Body Concerns In and Out of the Bedroom: Implications for Sexual ...

Body Concerns In and Out of the Bedroom: Implications for Sexual Pleasure and Problems


Diana T. Sanchez, Ph.D.,1,3 Amy K. Kiefer, Ph.D. 2


1Department of Psychology, Rutgers University, New Brunswick, New Jersey.
2Health Psychology Program, University of California, San Francisco, California.
3Correspondence concerning this article should be addressed at Rutgers University, Department
of Psychology, 53 Avenue E, Piscataway, New Jersey 08854-8040; e-mail:
disanche@rutgers.edu.

RUNNING HEAD: Body Shame and Sexuality
Correspondence and proofs:

Diana T. Sanchez, Ph.D.
Department of Psychology
Rutgers University
53 Avenue E
Piscataway, NJ 08854-8040
732-445-3552
Fax: 732-445-0036
E-mail: disanche@rutgers.edu

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ABSTRACT
Objectification theory (Fredrickson & Roberts, 1997) proposes that body image concerns impair
sexual function and satisfaction. The present study was designed to test whether body shame was
related to sexual problems and pleasure among heterosexual men and women (N = 320). Using
structural equation modeling, we tested whether adult men and women’s body shame was linked
to greater sexual problems (lower sexual arousability and ability to reach orgasm) and less
pleasure from physical intimacy. Although women were significantly more likely to report
appearance concerns than men across sexual and nonsexual contexts, appearance concerns were
positively related to both men and women’s sexual problems. The relationship between body
shame and sexual pleasure and problems was mediated by sexual self-consciousness during
physical intimacy. Men and women’s body shame was related to greater sexual self-
consciousness, which in turn predicted lower sexual pleasure and sexual arousability. Results
persisted controlling for relationship status and age. Being in a relationship was associated with
less sexual self-consciousness and less orgasm difficulty for men and women. Although some
paths were significantly stronger for women than for men, results largely supported the
proposition that body concerns negatively affect sexual pleasure and promote sexual problems
for both men and women. Findings were discussed in terms of objectification theory and the
increased cultural emphasis on physical appearance.
KEYWORDS: body image; gender; sexuality; shame; sexual arousal; objectification theory;
sexual self-consciousness; Internet research.

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INTRODUCTION
People spend an enormous amount of time, energy, and money in attempts to improve
their physical appearance. This preoccupation with beauty and physical improvement is reflected
in popular reality shows, such as “The Swan,” “Queer Eye for the Straight Guy,” and “Extreme
Makeover.” In “The Swan” and “Extreme Makeover,” women undergo numerous operations to
reach these beauty ideals. Correspondingly, the actual prevalence of cosmetic surgery has
increased dramatically over the last decade. The number of breast implant surgeries has
increased eightfold since 1992 (Duenwald, 2004). In 2001, 1.6 million people injected Botox®
into their facial muscles to reverse the signs of aging (McCarthy, 2002). Increases have been
seen among men as well as women: since 2002, men’s use of Botox® increased 88%, while the
number of men who underwent rhinoplasty increased 47% (i.e., “Plastic surgery catching on,”
2003).
Although body concerns may be more prevalent among women, recent studies suggest
that men have begun to focus more on their appearance. Over the last few decades, men have
come under increasing pressure to conform to lean, muscular ideals (for a review, see Frith &
Gleeson, 2004). Action figures sold as toys to young boys have become slimmer and more
muscular over the last 25 years (Baghurst, Hollander, Nardella, & Haff, 2006; Pope, Olivarda,
Gruber, & Borowiecki, 1999), as have male centerfolds between the years 1973 to 1997 (Leit,
Pope, & Grey, 2001). The naked male body is displayed more frequently in women’s
magazines, suggesting that men are increasingly becoming the object of the female gaze (Pope,
Olivardia, Boroweicki, & Cohane, 2001). According to St. John (2003), heterosexual men now
feel pressure to be “metrosexual,” a term recently coined for heterosexual men who devote
considerable attention to their physical appearance and clothing. These changes have led some

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theorists to argue that, similar to the unrealistically thin female body ideal, the media has created
physical ideals for men that are impossible to achieve (Salusso-Deonier, Markee, & Pedersen,
1993). In fact, research suggests that heterosexual men are becoming increasingly dissatisfied
with their physical appearance (Cohane & Pope, 2001; Frith & Gleeson, 2004; Zelman, 2005).
Although the societal ideals for men’s and women’s bodies are different (e.g., men strive
to be muscular and lean, while women strive for thinness), the drive to attain the idealized body
type may lead both men and women to experience heightened shame regarding their physical
appearance. Shame refers to the tendency to feel worthless or like a bad person in response to a
perceived failure to live up to specific cultural ideals (Lewis, 1992; Tangney, Miller, Flicker, &
Barlow, 1996). Even though the current ultra-thin female ideal and the lean muscular male ideal
are unrealistic for most people (e.g., Frith & Gleeson, 2004; Noll & Fredrickson, 1998), men and
women may experience pressure to achieve this essentially unattainable physical ideal. Their
perceived failure to attain this ideal may induce chronic shame over their perceived physical
shortcomings as well as anxiety that others will negatively evaluate their bodies. Because of the
increased emphasis on physical appearance and its potential implications for producing chronic
body shame, the current study was aimed at understanding how body shame affects men’s and
women’s sexual experiences, namely their experiences of sexual pleasure and problems.
Throughout this article, we use the term sexual problems to refer to difficulty with orgasm and
becoming sexually aroused, and low levels of sexual pleasure, while acknowledging that not all
men and women would consider these experiences problematic.
Many theorists have argued that body image concerns undermine sexual pleasure (e.g.,
Fredrickson & Roberts, 1997; Masters & Johnson, 1970). Despite the theorized link between
body concerns and sexual satisfaction, few studies have empirically studied this relationship or

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the particular mechanisms that might underlie it. The present study examined the relationship
between body shame and subjective sexual experiences and whether sexual self-consciousness
mediated this relationship (see Fig. 1).
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Insert Figure 1 about here
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A secondary focus of this article was to explore gender differences in the relationship
between body shame and subjective sexual experiences. Although feminist theorists have
primarily focused on how body image concerns affect women, we propose that body shame also
affects men’s sexual experiences.
Body Shame and Objectification Theory
Feminist theorists have repeatedly called attention to the central role of appearance in
women’s lives (Bartky, 1990; Berger, 1972; de Beauvoir, 1952; Fredrickson & Roberts, 1997;
McKinley & Hyde, 1996). According to objectification theory (Fredrickson & Roberts, 1997),
the Western sociocultural emphasis on women’s beauty leads to self-objectification, that is, the
tendency to regard one’s physical self primarily in terms of appearance and to adopt an
observer’s perspective on the physical self. Self-objectification has been linked to numerous
negative outcomes among women. When women are induced to self-objectify in lab settings
(e.g., are asked to wear a bathing suit or are exposed to objectifying media), they report increased
shame and anxiety (Calogero, 2004; Fredrickson, Roberts, Noll, Quinn, & Twenge, 1998;
Gapinski, Brownell, & LaFrance, 2003; Noll & Fredrickson, 1998; Roberts & Gettman, 2004).
Exposure to media images that depict ultra-thin body ideals increases women’s reports of body
shame and self-consciousness (Gapinski et al., 2003; Noll & Fredrickson, 1998; Roberts &
Gettman, 2004). These affective consequences of self-objectification (Gapinski et al., 2003;

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McKinley, 1998; Roberts & Gettman, 2004) may impede sexual arousal (Fredrickson & Roberts,
1997).
Given the increasing cultural emphasis on men’s appearance, men may also experience
the chronic body shame that results from self-objectification. Although Fredrickson et al. (1998)
failed to find the effects of self objectification on men, recent studies suggest that, exposure to
idealized images of male bodies heighten men’s body dissatisfaction (Aubrey, 2006; Baird &
Grieve, 2006; Harrison & Cantor, 1997; Labre, 2005; Lavine, Sweeney, & Wagner, 1999; Morry
& Staska, 2001). Moreover, men’s, as well as women’s, self-objectification predicted greater
symptoms of disordered eating, body shame, appearance-related reasons for exercise, as well
lower global self-esteem and lower body esteem (McKinley, 1998; Morry & Staska, 2001;
Strelan & Hargreaves, 2005). Thus, as with women, men’s tendency to self objectify may have
consequences for psychological well-being and affective evaluations of the body.
Body Shame and Sexual Pleasure and Problems
We propose that this negative affective state of body shame may undermine sexual
pleasure by increasing cognitive preoccupation with the body in sexual contexts, i.e., by
increasing sexual self-consciousness. Masters and Johnson (1970) argued that sexual self-
consciousness, which they referred to as “spectatoring,” impaired men’s and women’s sexual
responsiveness and satisfaction. By directing attention towards one’s appearance and away from
sexual pleasure, spectatoring was theorized to create erectile dysfunction and premature
ejaculation problems for men, and decrease physiological arousal and sexual desire for women
(Barlow, 1986; Faith & Schare, 1993; Masters & Johnson, 1970). When people are distracted by
concerns about their physical appearance, they may be unable to relax and focus on their own
sexual pleasure, which can influence sexual performance (Adams, Haynes, & Brayer, 1985;

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Beck, Barlow, Sakheim, & Abrahamson, 1987; Dove & Wiederman, 2000; Elliot & O'Donohue,
1997; Geer & Fuhr, 1976; Meana & Nunnink, 2006; Przybyla & Byrne, 1984). Meana and
Nunnink (2006) have proposed that being distracted by one’s appearance may have an even
stronger effect on men’s sexual satisfaction than on women’s because body concerns have
become so prevalent among women that they have become more accustomed to states of self-
objectification.
In the present study, we explore the previously untested links between body shame and
sexual problems and pleasure, as well as the mechanisms through which body shame might be
linked to sexual problems. Because sexual arousal, the ability to reach orgasm, and sexual
pleasure require attention and focus, we focused on these sexual problems and their connection
to body concerns among men and women for the present study. Although we believe that the
relationship between body concerns and subjective sexual experiences are likely reciprocal, i.e.,
body concerns affect sexual experiences as much as sexual experiences shape feelings about the
body, reciprocal causality cannot be statistically tested in correlational designs. Thus, we tested
and hypothesized the direction of causality that was most consistently discussed in the literature,
namely that body concerns led to sexual problems. This direction was favored because body
concerns emerge in early adolescence (at age 12-14; Byely, Archibald, Graber, & Brooks-Gunn,
2000; Huon & Lim, 1999) before the average age of first sexual experiences (estimates roughly
at age 16; Dickson, Paul, Herbison, & Silva, 1998). Because body concerns tend to precede
sexual experiences, we argue that the primary sources of body shame exist outside of the
bedroom. Thus, we favored this direction of causality.
Although we expand much previous work by our inclusion of male participants, the
current study was limited to heterosexuals out of concern that body image concerns would affect

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gay and lesbian populations differently than their heterosexual counterparts. According to
Fredrickson and Roberts (1997), self-objectification originates from the male gaze and the desire
to appeal to romantic partners, because men were seen as the primary consumers of sexualized
imagery and perceived to have the highest appearance standards for their potential romantic
partners (Siever, 1994). Accordingly gay men and heterosexual women were expected to report
the highest level of objectification and body concerns. Biased sampling issues aside (for
discussion of such issues, see Hausmann, Mangweth, Walch, Rupp, & Pope, 2004), research
comparing gay men to heterosexual men and lesbian women to heterosexual women has
supported this conclusion (Robinson & Holden, 1986; Siever, 1994; Yelland & Tiggeman,
2003). Heterosexual men, on average, show the least amount of appearance concerns compared
to lesbian women, heterosexual women, and gay men; however, this does not imply that
heterosexual men are impervious to appearance concerns.
Hypotheses

The following hypotheses constituted our structural model (see Fig. 1): (1) body shame
would be linked to less sexual arousability and pleasure and greater difficulties reaching orgasm,
relationships that would be mediated by sexual self-consciousness; (2) women would report
greater body concerns and sexual problems than men (i.e., difficulty becoming sexually aroused
and an inability to reach orgasm), because women typically report greater body concerns, greater
sexual dissatisfaction, less ability to orgasm, and lower sexual arousability than men
(Fredrickson & Roberts, 1997; Laumann, Paik, & Rosen, 1999); (3) however, we expected that
body concerns would relate to sexual problems and interfere with pleasure for both men and
women; (4) finally, we hypothesized that reduced sexual arousability and ability to orgasm
would predict lower overall sexual pleasure because the ability to become physically aroused and

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to achieve orgasm was proved to be an important component of sexual satisfaction for both men
and women (Laumann et al., 1999).
METHOD
Participants

We recruited participants over the Internet by posting the web link to the study on message
boards for 150 different U.S. Yahoo groups and 20 e-mail lists for University of Michigan
undergraduate and graduate students. Recruitment e-mails indicated that the Internet study was
completely anonymous, brief (15-20 minutes long), and included questions regarding approaches
to intimate relationships. A total of 320 participants completed the survey on the Internet over a
17-month period (June 2004-September 2005). There were 122 (38%) men and 198 (62%)
women. Participants ranged in age from 17 to 71 years (M = 31.01, SD = 12.96), and consisted
of 275 White/Caucasian Americans, 13 Asian/Asian Americans, 4 Black/African Americans, 12
Hispanic/Latino Americans, 1 Native Americans, 9 Multiracial Americans, and 6 failed to
indicate their racial identity.

Participants were also asked their relationship status: 71% of the sample indicated that
they were currently involved in a romantic relationship. Fifty-one percent of the sample indicated
having an income below $25,000, 27% between $25,000-50,000, 10% between $50,000-75,000,
7% between $75,000 and $100,000, 4% between $100,000 to $200,000, and 1% indicated an
income above $200,000. Participants level of education was as follows: Four percent completed
some high school, 8% completed high school, 42% completed some college education, 22% had
a college degree, 7% had some post college education, 14% had a master’s degree, and 3% had a
post master’s degree such as a Ph.D. or M.D. For the purposes of this study, only participants

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who indicated a heterosexual orientation and having engaged in sexual intercourse were included
in the analyses.1
Measures
Body shame was assessed with a subscale of the Objectified Body Consciousness Scale
(OBC; McKinley & Hyde, 1996). Eight items, rated on a scale of 1 (Strongly Agree) to 7
(Strongly Disagree), assessed the degree to which participants felt that they were a bad person if
they did not meet the cultural body ideal. Participants were asked to rate their agreement with
statements such as: “When I cannot control my weight, I feel like something must be wrong with
me”; “I feel ashamed of myself when I haven't made the effort to look my best”; and “When I'm
not exercising enough, I question whether I am a good person.” This measure was reliable for
both men (α = .82) and women (α = .87).2 The OBC has shown test-retest reliabilities in the .62
to .81 range and correlated appropriately with measures of body esteem and dieting (Lindberg,
Hyde, & McKinley, 2006; McKinley & Hyde, 1996).
Sexual self-consciousness was measured with the Body Image Self-Consciousness 15-
item scale developed by Wiederman (2000), which examined self-consciousness during sexual
intimacy. Each item was rated on a scale ranging from 1 (Never) to 6 (Always). Example items
include: “The idea of having sex without any covers over my body causes me anxiety”; “The
worst part of having sex is being nude in front of another person” ; and “During sexual activity,
it is (would be) difficult not to think about how unattractive my body is.” Higher scores on this
measure indicated greater self-consciousness during sexual activities. The scale was reliable for
both men (α = .95) and women (α = .95).2 The sexual self-consciousness scale has shown test-
retest reliabilities at .92 and correlated with measures of perceived attractiveness and sexual self-
esteem (Wiederman, 2000).

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