shame showed a negative link to the female orgasm. Forasmuch as subjective body dissatisfaction not being solely determined by the presence of negative evaluations but also by an absence of positive appraisals, lack of body appreciation displayed a negative relationship with the female orgasm. In consideration of this review’s context of sexology, genital body dissatisfaction subsequently illustrated no association between the physical genital image and the female orgasm. Since genital body dissatisfaction can further be rooted in negative feelings and beliefs toward the genitals, the genital self-image was highlighted within a Finnish sample as well as a sample from the United States. Both uncovered a positive relation between the genital self-image and the female orgasm. Consequently, the expected negative link between body dissatisfaction and the female orgasm can be supported. In more detail, the hypothesized negative relation between the female orgasm and subjective body dissatisfaction can be accepted. Additionally, the negative relation between the female orgasm and genital body dissatisfaction can be supported regarding the genital self-image yet not the physical genital image. Despite the negative relation found between body dissatisfaction and the female orgasm, the studies addressed in this review, except from one, evaluated the female orgasm by means of the FSFI, which is based on self-reports. This review takes a stand on socialization as a mechanism behind the relation between the female orgasm and body dissatisfaction yet overlooks the risk of self-reported answers possibly being influenced by traditional sexual scripts. Western scripts depict female gender roles on the basis of behavioral restrictions and personal control. A woman must not appear too keen for sexual activity, since this eagerness might raise concern about her character as well as femininity. Instead she must control her urges (Wiederman, 2005). It is the sexual double standard, the concept that people are judged differently with regard to the same actions based on their gender, for why women are stigmatized for various sexual behaviors (Rudman, Fetterold, & Sanchez, 2013). Due to these stigmata against female pleasure, women’s sexual behavior reports could be distorted. Therefore, further research must approach the female orgasm by means of physiological measurements to ensure for no discordance between women’s self-reported orgasmic responses and actual physiological reactions.

      In addition, all of the above studies were conducted within heterosexual samples. Results cannot be generalized since a whole part of the population is not considered at this point. Deviating mechanisms might be at play within different sexual orientations. It was found that heterosexual women orgasm less frequently than lesbian women (Van Rees, Spiering, & Laan, 2016). Indeed, the largest orgasm gap when comparing gender occurs during penile-vaginal intercourse (Salisbury & Fisher, 2013), nevertheless it is still the most commonly reported sexual behavior among heterosexual couples (Herbenick et al., 2010). However, clitoral stimulation has been found to be the primary source of the female orgasm, whereas the normative script of vaginal-penile intercourse includes the least amount of clitoral stimulation (Fisher, 1973; cited by Salisbury & Fisher, 2013). Knowledge about the clitoris was illustrated to be linked to orgasm frequency, with more knowledge existing in women than in men (Wade, Kremer, & Brown, 2005). Therefore, orgasm might play different roles in different sexual orientations. This must be addressed in further exploration in order to gain a broader knowledge of the interplay between the female orgasm and body dissatisfaction.

   In conclusion, the female orgasm and body dissatisfaction have proven to be related. In a broader context, the knowledge of this association can be used to incredibly benefit society in relation to sexual and psychological disorders as well as gender equality.

References

See below

Mona Klau

About the Author

My name is Mona and I am a first-year psychology student at the University of Amsterdam. Growing up in Germany, I decided after finishing a different undergraduate degree to move to Amsterdam and follow what I am genuinely passionate about, psychology. Always having felt the need to stand up for the improvement of gender equality, I saw the propaedeutic thesis as a great opportunity to highlight this important matter. Sex still being a taboo-topic especially in regard to women, I am trying to fight this still ongoing trend and reduce the orgasm gap between females and males with these findings.

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– Dondzilo, L., Rieger, E., Jayawardena, N., & Bell, J. (2018). Drive for thinness versus fear of fat: Approach and avoidance motivation regarding thin and non-thin images in women. Cognitive Therapy and Research, 43(3), 585–593. https://doi.org/10.1007/s10608-018-9989-3
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– Herbenick, Debra, Schick, V., Reece, M., Sanders, S., Dodge, B., & Fortenberry, J. D. (2011). The female genital self‐image scale (FGSIS): Results from a nationally representative probability sample of women in the United States. The Journal of Sexual Medicine, 8(1), 158–166. https://doi.org/10.1111/j.1743-6109.2010.02071.x
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– McKinley, N. M., & Hyde, J. S. (1996). The objectified body consciousness scale. Psychology of Women Quarterly, 20(2), 181–215. https://doi.org/10.1111/j.1471-6402.1996.tb00467.x
– Quinn-Nilas, C., Benson, L., Milhausen, R. R., Buchholz, A. C., & Goncalves, M. (2016). The relationship between body image and domains of sexual functioning among heterosexual, emerging adult women. Sexual Medicine, 4(3), 182–189. https://doi.org/10.1016/j.esxm.2016.02.004
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– Rudman, L. A., Fetterolf, J. C., & Sanchez, D. T. (2013). What motivates the sexual double standard? More support for male versus female control theory. Personality and Social Psychology Bulletin, 39(2), 250–263. https://doi.org/10.1177/0146167212472375
– Salisbury, C. M. A., & Fisher, W. A. (2013). “Did you come?” A qualitative exploration of gender differences in beliefs, experiences, and concerns regarding female orgasm occurrence during heterosexual sexual interactions. The Journal of Sex Research, 51(6), 616–631. https://doi.org/10.1080/00224499.2013.838934
– Sanchez, D. T., & Kiefer, A. K. (2007). Body concerns in and out of the bedroom: Implications for sexual pleasure and problems. Archives of Sexual Behavior, 36(6), 808–820. https://doi.org/10.1007/s10508-007-9205-0
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References

– Abel, G., & Fitzgerald, L. (2006). ‘When you come to it you feel like a dork asking a guy to put a condom on’: Is sex education addressing young people’s understandings of risk? Sex Education, 6(2), 105–119. https://doi.org/10.1080/14681810600578750
– Ackard, D., Kearney-Cooke, A., & Peterson, C. (2000). Effect of body image and self-image on women’s sexual behaviors. International Journal of Eating Disorders, 28(4), 442-429. https://doi.org/10.1002/1098-108x(200012)28:4<422::aid-eat10>3.0.co;2-1 
– Ålgars, M., Santtila, P., Jern, P., Johansson, A., Westerlund, M., & Sandnabba, N. K. (2011). Sexual body image and its correlates: A population-based study of Finnish women and men. International Journal of Sexual Health, 23(1), 26–34. https://doi.org/10.1080/19317611.2010.509692
– Avalos, L., Tylka, T. L., & Wood-Barcalow, N. (2005). The body appreciation scale: Development and psychometric evaluation. Body Image, 2(3), 285–297. https://doi.org/10.1016/j.bodyim.2005.06.002
– Berman, L. A., Berman, J., Miles, M., Pollets, D., & Powell, J. A. (2003). Genital self-image as a component of sexual health: Relationship between genital self-image, female sexual function, and quality of life measures. Journal of Sex & Marital Therapy, 29(sup1), 11–21. https://doi.org/10.1080/713847124
– Declaration of Sexual Rights. (2014). Retrieved from https://worldsexualhealth.net/wp content/uploads/2013/08/Declaration-of-Sexual-Rights-2014-plain-text.pdf
– Derogatis, L. R., & Melisaratos, N. (1979). The DSFI: A multidimensional measure of sexual functioning. Journal of Sex & Marital Therapy, 5(3), 244–281. https://doi.org/10.1080/00926237908403732
– Dondzilo, L., Rieger, E., Jayawardena, N., & Bell, J. (2018). Drive for thinness versus fear of fat: Approach and avoidance motivation regarding thin and non-thin images in women. Cognitive Therapy and Research, 43(3), 585–593. https://doi.org/10.1007/s10608-018-9989-3
– Faith, M. S., & Schare, M. L. (1993). The role of body image in sexually avoidant behavior. Archives of Sexual Behavior, 22(4), 345–356. https://doi.org/10.1007/bf01542123
– Frederick, D. A., John, H. K. St., Garcia, J. R., & Lloyd, E. A. (2017). Differences in orgasm frequency among gay, lesbian, bisexual, and heterosexual men and women in a U.S. national sample. Archives of Sexual Behavior, 47(1), 273–288. https://doi.org/10.1007/s10508-017 0939-z
– Fredrickson, B. L., & Roberts, T.-A. (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21(2), 173–206. https://doi.org/10.1111/j.1471-6402.1997.tb00108.x
– Goodman, M., Fashler, S., Miklos, J. R., Moore, R. D., & Brotto, L. A. (2011). The sexual, psychological, and body image health of women undergoing elective vulvovaginal plastic/cosmetic procedures: A pilot study. The American Journal of Cosmetic Surgery, 28(4), 219–226. https://doi.org/10.1177/074880681102800404
– Herbenick, Debby, Reece, M., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). An event-level analysis of the sexual characteristics and composition among adults ages 18 to 59: Results from a national probability sample in the United States. The Journal of Sexual Medicine, 7, 346–361. https://doi.org/10.1111/j.1743-6109.2010.02020.x
– Herbenick, Debra, Schick, V., Reece, M., Sanders, S., Dodge, B., & Fortenberry, J. D. (2011). The female genital self‐image scale (FGSIS): Results from a nationally representative probability sample of women in the United States. The Journal of Sexual Medicine, 8(1), 158–166. https://doi.org/10.1111/j.1743-6109.2010.02071.x
– Kiefer, A. K., Sanchez, D. T., Kalinka, C. J., & Ybarra, O. (2006). How women’s nonconscious association of sex with submission relates to their subjective sexual arousability and ability to reach orgasm. Sex Roles, 55(1–2), 83–94. https://doi.org/10.1007/s11199-006-9060-9
– Koch, P. B., Mansfield, P. K., Thurau, D., & Carey, M. (2005). “Feeling frumpy”: The relationships between body image and sexual response changes in midlife women. Journal of Sex Research, 42(3), 215–223. https://doi.org/10.1080/00224490509552276
– Komarnicky, T., Skakoon-Sparling, S., Milhausen, R. R., & Breuer, R. (2019). Genital self-image: Associations with other domains of body image and sexual response. Journal of Sex & Marital Therapy, 45(6), 524–537. https://doi.org/10.1080/0092623x.2019.1586018
– Kontula, O., & Miettinen, A. (2016). Determinants of female sexual orgasms. Socioaffective Neuroscience & Psychology, 6(1), 31624. https://doi.org/10.3402/snp.v6.31624
– McKinley, N. M., & Hyde, J. S. (1996). The objectified body consciousness scale. Psychology of Women Quarterly, 20(2), 181–215. https://doi.org/10.1111/j.1471-6402.1996.tb00467.x
– Quinn-Nilas, C., Benson, L., Milhausen, R. R., Buchholz, A. C., & Goncalves, M. (2016). The relationship between body image and domains of sexual functioning among heterosexual, emerging adult women. Sexual Medicine, 4(3), 182–189. https://doi.org/10.1016/j.esxm.2016.02.004
– Rosen, C. Brown, J. Heiman, S. Leib, R. (2000). The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26(2), 191–208. https://doi.org/10.1080/009262300278597
– Rudman, L. A., Fetterolf, J. C., & Sanchez, D. T. (2013). What motivates the sexual double standard? More support for male versus female control theory. Personality and Social Psychology Bulletin, 39(2), 250–263. https://doi.org/10.1177/0146167212472375
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