A review of research linking body image and sexual well-being

Refinement and Validation of the Head and Neck Lymphedema and Fibrosis Symptom Inventory

PURPOSE

Lymphedema and fibrosis (LEF) are common yet overlooked late effects of head and neck cancer and its therapy. Lack of reliable and valid measures of head and neck LEF is a critical barrier to the timely identification and management of head and neck LEF. To fill this gap, we developed and pilot tested a 64-item patient-reported outcome measure ( Lymphedema Symptom Intensity and Distress Survey-Head and Neck, LSIDS-H&N). This article aims to report the process of further validation and refinement of the tool.

METHODS AND MATERIALS

A prospective, longitudinal study was conducted, and 120 patients with oral cavity and oropharyngeal cancer were recruited. Participants completed the LSIDS-H&N at pretreatment, end of treatment, and every 3 months up to 12 months after treatment. SAS PROC VARCLUS was used to generate preliminary clusters of item responses. Internal consistency of the item responses within each cluster was assessed using Cronbach's alpha.

RESULTS

A total of 117 patients completed the study. The participants reported that the LSIDS-H&N was easy to understand and captured their symptoms and medical conditions. However, >50% of participants indicated that the survey was burdensome due to length. Thus, we proceeded with item reduction, and the shortened tool (33-item) was named Head and Neck Lymphedema and Fibrosis Symptom Inventory (HN-LEF Symptom Inventory). The subsequent exploration of symptom clusters identified 7 symptom domain clusters (eg, soft tissue and neurologic toxicity), all of which demonstrated good internal consistency.

CONCLUSIONS

The HN-LEF Symptom Inventory has been carefully developed and refined to allow clinicians and researchers to capture LEF-associated symptom burden and function impairments. Additional rigorous psychometric testing of the tool is ongoing to further validate the strength and internal validity of this tool.

Sexual function in hook-up culture: The role of body image

Hook-up mobile apps are increasing in popularity and research suggests sexual function may be lower among those who hook-up compared to those who have sex in a longer-term relationship. Sexual function is an important predictor of well-being; however, we know little about the psychosocial antecedents of sexual function, such as body image, among those who use hook-up apps. The current study aims to examine two measures of positive body image and one measure of body image self-consciousness during intimate activity among a sample of adult women and men who have hooked up in the previous month using a hook-up mobile app (N = 243). Our results suggest that higher body image self-consciousness during intimate activity was related to lower sexual function composite score and several specific domains (i.e., pain, arousal, orgasm, and lubrication) among women. Higher body appreciation was related to higher sexual satisfaction among women. Higher body image self-consciousness during intimate activity was related to higher erection difficulty, but not ejaculation difficulty, among men. These findings highlight the nuanced nature of body image and sexual function and provide further evidence that interventions for women and men aiming to improve some body image constructs may improve sexual function as well.

Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction

Introduction

This study explored the role of body image dissatisfaction on orgasmic response during partnered sex and masturbation and on sexual relationship satisfaction. The study also described typologies of women having different levels of body image satisfaction.

Methods

A sample of 257 Norwegian women responded to an online survey assessing body image dissatisfaction, problems with orgasm, and sexual relationship satisfaction. Using structural equation modeling and factor mixture modeling, the relationship between body image dissatisfaction and orgasmic response was assessed, and clusters of sexual response characteristics associated with varying levels of body image dissatisfaction were identified.

Main Outcome Measure

Orgasmic function during partnered sex and masturbation, along with sexual relationship satisfaction, were assessed as a function of body image.

Results

Body image dissatisfaction, along with a number of covariates, predicted higher levels of “problems with orgasm” during both partnered sex and masturbation, with no significant difference in the association depending on the type of sexual activity. Varying levels of body image dissatisfaction/satisfaction were associated with differences in orgasmic incidence, difficulty, and pleasure during partnered sex; with one orgasmic parameter during masturbation; and with sexual relationship satisfaction.

Conclusion

Body image dissatisfaction and likely concomitant psychological distress are related to impaired orgasmic response during both partnered sex and masturbation and may diminish sexual relationship satisfaction. Women with high body image dissatisfaction can be characterized by specific sexual response patterns.

Horvath Z, Smith BH, Sal D, et al. Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction. Sex Med 2020;8:740–751.

Evaluation of the own body in women with current and remitted borderline personality disorder: evidence for long-lasting effects of childhood sexual abuse

BACKGROUND

Evaluation of one's own body highly depends on psychopathology. In contrast to healthy women, body evaluation is negative in women from several diagnostic groups. Particularly negative ratings have been reported in disorders related to childhood sexual abuse (CSA) including borderline personality disorder (BPD). However, it is unknown whether this negative evaluation persists beyond symptomatic remission, whether it depends on the topography of body areas (sexually connoted versus neutral areas), and whether it depends on CSA.

OBJECTIVE

First, we aimed at a quantitative comparison of body evaluation across three diagnostic groups: current BPD (cBPD), remitted BPD (rBPD), and healthy controls (HC). Second, we aimed at clarifying the potentially moderating role of a history of CSA and of the sexual connotation of body areas.

METHODS

The study included 68 women from the diagnostic groups of interest (cBPD, rBPD, and HC). These diagnoses were established with the International Personality Disorder Examination. The participants used the Survey of Body Areas to quantify the evaluation of the own body and the Childhood Trauma Questionnaire for assessing CSA.

RESULTS

While the evaluation of the own body was generally negative in women from the cBPD group it was positive in those who had remitted from BPD. However, their positive scores were strictly confined to neutral body areas, whereas the evaluation of sexually connoted body areas was negative, resembling the respective evaluation in cBPD patients and contrasting the positive evaluation of sexually connoted areas in healthy women. The negative evaluation of sexually connoted areas in remitted women was significantly related to a history of CSA.

CONCLUSIONS

Women with BPD may require a specifically designed intervention to achieve a positive evaluation of their entire body. The evaluation of sexually connoted body areas seems to remain an issue even after remission from the disorder has been achieved.

The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations

The Breast Size Satisfaction Survey (BSSS) was established to assess women's breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η² = .02-.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women's psychological and physical well-being.

Body image during sexual activity in the population of Polish adult women

Introduction

Recently it has been shown that body image during sexual activities is a better predictor of the diversity of sexual experience than body image as a psychological trait. To measure contextual body image (as a state) the Body Exposure During Sexual Activity Questionnaire (BESAQ) was developed.

Material and methods

845 women aged 18-55 years were included in the study. The original model was first translated into Polish and consulted to create the version to be further validated. The original model was tested using confirmatory factor analysis (CFA). The population was divided in two equal groups – group 1 was used for exploratory factor analysis. Discriminant and convergent validity were checked. Sexual function was assessed by the Changes in Sexual Function Questionnaire.

Results

The Polish model of BESAQ (BESAQ-PL) consisted of 28 items with 2 lower-order factors. It had a satisfactory goodness of fit – comparative fit index (CFI) = 0.93, Tucker-Lewis index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.06 and χ² = 1360.0, df = 337, p< 0.001, excellent internal consistency measured by Cronbach’s α = 0.88 and satisfactory discriminate validity. State body image (BESAQ-PL) did not predict sexual functioning. Face was the most important for self-consciousness during sexual contact in the population of Polish women.

Conclusions

State body image correlates with sexual functions but is not a major factor influencing sexual performance. Women in Poland are not anxious about body exposure during sexual activity. The BESAQ-PL may be used in the population of Polish women between 18 and 55 years of age.

"It's not perfect but it's mine": Genital self-image among women living in Italy

The purpose of this article is to describe Italian women's attitudes toward their genitals, and the intersection of genital self-image (GSI) and reproductive and sexual health behaviors. Individual interviews were conducted with 46 reproductive-aged women. All interviews were transcribed verbatim with observer comments to identify emerging data patterns. Researchers completed coding between and within interviews for a constant comparative approach to data analysis to identify emergent themes. Participants expressed embarrassment discussing genitals and equated this with societal taboos; however, friends provided one opportunity to speak more openly. Odor discussions and hygiene practices were frequently occurring themes, especially during menstruation. GSI limited some daily activities and sexual experiences due to feelings of self-consciousness. Concerns stemmed from limited knowledge about how women's genitals should look, smell, and feel. In contrast, some women detailed positive GSI in terms of autonomy and self-care. Results illustrate practical recommendations for healthcare providers to address women's genital concerns and improve women's GSI and overall reproductive and sexual health experiences.