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Alavi-Arjas F, Goodman MP, Simbar M, Alavi Majd H, Nahidi F. The strength of correlation between female genital self-image and sexual function: a systematic review and meta-analysis. J Sex Med 2023; 20:1376-1383. [PMID: 37814530 DOI: 10.1093/jsxmed/qdad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/26/2023] [Accepted: 08/24/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Mounting evidence indicates that female genital aesthetic complaints impact sexual relationships. AIM The study sought to determine the strength of the correlation between genital self-image and sexual function. METHODS Electronic databases were comprehensively searched including PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library from January 2000 to December 2022. After duplicate removal, 146 articles were retrieved by searching keywords in titles and abstracts. OUTCOMES A positive correlation is noted between genital self-image and sexual function; the strength of this correlation was 0.375. RESULTS By omitting irrelevant articles according to the eligibility criteria, 16 articles remained for a total of 13 505 participants. All but 1 of them indicated a statistically significant positive correlation between genital self-image and sexual function. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity. CLINICAL IMPLICATIONS The results of this study may be used in counseling women with sexual dysfunction who are dissatisfied with their genital appearance. STRENGTHS AND LIMITATIONS This study is the first systematic review to reveal the strength of the correlation between genital self-image and sexual function. The most important limitation of this study is the heterogeneity of the studies reported. CONCLUSION This systematic review indicates a positive correlation between genital self-image and sexual function. The results are restricted by inconsistency of the articles considered. Using different tools in different cultural contexts without considering confounding factors leads to a wide range of correlation sizes and significant heterogeneity is evident.
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Affiliation(s)
- Fatemeh Alavi-Arjas
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Michael P Goodman
- Department of Obstetrics and Gynecology, California Northstate University College of Medicine, Elk Grove CA 95757, United States
- The Labiaplasty and Vaginoplasty Training Institute of America, Winters, CA 95694, United States
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1971653313, Iran
| | - Fatemeh Nahidi
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
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Malary M, Hamzehgardeshi Z, Keramat A, Yunesian M, Farjamfar M. Psychosexual counseling intervention to improve women's genital self-image: Study protocol for a randomized controlled trial based on a multistage mixed method design. Health Sci Rep 2023; 6:e1720. [PMID: 38028697 PMCID: PMC10665641 DOI: 10.1002/hsr2.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Genital self-image (GSI) is a major barrier to reproductive and sexual health for women. This practical randomized trial aims to evaluate the effect of psychosexual counseling based on a cognitive-behavioral approach to promoting GSI for reproductive-age married Iranian women. Methods Married women aged 15-49 years under the coverage of health centers will be invited to join the study. The study will be conducted using a multistage mixed method design in three phases. In the first phase, semi-structured interviews with women and key informants will be conducted to understand better the GSI concept, the factors influencing it, and the interventions promoting it. Simultaneously, a literature review will be conducted by searching electronic databases to find the factors influencing GSI and the interventions to enhance it.In the second phase, the GSI-related factors, sexual and reproductive health outcomes correlated with GSI, and intervention programs for promoting GSI in women will be extracted from the integration of qualitative study and literature review. Then, based on the expert panel's priority, a suitable program will be prepared.In the third phase, at first, a cross-sectional study will be conducted to identify women with poor GSI and the factors relating to GSI, and then psychosexual counseling intervention will be performed. For the randomized controlled trial study, participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using the Female Genital Self-Image Scale and sexual and reproductive health outcomes correlated with GSI at baseline, immediate, and 2-month follow-up assessments. The impact of the intervention on the promotion of GSI will be evaluated. Discussion This study provides a counseling program for promoting GSI. If this interventional program is successful, it has practical potential to be generalized for Iranian Women with poor GSI.
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Affiliation(s)
- Mina Malary
- Student Research Committee, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Zeinab Hamzehgardeshi
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
- Department of Reproductive Health and MidwiferyMazandaran University of Medical SciencesSariIran
| | - Afsaneh Keramat
- Department of Reproductive Health and Midwifery, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Masoud Yunesian
- Department of Research Methodology and Data Analysis, Institute for Environmental ResearchTehran University of Medical SciencesTehranIran
- Department of Environmental Health Engineering, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Maryam Farjamfar
- Clinical Research Development Unit, Imam Hossein HospitalShahroud University of Medical SciencesIran
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Women's aesthetic perceptions of the genitalia and their association with anatomical measurements. Arch Gynecol Obstet 2023; 307:1847-1857. [PMID: 36806765 DOI: 10.1007/s00404-023-06956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND The purpose of this study is to determine women's perceptions of the vulva with the criteria defined in the literature for the ideal vulva and determine their relationship with anatomical measurements to determine the extent to which women's perceptions of normal align with our aesthetic standards of normality. METHODS First of all, a questionnaire was given to all participants. The items of the data collection form included personal information, obstetric and gynecological information, their perceptions of their external genitalia and any physical, sexual, psychological, and hygiene problems they experience. Then examination and measurements of the external genitalia were performed. RESULTS The majority of participants considered their genitalia normal (n = 101, 89.4%), while 12 participants (10.6%) considered them abnormal. Statistical analyses showed that women's perception of their genitalia as normal in appearance and size was associated with labia minora asymmetry (p = 0.023 and p = 0.006, respectively) and hyperpigmentation (p = 0.010 and p = 0.047, respectively) but not with labia minora measurements or protrusion (p > 0.05). CONCLUSIONS Although there is a tendency in the field of aesthetic surgery to define ideals and aesthetic standards for all parts of the body, our definitions of normality do not always coincide with those of the individual. The appearance of the genitalia is as personal as the face, and an individual's self-perception is more important than our ideal. LEVEL IV Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
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Hustad IB, Malmqvist K, Ivanova E, Rück C, Enander J. Does Size Matter? Genital Self-Image, Genital Size, Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women. J Sex Med 2022; 19:1378-1386. [DOI: 10.1016/j.jsxm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
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Piro TJ, Saeed AA, Abdulla WH, Safari K. Women’s experience and perspectives toward genital cosmetic surgery in Erbil city/Iraq: a qualitative study. BMC Womens Health 2022; 22:340. [PMID: 35962332 PMCID: PMC9373366 DOI: 10.1186/s12905-022-01921-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nowadays, Female Genital Cosmetic Surgery is quite prevalent, resulting in a wide range of medical and cultural implications. The majority of women who undergo this operation suffer from anxiety, depression, and other emotional symptoms. The present study was carried out in order to explore women’s perspective on and experience of genital cosmetic surgery given their special context and cultural aspects. Methods The qualitative study applying content analysis examined the experiences of nine women who received genital cosmetic surgery in Erbil, Kurdistan-Iraq, between 2021 and 2022. Each of the semi-in-depth face-to-face interviews lasted between 40 and 60 min and was conducted at the physician's clinics. Results Semi-structured interviews led to emergence of two main themes, namely “husband satisfaction” and “self-confidence”. Interpreting the participants’ stories resulted in some relevant subthemes and meaning units like “ugly appearance”, “anxiety related to husband undesirable intercourse”, and “dyspareunia”. Finally, the related conclusions of each theme were explored. Conclusion As suggested by the study findings, female genital cosmetic surgery improves the women’s body image and sexual function and the couples’ sexual satisfaction, especially that of husbands. Because of the people’s sociocultural aspects in Kurdistan region, their awareness of female sexual needs and marital relationship needs to be raised.
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Mohammed GF, Saad HM. Severe COVID-19 has Low Testosterone, Estrogen Levels, and Impaired Sexuality. SEXOLOGIES 2022. [PMCID: PMC9061178 DOI: 10.1016/j.sexol.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For assessing whether women with and without COVID-19 differed with regard to female genital self-image, sexual function and hormonal profile. Female genital self-image being assessed with the female genital self-image scale (FGSIS) and Female Sexual Function Index (FSFI) and laboratory investigations. The study had revealed significant differences in all domains of the FSFI except pain between the cases and the controls. The study had demonstrated significant differences in all domains of the FGSIS between the cases and the controls. The study had shown significant decline in the post-COVID-19 serum levels of total testosterone (TT), free testosterone (FT) and estradiol (E) between the two groups (P < 0.05). Positive correlations between serum TT, FT, E and FGSIS domains and total score of FGSIS in the cases were observed.
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Somavilla P, Pasqualoto AS, Braz MM. Genital self-image, sexual function and pelvic floor discomfort in COVID-19 pandemic scenario. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.356011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Sexual health is an important area of women's health, comprising aspects that can be affected by stressors, such as in the COVID-19 pandemic scenario. Objective: To investigate genital self-image, sexual function and pelvic floor discomfort in young female university students during the COVID-19 pandemic, comparing these factors with their sexual activity. Methods: This study is a quantitative and cross-sectional survey of young female university students during the COVID-19 pandemic period, carried out through an online form. To assess the variables, the Female Sexual Function Index, Pelvic Floor Distress Inventory, and Female Genital Self-Image Scale were used. Results: 182 women participated in the study, and the general mean age was 22.06 ± 2.75 years. Sexually active women (n = 128) had significantly better genital self-image compared to inactive women (22.87 ± 2.92 vs. 20.85 ± 4.41; p = 0.004). Likewise, better genital self-image was also observed in women without sexual dysfunction (23.36 ± 2.72 vs. 21.11 ± 2.96; p < 0.001) and in those who reported fewer symptoms of pelvic floor discomfort (p = 0.014). Conclusion: A positive genital self-image was associated with fewer sexual dysfunctions, better sexual function, and fewer symptoms of pelvic floor discomfort. Furthermore, sexual activity is associated with a better genital self-image.
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Schmidt CN, Rowen TS. Female Genital Self-Image and Modification. J Sex Med 2021; 18:1945-1949. [PMID: 34688584 DOI: 10.1016/j.jsxm.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
There has been an increase in genital cosmentic surgeries over the past decade, with the most common procedure being labiaplasty. This trend has many origins, but a significant motivator is genital self image, which has been shown to be very culturally influenced. Furthermore genital self modification, by way of grooming also is felt to play a role in the desire to surgically alter one's genital appearance. Given the cultural aspect of these practices, sexual health proivders should be aware of the role of self image and self modification in the drive towards persuing surgical changes to the genitals. Schmidt CN, Rowen TS. Female Genital Self-Image and Modification. J Sex Med 2021;18:1945-1949.
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Affiliation(s)
- Christina N Schmidt
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tami S Rowen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA..
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Benabe E, Fuentes Y, Roldan G, Ramos M, Pastrana M, Romaguera J. The perceptions of female genital self-image and its associations with female sexual distress. Int J Gynaecol Obstet 2021; 157:90-95. [PMID: 34270108 DOI: 10.1002/ijgo.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the perception of women living in Puerto Rico regarding their genitalia and explore the associations of those perceptions with female sexual distress. METHODS Women from Puerto Rico willing to complete a self-administered online survey from June 2018 through July 2020 were included in this cross-sectional study. Inclusion criteria included being between 21 and 65 years of age, living in Puerto Rico, having identified as heterosexual, bisexual, or lesbian, and having been sexually active. Descriptive statistics were calculated. The Mann-Whitney test, Pearson's correlation, and robust linear regression were used to associate female genital self-image and sexual distress. RESULTS The most common negative thought and perception within women was dissatisfaction with the size of their genitalia (21.9%), and 21.3% of women contemplated undergoing cosmetic surgery, mainly to increase and improve sensation. For each 1-unit increase in the Female Genital Self-Image Scale score, the Female Sexual Distress Scale-Revised score decreased by 1.24 units (95% confidence interval -1.67 to -0.82). CONCLUSION A better genital self-image perception might lower levels of sexual distress. Screening instruments could help to identify poor genital perception and sexual distress.
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Affiliation(s)
- Erika Benabe
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico
| | - Yesenia Fuentes
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico
| | - Gabriela Roldan
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico
| | - Mariluz Ramos
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico
| | - Manuel Pastrana
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico
| | - Josefina Romaguera
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico.,Department of Obstetrics and Gynecology, University of Puerto Rico, San Juan, Puerto Rico
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Rouzi AA, Berg RC, Alamoudi R, Alzaban F, Sehlo M. Female Genital Self-Image in Women With and Without Female Genital Mutilation/Cutting in Jeddah, Saudi Arabia. Sex Med 2020; 8:752-756. [PMID: 32739135 PMCID: PMC7691868 DOI: 10.1016/j.esxm.2020.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/24/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The consequences of female genital mutilation/cutting (FGM/C) on female genital self-image are not known. AIM To assess whether women with and without FGM/C differed with regard to female genital self-image. METHODS A survey was administered to a group of women attending the King Abdulaziz University Hospital obstetrics and gynecology clinic from December 2016 to August 2017. 963 consecutive adult women seen at the clinic completed the survey. MAIN OUTCOME MEASURES The main outcome measure of this study was female genital self-image being assessed with the female genital self-image scale (FGSIS). RESULTS One-fifth (18.2%) of the women self-reported having undergone FGM/C as young girls. Women with FGM/C had a similar FGSIS score as women with no FGM/C (21.3 ± 4.6, n = 175 vs 21.6 ± 4.8, n = 756, analysis of variance, P = .37). In multivariate regression analysis, only level of education remained independently associated with the FGSIS score. Women with some university education had a greater mean FGSIS score than women with no university education (22.1 ± 4.49, n = 564 vs 20.8 ± 5.03, n = 399, P < .0001). CONCLUSIONS Women with and without FGM/C in a Saudi Arabian clinic generally had a similarly positive genital self-image. Only level of education was independently associated with the FGSIS score. Rouzi AA, Berg RC, Alamoudi R, et al. Female Genital Self-Image in Women With and Without Female Genital Mutilation/Cutting in Jeddah, Saudi Arabia. Sex Med 2020;8:752-756.
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Affiliation(s)
- Abdulrahim A Rouzi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Rigmor C Berg
- Department of Community Medicine, Tromso University, Tromsø, Norway; Norwegian Institute of Public Health, Oslo, Norway
| | - Rana Alamoudi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faten Alzaban
- Department of Psychiatry, King Abdulaziz University, Oslo, Norway
| | - Mohammad Sehlo
- Department of Psychiatry, King Abdulaziz University, Oslo, Norway; Department of Psychiatry, Zagazig University, Zagazig, Egypt
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Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, Zewdie D. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 393:2440-2454. [PMID: 31155275 DOI: 10.1016/s0140-6736(19)30652-x] [Citation(s) in RCA: 434] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.
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Affiliation(s)
- Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | | | - Neisha Opper
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Maria Stavropoulou
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Caroline Harper
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Marcos Nascimento
- Programa de Posgraduação em Saúde da Criança e da Mulher, Instituto Fernandes Figueira-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Debrework Zewdie
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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