The Impact of Body Awareness on Women's Sexual Health: A Comprehensive Review.

INTRODUCTION: Body awareness has been linked to female sexual response in laboratory manipulation studies and is used in clinical settings to ameliorate sexual difficulties. AIM: To evaluate and review the literature on body awareness and female sexual function. METHODS: A literature review was conducted through PsycInfo, PsycARTICLES, and PubMed using terms such as body awareness and sexual function. A manual search also was conducted using reference lists. MAIN OUTCOME MEASURES: Studies were included if manipulated body awareness was a main variable of interest and if outcome variables included female sexual functioning or sexual response. RESULTS: 29 studies were included in this review and grouped into 3 categories: sensate focus (n = 7), mindfulness (n = 13), and laboratory manipulations of body awareness (n = 9). Body awareness is identified as an area of importance for female sexuality. Explicit instructions aimed at increasing body awareness, including those used in the clinical techniques of sensate focus and mindfulness, appear to enhance sexual response for many women, including women with low sexual arousal, hypoactive desire, anorgasmia, and sexual pain and in non-clinical samples. Induction of implicit body awareness also resulted in increased arousal in 1 study. CONCLUSION: Body awareness appears to enhance sexual well-being for some women. This is supported by laboratory manipulation studies conducted on women with and without sexual difficulties and by intervention studies using sensate focus and mindfulness for women with a range of sexual problems. The extent to which enhanced body awareness accounts for results in intervention studies is often unclear because of other features of the interventions and/or study design. This review provides the field with a summary of intervention and laboratory studies on body awareness, with results pointing toward body awareness as an integral component of treatment for sexual dysfunction. Seal BN, Meston CM. The Impact of Body Awareness on Women's Sexual Health: A Comprehensive Review. Sex Med Rev 2020;8:242-255.

A comparison of demographic and psychosexual characteristics of women with primary versus secondary provoked vestibulodynia.

OBJECTIVES: Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting approximately 12% of premenopausal women. It has been speculated that primary (ie, lifelong) and secondary (ie, acquired) PVD may represent 2 distinct conditions with different etiologies. There is also evidence that primary and secondary PVD subtypes may respond differently to conventional treatments. The goal of this study was to compare the demographic, clinical, and psychosexual characteristics of a large sample of premenopausal women with primary and secondary PVD. METHODS: A total of 132 premenopausal women (n=42 primary; n=90 secondary) with PVD who sought treatment in a Multidisciplinary Vulvodynia Program completed demographic questions and a battery of validated self-report measures before treatment. RESULTS: Women with primary PVD had a longer duration of PVD as well as more time before diagnosis. Women with secondary PVD reported significantly more clitoral hood pain, higher overall vestibular pain levels, more overall sexual dysfunction and sex-related distress, and proportionately more intercourse occasions that were painful. Women with primary pain stated they had significantly more dysmenorrhea and were more likely to report that their partners were unaware of their PVD symptoms. There were no significant subtype differences on any psychological measure but a trend towards higher magnification of symptoms in women with secondary PVD. DISCUSSION: Overall the findings suggest some important differences in the characteristics of women with primary versus secondary PVD which may have management-related implications.

Provoked vestibulodynia-women's experience of participating in a multidisciplinary vulvodynia program.

INTRODUCTION: Provoked Vestibulodynia (PVD) is the most common cause of pain with intercourse that affects reproductively aged women. The treatment outcome literature suggests that existing treatments, when administered individually, may have only limited benefits for improving pain, and that multidisciplinary approaches may be more effective for reducing pain and pain-associated distress. A program that offers education, group cognitive behavioral therapy, pelvic floor physiotherapy, and medical appointments was developed and implemented at our hospital site. AIM: To explore the experiences of women who participated in the Multidisciplinary Vulvodynia Program (MVP) in order to identify the perceived benefits of this program. METHODS: Qualitative retrospective study. A semi-structured interview format was used to interview graduates of the MVP. Nineteen women, mean age 30.8 (20-54 years), participated in a one-on-one in-depth interview with a trained interviewer. The key question asked was "What has been the impact of the mvp on your life?" interviews were audio-recorded, transcribed, and qualitatively analyzed for major themes. MAIN OUTCOME MEASURE: Content analysis of interview transcripts. RESULTS: Five main themes emerged and included: increased knowledge, gained tools/skills, perceived improved mood/psychological well-being, a sense of validation and support, and an enhanced sense of empowerment. CONCLUSION: Overall, a multidisciplinary vulvodynia program was perceived as being beneficial for women with PVD.

Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse.

Although sexual difficulties related to a history of childhood sexual abuse (CSA) are common, there are no efficacious treatments to address sexual distress. Recent evidence for the benefits of mindfulness, which emphasizes present-moment non-judgmental awareness, in the treatment of women's sexual concerns provided the impetus for this pilot study. Twenty partnered women with sexual difficulties and significant sexual distress, and a history of CSA were randomized to two sessions of either a cognitive behavioral (CBT, n = 8) or mindfulness-based (MBT, n = 12) group treatment (age: M = 35.8 years, range: 22-54 years). Hierarchical Linear Modeling to assess changes in concordance between laboratory-based subjective and genital sexual arousal revealed a significant effect of MBT on concordance such that women in the MBT group experienced a significantly greater subjective sexual arousal response to the same level of genital arousal compared to the CBT group and to pre-treatment. Both groups also experienced a significant decrease in sexual distress. These data support the further study of mindfulness-based approaches in the treatment of sexual difficulties characterized by a disconnection between genital and subjective sexual response.

The association between sexual satisfaction and body image in women.

INTRODUCTION: Although sexual functioning has been linked to sexual satisfaction, it only partially explains the degree to which women report being sexually satisfied. Other factors include quality of life, relational variables, and individual factors such as body image. Of the few studies that have investigated the link between body image and sexual satisfaction, most have considered body image to be a single construct and have shown mixed results. AIM: The present study assessed multiple body image variables in order to better understand which aspects of body image influence multiple domains of sexual satisfaction, including sexual communication, compatibility, contentment, personal concern, and relational concern in a community sample of women. METHODS: Women between the ages of 18 and 49 years in sexual relationships (N = 154) participated in an Internet survey that assessed sexual functioning, five domains of sexual satisfaction, and several body image variables. MAIN OUTCOME MEASURES: Body image variables included the sexual attractiveness, weight concern, and physical condition subscales of the Body Esteem Scale, the appearance-based subscale of the Cognitive Distractions During Sexual Activity Scale, and body mass index. Total score of the Sexual Satisfaction Scale for Women was the main outcome measure. Sexual functioning was measured by a modified Female Sexual Function Index. RESULTS: Consistent with expectations, correlations indicated significant positive relationships between sexual functioning, sexual satisfaction, and all body image variables. A multiple regression analysis revealed that sexual satisfaction was predicted by high body esteem and low frequency of appearance-based distracting thoughts during sexual activity, even after controlling for sexual functioning status. CONCLUSION: Several aspects of body image, including weight concern, physical condition, sexual attractiveness, and thoughts about the body during sexual activity predict sexual satisfaction in women. The findings suggest that women who experience low sexual satisfaction may benefit from treatments that target these specific aspects of body image.

The association between body esteem and sexual desire among college women.

Relationships between body image variables and sexuality have been found among several groups of women. However, research has largely focused on generalized experiences of sexuality. With the exception of two studies which focused on specific medical populations, to our knowledge there has been no investigation of the relationship between body image and acute measures of sexual response. In the current study, we investigated the relationships between body esteem, sexual response to erotica in a laboratory-setting, and self-reported sexual functioning in a non-clinical sample of 85 college women. Women participated in one study session, during which mental sexual arousal, perceptions of physical arousal, and sexual desire were assessed. Results showed that higher body esteem was significantly positively related to sexual desire in response to erotica in the laboratory setting. Similarly, higher body esteem was positively related to self-reported measures of sexual desire, as assessed by a validated measure of sexual function. The sexual attractiveness and weight concern subscales of the Body Esteem Scale, which relate to body characteristics that are most likely to be under public scrutiny, were particularly linked to sexual desire. This is the first study to show that body esteem is related to sexual responses to a standardized erotic stimulus in a laboratory setting.

The impact of body awareness on sexual arousal in women with sexual dysfunction.

INTRODUCTION: The impact of self-awareness during sexual activity has been widely discussed. However, research has been largely focused on the effects of performance anxiety in male erectile functioning. It has been suggested that physical appearance concerns may have a similar influence on sexual function in women as does men's self-awareness about erectile function. However, the role that physical appearance or awareness of one's body may play in female sexual response has received little empiric attention. AIM: To examine the effects of body awareness and self-report levels of body esteem on sexual response in 21 sexually dysfunctional women. METHODS: Body awareness was induced in one of two counterbalanced sessions. A full-length mirror was placed in front of participants throughout the experimental session, and participants were instructed to use the mirror to place 10 electrodes on each side of their bodies to prepare for a possible electrocardiogram. This methodology was used to ensure that women looked at themselves in the mirror and became more aware of their bodies during the experimental session. MAIN OUTCOME MEASURES: Self-reported mental arousal, perceptions of physical arousal, physiological sexual arousal, affect, anxiety, and cognitive distraction responses to erotica. RESULTS: Results showed that subjective mental sexual arousal and perceptions of physical sexual arousal increased in response to erotica in the Body Awareness condition compared to in the No Body Awareness condition. These results were not accounted for by level of body esteem. There were no changes in physiological sexual arousal, affect, anxiety, or level of cognitive distraction across the two conditions. CONCLUSIONS: Findings suggest that awareness of one's body is related to increased subjective sexual response in conditions where cognitive distraction does not occur. It is particularly noteworthy that the current sample was made up of sexually dysfunctional women, all of whom had relatively low body image.

Sex differences in memory for sexually-relevant information.

The present study was conducted in an attempt to examine potential differences between men and women in memory for sexually relevant information. A total of 77 undergraduate students (31 men, 46 women) read a sexual story and completed memory tasks in response to the story. Based on previous research, we hypothesized that differences would exist between men and women for different types of sexual information and we hoped to understand whether specific variables (sexual experiences, sexual functioning, and reactions to the sexual story) could explain such differences. Men were more likely to remember erotic or explicit details of the story, whereas women were more likely to remember love and emotional bonding details of the story. Additionally, women were more likely to recall information referencing the characters in the story. Results from regression analyses indicated that sexual desire and satisfaction were related to differences in recall and recognition of the love and emotional bonding aspects of the story, and that frequency of sexual intercourse was related to differences in the recall of erotic or explicit details of the story. The significant results obtained in this study correspond to previously established sex differences in memory for sexual information.

Acculturation and sexual function in Asian women.

Cultural effects on sexuality are pervasive and potentially of great clinical importance, but have not yet received sustained empirical attention. The purpose of this study was to explore the role of acculturation on sexual permissiveness and sexual function, with a particular focus on arousal in Asian women living in Canada. We also compared questionnaire responses between Asian and Euro-Canadian groups in hopes of investigating whether acculturation captured unique information not predicted by ethnic group affiliation. Euro-Canadian (n = 173) and Asian (n = 176) female university students completed a battery of questionnaires in private. Euro-Canadian women had significantly more sexual knowledge and experiences, more liberal attitudes, and higher rates of desire, arousal, sexual receptivity, and sexual pleasure. Anxiety from anticipated sexual activity was significantly higher in Asian women, but the groups did not differ significantly on relationship satisfaction or problems with sexual function. Acculturation to Western culture, as well as maintained affiliation with traditional Asian heritage, were both significantly and independently related to sexual attitudes above and beyond length of residency in Canada, and beyond ethnic group comparisons. Overall, these data suggest that measurement of acculturation may capture information about an individual's unique acculturation pattern that is not evident when focusing solely on ethnic group comparisons or length of residency, and that such findings may be important in facilitating the assessment, classification, and treatment of sexual difficulties in Asian women.

Oral contraceptive use and female genital arousal: methodological considerations.

This study explored effects of oral contraceptive pill (OCP) use on physiological sexual arousal as measured by a vaginal photoplethysmograph. Sixteen women aged 18-29 viewed audiovisual neutral and erotic stimuli before and an average of 6 weeks following the onset of OCP use. Although subjective measures of sexual arousal, including perceptions of genital arousal, significantly increased in response to erotic stimuli both before and after OCP onset, physiological sexual arousal only increased before OCP use. A comparison of individual responses before and after OCP onset reveals a much higher degree of intrasubject variability after OCP onset. We discuss these findings as they relate to OCP use as a confounding methodological variable to consider in future investigations employing vaginal photoplethysmography.

Sex differences in recall of real or nonsense words.

Women perform better than men on tests of verbal memory, but the nature of this advantage has not been precisely established. To examine whether phonemic memory is a factor in the female advantage, we presented, along with other verbal memory tasks, one containing nonsense words. Overall, there was the expected female advantage. However, an examination of the individual tests showed female superiority in recall of the real words but not the nonsense words.