‘If I don’t get the baby,just give me the body’: exploring self-image and self-esteem among women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common disorders affecting women of reproductive age worldwide. Existing research highlights negatively impacted self-image as a common experience among women with the condition. We explored these experiences, using body mapping as a tool to best facilitate reflection and narrative building. Body mapping, an arts-based data collection method, allows the participant to drive the process, best facilitating in-depth reflection. We completed body mapping sessions and online interviews with 11 women living in the Western Cape Province of South Africa. The data were analysed using reflexive thematic analysis. During the interviews, participants reflected on their experiences relating to their symptoms, and the negative impact that these symptoms had on their self-image and self-esteem. These symptoms left women feeling as though they were not feminine enough due to their appearance and limited fertility. Their feminine identities were therefore challenged by themselves and in some instances by others who were close to them. Participants also engaged in social comparison, by comparing themselves to other women, which added to their negative self-image and self-esteem. Current ideals of femininity and appearance are damaging to women with PCOS and must become more inclusive.

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting women of reproductive age (El Hayek et al., 2016). PCOS is characterised by hyperandrogenism, polycystic ovaries, reproductive dysfunction, and altered physical appearance. Symptoms include irregular periods, hirsutism, acne, male-patterned baldness, and weight gain. Women with PCOS report compromised health-related quality of life and increased risk of depressive or anxiety disorders (Açmaz et al., 2013; Cooney et al., 2017; Pfister & Rømer, 2017; Sari et al., 2020; Williams et al., 2016). Similarly, research shows that women with PCOS report low levels of self-compassion and body compassion (Van Niekerk et al., 2022) when compared with women with infertility who were not diagnosed with PCOS.

Although there is some cultural and contextual variation regarding internalised beauty ideals, commonly held ideals encompass a slim and hairless body with blemish-free skin (Bazarganipour et al., 2013; Thomas et al., 2014). The clinical features of PCOS, such as hirsutism, acne, and weight gain, directly contradict these ideals (McCuen-Wurst et al., 2017; Thomas et al., 2014). In addition, many women with PCOS view several of their symptoms, such as hirsutism, as masculine (Pfister & Rømer, 2017; Thomas et al., 2014). As a result, women with PCOS may view themselves as less feminine than women without PCOS (Thomas et al., 2014).

PCOS patients’ self-image and self-esteem are negatively impacted by the disease (McCuen-Wurst et al., 2017). Quantitative studies in Iran and Australia show low self-esteem in women with PCOS (Bazarganipour et al., 2013; Tay et al., 2019). Few qualitative studies have explored living with PCOS. These qualitative studies were conducted in the United Kingdom (Hadjiconstantinou et al., 2017; Tomlinson et al., 2017; Williams et al., 2015), Iran (Ekramzadeh et al., 2020; Farajzadegan et al., 2023), Pakistan (Athar & Javed, 2024), Canada (Ismayilova & Yaya, 2022, 2023); and Australia (Copp et al., 2019; Ee et al., 2020). These studies described experiences of delayed diagnosis (Ee et al., 2020; Hadjiconstantinou et al., 2017; Tomlinson et al., 2017), poor health care characterised by unempathic health care providers and a lack of information and support from health care providers (Ee et al., 2020; Ismayilova & Yaya, 2022, 2023; Tomlinson et al., 2017; Wright et al., 2020, 2024); stigma (Athar & Javed, 2024; Ismayilova & Yaya, 2022), psychological distress and coping (Athar & Javed, 2024; Ekramzadeh et al., 2020; Farajzadegan et al., 2023; Hadjiconstantinou et al., 2017; Wright et al., 2020, 2024), and the impact of PCOS on feminine identity (Ee et al., 2020; Williams et al., 2015; Wright et al., 2020). However, no qualitative studies have conducted an in-depth exploration of self-esteem and self-image in women with PCOS.

Body mapping is an arts-based qualitative technique and is a suitable method for exploring lived experience among people with health conditions (Coetzee et al., 2019; Boydell, 2020; Lys et al., 2018). The technique aims to gather insight on a participant’s experience of their body, their external world and the meanings they have drawn from their experiences (Coetzee et al., 2019; Dew et al., 2018; Lys et al., 2018). The process requires the participant to create a to-scale outline of their body and fill it with figurative representations of their experiences (Coetzee et al., 2019; Lys et al., 2018). This allows the participant to deeply engage their experiences through focusing on their bodies, resulting in a potentially richer narrative than traditional qualitative techniques may elucidate. Interviews conducted after developing body maps provide a space for participants to recount experiences and uncover meaning (Coetzee et al., 2019; Lys et al., 2018).

Considering that symptoms of PCOS are located within the body and these symptoms impact self-esteem and self-image, we thought that body mapping would be an ideal tool for participants to consider their symptoms and their impact on self-esteem and self-image. Our aim was therefore to explore self-image and self-esteem among women with PCOS, using body mapping as a tool to supplement qualitative interviews.

Methods

Participants

Participants were recruited through an online Facebook support group for South African women with PCOS. To be eligible for the study participants needed to be a female, over the age of 18 years, reside in the Western Cape in South Africa, diagnosed with PCOS and willing to take part in both the body mapping session and the interview session. Anyone interested in the study, who met these criteria, were instructed to contact the researchers using the contact information provided in the flyer. Snowball sampling was used as an additional participant recruitment procedure.

Participants were 11 women, between the ages of 20 and 45 (M_age = 32 years). Most of the women were either married (n = 5) or in a relationship (n = 5) and one participant was single. Most participants did not have children (n = 9). Participants were well-educated, with one having completed high school, five with diplomas or certificates, two with undergraduate degrees, and three with postgraduate degrees. Most of the participants were employed (n = 9).

Instruments

A body mapping facilitation guide was used to structure the body mapping process. The guide contained both instructions for body mapping and questions that prompted participants to construct their body maps. An interview guide was used to facilitate the interviews. The interview guide consisted of open-ended questions, asking participants to reflect on their body maps and their relationship with their bodies and PCOS. The guide was created by the researchers to allow the participants to reflect on their body maps and how PCOS impacted their self-esteem and self-image. The questions were based on the extant literature on PCOS and self-esteem and self-image but were also meant to be exploratory. The following are examples of questions asked:

• On your body map, you drew XXX (referring to an element of the body map). Please tell me more about that. What does it represent? Tell me what this means to you?

• When you look at your body map, how does it make you feel about your body?

Procedure

Each participant completed a private body mapping session with the first author. These sessions took place in rented offices in the Western Cape that were located close to participants’ homes or places of work. Body mapping was used as a tool to explore self-image and self-esteem and was not meant to be analysed as data in this study. The body mapping process began by drawing an outline of the participant’s body, completed either by the participant or the facilitator. The participant then completed a mindfulness exercise, as suggested by Gastaldo et al. (2012), allowing for reflection on the experience with PCOS in relation to the body and an exploration of associated imagery. Each participant was then tasked to add to the body map what they felt best represented their PCOS experience inclusive of the use of colour, imagery, or phrases. These additions were accompanied by reflections on their meaning, prompted by the facilitator. The process was largely led by the participant and allowed them to share their narrative as they understood it. These sessions were audio recorded. The duration of the body mapping sessions were approximately 90 minutes.

The interview session took place online, within a week of the first session. This time frame was chosen to ensure participants had time to reflect on the first session but were also able to recall it clearly. Interviews took place using Zoom or Microsoft Teams, depending on the participant’s preference. The interviews were recorded and transcribed. The shortest interview lasted 1 hour 6 minutes and the longest was 2 hours 15 minutes.

Ethical considerations

This study received ethical approval from the Stellenbosch University Health Research Ethics Committee (ref no. S20/02/058). The study took place in 2021 when limited COVID-19 restrictions were in place. The body mapping session took place in person but the interviews took place online to reduce unnecessary contact. COVID-19 guidelines were adhered to during the body mapping sessions, including masking and sanitisation of hands, surfaces, and any materials used during the session. All participants provided written informed consent to participate in the study. Pseudonyms were used in all reporting. The data were only accessible to the researchers and hard copies of the body maps and consent forms are kept in a locked cupboard only available to the principal investigator.

The topic is one that was potentially triggering and counselling services were made available to all participants, with the researchers covering all costs. However, no participants took up the offer for counselling. In addition, participants were informed that they could take breaks during the body mapping and interview when needed and did not have to answer any questions that made them uncomfortable.

Data analysis

The transcriptions were analysed in ATLAS.ti and pseudonyms were used to protect the identities of participants. Each transcript was analysed using reflexive thematic analysis (RTA), as established by Clarke and Braun (2017), with reference to the image of the related body map. This method was used to ensure optimal data familiarisation, to identify key quotes and develop codes and themes making up the ‘central organising concept’ (p. 298). The process also involved secondary screening for relevance.

The first author conducted the data analysis by familiarising herself with the data. She did this by conducting and transcribing the interviews. The second author also familiarised herself with the data by listening to the interviews and reading the transcripts. The first author then coded the data using an inductive approach, and these codes were discussed between both authors. This collaborative approach was used throughout the analysis to ensure that the codes and themes were fairly captured. Codes were then grouped into themes; these themes were reviewed and defined. This process did not follow in a linear manner as we often moved back and forth between these stages until the researchers were satisfied with the themes that were produced.

The first author’s interest in the topic stemmed from her own experiences with PCOS. This was disclosed to the second author at the start of the study. Having personal experience is an advantage as it provides the researcher with an emic perspective and can add to our understanding of the phenomenon being studied. Simultaneously, this emic perspective could also result in bias, especially when analysing data. For this reason, the second author played an active role in this study by listening to all interviews and regularly debriefing the first author. The second author also guided the first author when it came to analysis by making recommendations regarding codes and themes.

Findings

We constructed three themes that describe PCOS and its impact on self-image and self-esteem and named them as follows: (1) feeling like a ‘hairy beast’: hirsutism and other symptoms, (2) being the designated ugly, fat friend (DUFF), and (3) disrupted femininity.

Feeling like a ‘hairy beast’: hirsutism and other symptoms

Several symptoms were described by participants, relating to skin, hair, reproduction, emotional distress, menstrual symptoms, pain, and weight. These symptoms are described to the reader to provide context to their experiences related to body image and self-esteem.

Many participants reported skin-related symptoms such as acne and hyperpigmentation. These symptoms were reported as affecting several areas of the body but were notably more distressing on more visible areas, such as the face. This positioning made these symptoms harder to conceal and thus exacerbating vulnerability for scrutiny and judgement. Similarly, hair-related symptoms such as alopecia (abnormal hairloss or thinning) and hirsutism were highlighted as a point of insecurity and stress. Descriptors such as ‘shedding animal’ and ‘hairy beast’ were used to describe these experiences, respectively. These descriptors indicate that symptoms of PCOS not only made participants feel less womanly, they also may have made them feel less human. Participants reported great financial and time costs associated with symptom management. Active efforts were made to reduce the appearance of these symptoms, so as to conform with female beauty standards.

Infertility and traumatic pregnancy were common symptoms reported by participants. Most of the women described repeated failed attempts to fall pregnant naturally, with some only receiving a PCOS diagnosis after seeking conception advice. Women’s struggles with infertility resulted in intense feelings of sadness and longing for a child. These feelings were aggravated by questioning, teasing and commentary about their struggles from friends, family and colleagues.

Atypical menstruation was also commonly reported, with participants stating that they experienced irregular, abnormally heavy or absent menstruation. Many described not getting their period for months on end and in some extreme cases, not for well over a year. Some participants reported that they experienced their periods as unpredictable and described their period almost as a sentient being that ‘suddenly decides to arrive when it feels like it’ (Aaliyah, a woman in her forties), indicating a lack of control over their bodies. Other participants reported more regular menstrual cycles but with heavy bleeding or lighter bleeding for a prolonged period, sometimes lasting several weeks.

All participants mentioned some level of dissatisfaction with their weight. Some participants described gaining weight at a pace that was abnormal despite significant effort to combat gaining. Others described being surprised with how quickly they were able to gain weight, with some stating that they felt as though just looking at food made them gain weight. They used descriptors such as ‘nonstop’ and ‘uncontrollable’ to describe their weight gain. Jennifer encapsulates this struggle with weight in this quote:

That is what my reality is. I’m constantly, constantly, constantly gaining weight. So I’m not actually trying to lose weight, I’m just trying to not pick up any more weight. . . You almost become scared of losing weight in a way because you know you’re going to gain it back.

Tracey joked that after struggling with infertility, she felt she at least deserved the body she desired. She made the following statement, which indicates that multiple challenges associated with PCOS:

‘If I don’t get the baby, just give me the body’

This statement refers to both dissatisfaction with infertility and weight as a result of PCOS. Our interpretation of this statement is that on some level Tracey may accept her infertility, but would like to alter her physical appearance as a consolation for not being able to have a child. Alternately, Tracey may be referring to it not being fair to experience infertility and body-appearance issues, and seems to bargain that if she cannot have one, she should have the other. This theme shows that there are several symptoms of PCOS that play a central role in patients’ lived experiences of the disease. Many of these symptoms seemed difficult to control, and had a negative impact on participants’ self-esteem as they threatened their feminine identity.

Being the designated ugly, fat friend (DUFF)

Participants reported that living with PCOS negatively impacted their self-image and self-esteem. Some reported that they had achieved a level of acceptance or self-love, but still experienced low self-esteem for extended periods of their lives. Women described strong feelings of unhappiness or dissatisfaction related to their bodies and wished to change their appearance. The following four sub-themes capture participants’ perceptions about themselves: (1) self-hatred and self-loathing; (2) constant self-policing; (3) drawing comparisons to other women; and (4) social withdrawal.

Self-hatred and self-loathing

Some participants reported that their self-esteem was severely impacted by their physical symptoms, resulting in self-hatred or self-loathing. Several participants shared that they could not identify anything positive about themselves or that they felt they were ‘not enough’. This feeling of complete lack of positive regard for themselves and their bodies is echoed in this statement made by Yusra, a woman in her late thirties.

I’m looking at this [her body map] and, and the first thing that comes to mind is, I actually hate my body. Can you really hate your body so much? It’s like, I don’t see anything positive.

This self-loathing was also reflected in the terms women used to describe their bodies, both on their maps and in the accompanying interviews. They used words such as ‘fat’, ‘broken’, ‘hippo’ ‘beast’, ‘ugly’ and ‘worthless’ to describe themselves. The words used were harsh, indicating intense dissatisfaction and overly self-critical views of their bodies.

Constant self-policing

Participants reported that they were preoccupied with their appearance, with some indicating the preoccupation bordered on obsession. Women shared that they felt a need to manage their appearance to the extent of perfection to detract from what they were most insecure about. They described intense exercise and diet regimens, agonising over clothing choices and using their work ethic or personality as a distraction from their appearance, among other strategies. For some of the women, the need to police their appearance was so strong that it caused them to be fearful of situations where they may not have control over their appearance. For example, Robyn, a woman in her thirties, shared one of her biggest fears related to potentially giving birth because she would not have control over her physical appearance during this time.

I’ve always had this phobia of going to hospital and having to be without make up and I’m going to be so ugly. . . I was like, what am I going to do, am I going to have to pack a bag and even in the pain after pregnancy just going to have to put some make-up on before I appear on photo.

Drawing comparisons to other women

All participants reported that they compared themselves to other women. For most participants, these comparisons related to the feelings of insecurity they held about their own lives and bodies. Participants described using other women around them and in media as a yardstick for how they evaluated themselves. These comparisons left women feeling inferior to those who they compared themselves to, which may further impact their self-image and self-esteem. For many, making social comparisons exacerbated the negative opinions they already held about themselves. Sofia, a 23 year-old student, described one such comparison in the following statement:

If you look in magazines and stuff, you don’t see girls with any hair on their bodies or any acne. And then when you grow up with girls around you that look exactly like that. When you’re that young, you don’t notice, okay, they’re probably shaving and wearing make-up.

You’re just like, ‘Oh, I don’t look like that’. So, you know, I’m must not be as pretty as they are.

This quote highlights a common subtheme that was developed, that of ‘feeling different’ or not ‘fitting the mould’, as described by multiple participants. Noxolo also shared similar experiences, going as far as to describe herself in comparison to her female friends as the ‘DUFF’, a colloquial acronym for ‘designated ugly, fat friend’. This term may indicate that she saw herself as uglier and fatter than her friends, and while she seems to have accepted this term for herself, this construction of part of her identity is problematic and it may also impact her self-esteem and self-image negatively.

In addition, most participants reported that their self-esteem was negatively impacted by the opinions of those around them, from family to colleagues. Many participants reported that they felt that other people without PCOS did not understand the extent of the disorder’s impact. This fed into their insecurity and affected their self-esteem as they described feeling judged for certain aspects of their appearance that others felt they should be able to control, such as Robyn’s experience as presented below:

You become despondent when there’s no results and people are making these comments, but are you really as consistent and exercising as much as you’re saying, are you not cheating, like eating behind closed doors because we can’t see results the way we see in your brother and your friends?

In Robyn’s statement, she narrates her struggle to lose weight. Even though she was working on eating correctly and exercising regularly, she struggled to lose weight because of her PCOS. Others questioned her eating and exercise, as she was not losing weight. This questioning was hurtful to Robyn. For Tracey, her ex-partner’s comments made her extremely aware of how she looked and how others might perceive her, as he compared her to other women.

My ex was very like, he was very mentally abusive. He would always say, like I’d be working hard, would be gyming, I would be working hard and then he would be like ja but so

And [referring to someone else] so is thinner than you. You’re still fat. It would hurt because I was putting in the work and it made me feel so self-conscious. Like nothing I did was good enough.

From the quotations above it is clear that women compared themselves to other women, but these comparisons were also made by those close to the participants, which may have reinforced their negative self-perception.

Social withdrawal

Participants reported that these negative comments from others resulted in them withdrawing from social interaction. They stated that even though they were aware that the scrutiny and unkind comments from others may have been due to a lack of awareness of PCOS, they still felt it better to avoid social situations as much as possible. Participants described avoiding events where they would have to ‘dress fancy’ (Jennifer) or events that triggered them, like baby showers (Stacey, a woman in her early thirties). Cassandra, a woman in her late twenties, shared the following,

You feel like nobody understands what you’re going through, or they are just judging you. I feel alone. Well, I do it to myself though. So like, I kind of isolate myself as my way of dealing with things. I just stay away from stuff like relationships.

For several of the women, the deep-rooted insecurities they struggled with, and the subsequent avoidance of social situations, affected their careers. They felt their PCOS and self-perception prevented them from taking opportunities and thus held them back. Aaliyah, a woman working in IT, describes one of several experiences where a task requiring people to see her physical appearance caused her to not take an opportunity,

I’ve also been asked to do presentations at conferences, but I’ve always turned that down.

Disrupted femininity

Another common finding was that PCOS disrupted women’s perceptions of their femininity. The overarching sentiment expressed by participants was that their symptoms of PCOS negatively impacted their feminine identity, resulting in feelings of insecurity and frustration. These feelings were fed by the impact PCOS had on their appearance but also on the way their bodies failed to function. Many of the women spoke about feeling that they did not fit common beauty ideals representing femininity. Moreover, participants stated that feminine ideal bodily functioning was characterised by regular, manageable periods and the ability to fall pregnant easily. It is necessary to give the disclaimer that many of the ideas shared by the women represent traditional, cisnormative definitions of womanhood and femininity. While many of the women questioned these beliefs themselves, they formed an integral part of each woman’s narrative and identity-related experience. Mainstream beauty and feminine ideals are inescapable.

Menstrual irregularity and infertility were considered major threats to their feminine identity. Both experiences connected to an overarching belief held by the women that their bodies were not capable of doing what was naturally expected of female bodies. Cassandra highlights this concept in her feelings around struggling to have periods,

You’re a woman, these things [menstruation] are supposed to be happening. And if it’s not happening, then it’s obviously a sign that something’s just not working the way it’s supposed to. You kind of feel like something is broken. . . it’s like, if you have a photocopier that won’t make photocopies, that’s what you’re supposed to supposed to do but your body won’t do it.

Cassandra compared her body’s ability to become pregnant with that of a photocopier, whose sole purpose it is to make photocopies. In doing this, she shares her underlying belief that the purpose of the female body is to reproduce, and that failure to do so renders it broken or of no use.

Disrupted femininity was also expressed in relation to appearance. Most participants shared that part of their insecurity surrounding their appearance was linked to feeling masculine due to their perceived body shape and the excessive growth of unwanted hair. Once again, the women’s experiences of body insecurity and feeling feminine connect to preconceived and standard ideas of femininity.

Discussion

In this article, we describe the impact of PCOS on women’s lives based on interviews and body maps with 11 women diagnosed with PCOS. We paid particular attention to the impact of PCOS on their self-image and self-esteem and the role that it played in shaping their identity. Participants reported a range of PCOS symptoms that were similar such as hyperpigmentation, face and body acne, alopecia, hirsutism, weight gain and infertility. The participants reported that they struggled to find effective treatment methods, as reported in several other studies (Cree-Green, 2017; Naz, 2014). The women in this study shared that hirsutism, weight gain, and infertility were the symptoms that had the greatest impact on them. This finding is also echoed in the existing literature (Kaczmarek et al., 2016; Khomami et al., 2015; Zhang et al., 2020).

Participants reported low self-esteem and negative self-perception due to their PCOS symptoms. For many of the women, this was communicated as self-loathing or self-blame and connected to several key symptoms of PCOS, such as being overweight, hirsutism, and infertility. Participants reported engaging in negative self-talk by referring to themselves as a ‘hippo’ or ‘fat’ and stated that they hated their bodies because of their weight, indicating low self-esteem in participants. These findings echo the findings from studies conducted in America (Alur-Gupta et al., 2019), Australia (Ee et al., 2020) and the United Kingdom (Williams et al., 2016), which identified a preoccupation with weight and associated low self-esteem among women with PCOS. These studies were similar to ours but differed in their collection methods and the context of the participants (both from high income countries with relatively well-structured public health care systems). There is notably a gap in qualitative research among women with PCOS, particularly in less-developed countries.

The findings of this study also highlighted the influence of hirsutism and unwanted bodily hair on women’s self-image and self-esteem. This finding was also associated with negative self-talk, with women using words like ‘hairy beast’ to describe themselves. These findings echo the study by Pfister and Rømer (2017), whose participants attributed the greatest distress and impact on their self-esteem to hirsutism. The study also reported women taking great lengths to hide or remove their hair, costing them both money and time. As mentioned above, these findings were echoed in the results of this study as the participants reported spending large sums of money on hair removal.

Women described the impact on their self-esteem causing them to avoid social interaction and isolate themselves. The experience of feeling isolated or isolating themselves was shared by the women in another UK-based study by Williams et al. (2015). As was the case with participants in this study, the participants in the UK study reported isolating themselves because of the feeling that the people in their life did not understand them. The women in this study also reported that the combination of their impacted self-esteem and pressure from others surrounding falling pregnant made them feel even more isolated (Williams et al., 2015). This experience was also echoed in the study by Zhang et al. (2020) who collected data from an existing hospital-based cohort of Chinese PCOS patients diagnosed with infertility. The study identified low self-esteem, anxiety, guilt, and distress in the infertility domain (Zhang et al., 2020).

We speculate that the external pressure to fall pregnant could be stemming from internalised gender stereotypes. Like the women in this study and the existing literature, their family, friends and colleagues may also have assimilated that being able to bare children is an inherent female trait (Sharma & Mishra, 2018; Thorpe et al., 2019; Zhang et al., 2020). The researchers of the study based in China reported that as traditional Chinese beliefs consider childbearing of the utmost importance, the combination of social pressure and infertility experienced by Chinese women with PCOS may be the cause psychological distress outlined by their findings (Zhang et al., 2020). The findings in this study were similar but the effect of social pressure to fall pregnant impacted both women who wanted to fall pregnant and those who did not. This suggests the extent of the powerful influence of this social norm. Similar findings were reported in a Canadian study by Thorpe and colleagues (2019) and an Indian study by Sharma and Mishra (2018). The Indian study identified widely held beliefs similar to that of Zhang et al. (2020), highlighting the prevailing belief in this section of Indian society that women are ‘defective’ if they are unable to conceive a child (Sharma & Mishra, 2018, p. 133). As a result, participants shared feeling overwhelming incompleteness and failure (Sharma & Mishra, 2018). The Canadian study shared similar results as well as echoing the sentiment of PCOS taking away all aspects of self that made the participants feel like women (Thorpe et al., 2019).

Participants in this study reported feeling unattractive and not feminine enough due to their symptoms of PCOS. Many symptoms of PCOS directly oppose standard feminine beauty ideals and this resulted in women developing negative feelings about themselves. These feelings maybe have also been influenced when participants compared themselves to other women.

According to social comparison theory, human beings have an innate need to evaluate their own abilities and traits and do so by drawing comparisons between themselves and others (Festinger, 1954). If an individual compares themselves to a person with greater standing in the facet of self they are comparing, they will engage in upwards comparison, which may negatively impact their self-esteem (Festinger, 1954; Li et al., 2019). Participants in our study compared themselves to women who possessed traits that were seemed desirable, such as blemish-free and hair-free skin and the ability to have biological children. Comparisons made between women with PCOS and those without PCOS impacted their self-esteem. The comparisons were made based on popular standards of beauty and feminity, perpetuated by society. Sadly, these standards are out of reach of many women, and unfair to many, especially women with PCOS.

We identified several limitations to this study. While there is little research on PCOS in South Africa, our methods mean that this study may not be generalised. In-person interviews were preferred but online interviews were necesitated due to the COVID-19 pandemic. We recommend that a more in-depth study, exploring meaning-making among women with PCOS would also be of great value. Finally, this article has demonstrated the impact of PCOS on women’s self-esteem, and we therefore recommend that an intervention study aimed at improving self-esteem among women with PCOS be developed and evaluated. A group intervention may have the added benefit of reducing the sense of isolation reported by participants.

Conclusion

We found that participants experienced poor body image and self-esteem due to PCOS. Psychologists can play an important role in supporting women with PCOS, improving self-esteem, reducing distress, and increasing confidence so as to decrease social isolation. As social constructions of beauty and femininity were identified as negatively impacting their self-esteem and body image, psychologists can also play a role in alleviating this by advocating for patients with PCOS in society by deconstructing current narratives of beauty ideals. Critical reflections on how women are viewed in society and how certain perceptions of women are favoured in society can make us question the standards or ideals set for women. Social constructions of beauty and femininity have to be interrogated and changed, allowing for inclusivity.