Research on psychological factors related to female sexual functioning has been growing in recent years. Our study draws on the existing sexual health literature and objectification theory to test a model of female sexual functioning. Using structural equation modeling, we examined the associations of body surveillance and internalization of cultural standards of beauty with appearance anxiety, depression, and sexual health (i.e., physical sexual functioning and subjective sexual well-being) in a sample of 426 sexually active, heterosexual, cisgender women. Further, we investigated the role of depression and appearance anxiety as mediators of the associations of body surveillance and internalization of cultural standards of beauty with sexual health. Our findings contribute to the growing body of empirical research that examines the role of sociocultural and psychological factors in female sexual functioning. Results suggest that depression and appearance anxiety fully mediated the relations of body surveillance with sexual well-being. However, internalization of cultural standards of beauty was not significant with any study outcomes. These findings expand on existing objectification theory literature by elucidating the associations of body surveillance and internalization of cultural standards of beauty with sexual functioning as well as by highlighting the importance of attending to body image, appearance anxiety, and depression when working clinically with women reporting concerns with their sexual functioning.
AbrahamL.SymondsT.MayK.AlthofS. E.Hallam-JonesR.RosenR. C. (2009). Psychometric validation of gender nonspecific Sexual Confidence and Sexual Relationship Scales in men and women. Journal of Sexual Medicine, 6, 2244–2254. doi:10.1111/j.1743-6109.2009.01336.x
2.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
AntonyM. M.BielingP. J.CoxB. J.EnnsM. W.SwinsonR. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181. doi:10.1037/1040-3590.10.2.176
6.
AraujoA. B.MohrB. A.McKinlayJ. B. (2004). Changes in sexual function in middle-aged and older men: Longitudinal data from the Massachusetts Male Aging Study. Journal of the American Geriatrics Society, 52, 1502–1509.
7.
BaldwinD. S. (2001). Depression and sexual dysfunction. British Medical Bulletin, 57, 81–99. Retrieved fromhttp://bmb.oxfordjournals.org
8.
BassonR.LeiblumS.BrottoL.DerogatisL. A.FourcroyJ.Fugl-MeyerK.…SchultzW. W. (2003). Definitions of women’s sexual dysfunction reconsidered: Advocating expansion and revision. Journal of Psychosomatic Obstetrics and Gynecology, 24, 221–229.
9.
BrottoL. A.BassonR.LuriaM. (2008). A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. Journal of Sexual Medicine, 5, 1646–1659.
10.
CalogeroR. M.ThompsonJ. K. (2009a). Potential implications of the objectification of women’s bodies for women’s sexual satisfaction. Body Image, 6, 145–148. 10.1016/j.bodyim.2009.01.001
11.
CalogeroR. M.ThompsonJ. K. (2009b). Sexual self-esteem in American and British college women: Relations with self-objectification and eating problems. Sex Roles, 60, 160–173. doi:10.1007/s11199-008-9517-0
12.
CarrE. R.SzymanskiD. M. (2011). Sexual objectification and substance abuse in young adult women. The Counseling Psychologist, 39, 39–66. 10.1177/0011000010378449
13.
CashT. F. (2004). Body-image assessments: Manuals and questionnaires. Norfolk, VA: Old Dominion University. Retrieved fromhttp://www.body-images.com
14.
CashT. F.MaikkulaC. L.YamamiyaY. (2004). “Baring the body in the bedroom”: Body image, sexual self-schemas, and sexual functioning among college women and men. Electronic Journal of Human Sexuality, 7. Retrieved fromhttp://www.ejhs.org/volume7/bodyimage/html
15.
CrawfordJ.CayleyC.LovibondP. F.WilsonP. H.HartleyC. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Australian Psychologist, 46, 3–14. doi:10.1111/j:1742-9544.2010.00003.x
16.
de JongheJ. F.BanekeJ. J. (1989). The Zung Self-Rating Depression Scale: A replication study on reliability, validity and prediction. Psychological Reports, 64, 833–834. 10.2466/pr0.1989.64.3.833
17.
DionK. L.DionK. K.KeelanJ. P. (1990). Appearance anxiety as a dimension of social-evaluative anxiety: Exploring the ugly duckling syndrome. Contemporary Social Psychology, 14, 220–225.
18.
DundonC. M.RelliniA. H. (2010). More than sexual function: Predictors of sexual satisfaction in a sample of women age 40-70. Journal of Sexual Medicine, 7, 896–904. doi:10.1111/j.1743-6109.2009.01557.x
19.
DunnK. M.CroftP. R.HackettG. I. (1999). Association of sexual problems with social, psychological, and physical problems in men and women: A cross-sectional population survey. Journal of Epidemiology & Community Health, 53, 144–148. 10.1136/jech.53.3.144
20.
EatonW. W.SmithC.YbarraM.MuntanerC.TienA. (2004). Center for Epidemiologic Studies Depression Scale: Review and revision (CESD and CESD-R). In MaruishM. E. (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (Vol. 3, 3rd ed., pp. 363–377). Mahwah, NJ: Lawrence Erlbaum.
21.
FrankE.AndersonC.RubinsteinD. (1978). Frequency of sexual dysfunction in “normal” couples. New England Journal of Medicine, 299, 111–115.
22.
FredricksonB. L.RobertsT. (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173–206. doi:10.1111/j.1471-6402.1997.tb00108.x
23.
GabrysJ. B.PetersK. (1985). Reliability, discriminant and predictive validity of the Zung Self-Rating Depression Scale. Psychological Reports, 57, 1091–1096. 10.2466/pr0.1985.57.3f.1091
24.
HarrisonK.FredricksonB. L. (2003). Women’s sport media, self-objectification, and mental health in Black and White adolescent females. Journal of Communication, 53, 216–232. doi:10.1111/j.1460-2466.2003.tb02587.x
25.
HartmannU. (2007). Depression and sexual dysfunction. Journal of Men’s Health & Gender, 4, 18–25. 10.1016/j.jmhg.2006.12.003
26.
HayesR. D.DennersteinL.BennettC. M.SidatM.GurrinL. C.FairleyC. K. (2008). Risk factors for female sexual dysfunction in the general population: Exploring factors associated with low sexual function and sexual distress. Journal of Sexual Medicine, 5, 1681–1693. doi:10.1111/j.1743-6109.2008.00838.x
27.
HeinbergL. J.ThompsonJ. K.StormerS. (1995). Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire. International Journal of Eating Disorders, 17, 81–89. doi:10.1002/1098-108X
28.
HendrickxL.GijsL.EnzlinP. (2014). Prevalence rates of sexual difficulties and associated distress in heterosexual men and women: Results from an internet survey in Flanders. The Journal of Sex Research, 51, 1–12. 10.1080/00224499.2013.819065
29.
HenryJ. D.CrawfordJ. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239. 10.1348/014466505X29657
30.
KlineR. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York, NY: The Guilford Press.
31.
La RocqueC. L.CioeJ. (2011). An evaluation of the relationship between body image and sexual avoidance. Journal of Sex Research, 48, 397–408. 10.1080/00224499.2010.499522
32.
LaumannE. O.PaikA.GlasserD. B.KangJ.-H.WangT.LevinsonB.…GingellC. (2006). A cross-national study of subjective sexual well-being among older women and men: Findings from the Global Study of Sexual Attitudes and Behaviors. Archives of Sexual Behavior, 35, 145–161.
33.
LaumannE. O.PaikA.RosenR. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537–544. 10.1001/jama.281.6.537
34.
LovibondP. F.LovibondS. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scale (DASS) with the beck depression and anxiety inventories. Behaviour Research Therapy, 33, 335–343. doi:10.1016/0005-7967(94)00075-U
35.
LutfeyK. E.LinkC. L.RosenR. C.WiegelM.McKinlayJ. B. (2009). Prevalence and correlates of sexual activity and function in women: Results from the Boston Area Community Health (BACH) Survey. Archives of Sexual Behavior, 38, 514–527. doi:10.1007/s10508-007-9290-0
36.
MallinckrodtM.AbrahamT. W.WeiM.RussellD. W. (2006). Advances in testing the statistical significance of mediation effects. Journal of Counseling Psychology, 53, 372–378. doi:10.1037/0022-0167.53.3.372
37.
MastersW. H.JohnsonV. E. (1970). Human sexual inadequacy. Boston, MA: Little, Brown.
38.
McKinleyN. M.HydeJ. S. (1996). The Objectified Body Consciousness Scale: Development and validation. Psychology of Women Quarterly, 20, 181–215. doi:10.1111/j.1471-6402.1996.tb00467.x
39.
MizeS. J. S.IantaffiA. (2013). The place of mindfulness in a sensorimotor psychotherapy intervention to improve women’s sexual health. Sexual and Relationship Therapy, 28, 63–76. 10.1080/14681994.2013.770144
40.
MoggeN. L.SteinbergJ. S.FremouwW.MesserJ. (2008). The Assessment of Depression Inventory (ADI): An appraisal of validity in an outpatient sample. Depression and Anxiety, 25, 64–68. 10.1002/da.20247
41.
MoradiB.HuangY. (2008). Objectification theory and psychology of women: A decade of advances and future directions. Psychology of Women Quarterly, 32, 377–398. doi:10.1111/j.1471-6402.2008.00452.x
42.
MoradiB.DirksD.MattesonA. V. (2005). Roles of sexual objectification experiences and internalization of standards of beauty in eating disorder symptomatology: A test and extension of objectification theory. Journal of Counseling Psychology, 52, 420–428. doi:10.1037/0022-0167.52.3.420
43.
MuehlenkampJ. L.Saris-BaglamaR. N. (2002). Self-objectification and its psychological outcomes for college women. Psychology of Women Quarterly, 26, 371–379. doi:10.1111/1471-6402.t01-1-00076
44.
MuthénL. K.MuthénB. O. (1998–2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Author.
45.
ParentM. C. (2013). Handling item-level missing data: Simpler is just as good. The Counseling Psychologist, 41, 568–600. 10.1177/0011000012445176
46.
PaulsR. N.OcchinoJ. A.DryfhoutV. L. (2008). Effects of pregnancy of female sexual function and body image: A prospective study. Journal of Sexual Medicine, 5, 1915–1922. doi:10.1111/j.1743-6109.2008.00884.x
47.
PiccinelliM.WilkinsonG. (2000). Gender differences in depression: Critical review. The British Journal of Psychiatry, 177, 486–492. 10.1192/bjp.177.6.486
48.
RosenR.BrownC.HeimanJ.LeiblumS.MestonC. M.ShabsighR.…D’AgostinoR.Jr (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26, 191–208. 10.1080/009262300278597
49.
SchnatzP. F.WhitehurstS. K.SullivanD. M. (2010). Sexual dysfunction, depression, and anxiety among patients of an inner-city menopause clinic. Journal of Women’s Health, 19, 1843–1849. doi:10.1089=jwh.2009.1800
50.
ShifrenJ. L.MonzB. U.RussoP. A.SegrettiA.JohannesC. B. (2008). Sexual problems and distress in United States women. Obstetrics & Gynecology, 112, 970–978. 10.1097/AOG.0b013e3181898cdb
51.
SimonsJ.CareyM. P. (2001). Prevalence of sexual dysfunctions: Results from a decade of research. Archives of Sexual Behavior, 30, 177–219.
52.
SmolakL.MurnenS. K. (2011). The sexualization of girls and women as a primary antecedent of self-objectification. In CalogeroR. M.Tantleff-DunnS.ThompsonJ. K. (Eds.), Self-objectification in women: Causes, consequences, and counteractions (pp. 53–75). Washington, DC: American Psychological Association.
53.
SpectorI. P.CareyM. P. (1990). Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Archives of Sexual Behavior, 19, 389–408. 10.1007/BF01541933
54.
SteerA.TiggemannM. (2008). The role of self-objectification in women’s sexual functioning. Journal of Social and Clinical Psychology, 27, 205–225. 10.1521/jscp.2008.27.3.205
55.
SymondsT.BoolellM.QuirkF. (2005). Development of a questionnaire on sexual quality of life in women. Journal of Sex & Marital Therapy, 31, 385–397. 10.1080/00926230591006502
56.
SzymanskiD. M.MoffittL. B.CarrE. R. (2011). Sexual objectification of women: Advances to theory and research. The Counseling Psychologist, 39, 6–38. 10.1177/0011000010378402
57.
TiggemannM.KuringJ. K. (2004). The role of body objectification in disordered eating and depressed mood. British Journal of Clinical Psychology, 43, 299–311. 10.1348/0144665031752925
58.
TiggemannM.WilliamsE. (2012). The role of self-objectification in disordered eating, depressed mood, and sexual functioning among women: A comprehensive test of objectification theory. Psychology of Women Quarterly, 36, 66–75. 10.1177/0361684311420250
59.
TolmanD. L.ImpettE. A.TracyA. J.MichaelA. (2006). Looking good, sounding good: Femininity ideology and adolescent girls’ mental health. Psychology of Women Quarterly, 30, 85–95. doi:10.1111/j.1471-6402.2006.00265.x
60.
Van DamN. T.EarleywineM. (2011). Validation of the Center for Epidemiologic Studies Depression Scale–Revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research, 186, 128–132. 10.1016/j.psychres.2010.08.018
61.
WestonR.GoreP. A. (2006). A brief guide to structural equation modeling. The Counseling Psychologist, 34, 719–751. 10.1177/0011000006286345
62.
WilliamsJ.MackinnonD. P. (2008). Resampling and distribution of the product methods for testing indirect effects in complex models. Structural Equation Modeling, 15, 23–51.
63.
WilliamsJ. R.HirschE. S.AndersonK.BushA. L.GoldsteinS. R.GrillS.…MarshL. (2012). A comparison of nine scales to detect depression in Parkinson disease: Which scale to use?Neurology, 78, 998–1006. 10.1212/WNL.0b013e31824d587f
YamamiyaY.CashT. F.ThompsonJ. K. (2006). Sexual experiences among college women: The differential effects of general versus contextual body images on sexuality. Sex Roles, 55, 421–427. doi:10.1007/s11199-006-9096-x
66.
ZungW. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70. 10.1001/archpsyc.1965.01720310065008
67.
ZungW. W. (1971). The differentiation of anxiety and depressive disorders: A biometric approach. Psychosomatics: Journal of Consultation Liaison Psychiatry, 12, 380–384.
68.
ZungW. W. (1972). How normal is depression?Psychosomatics: Journal of Consultation Liaison Psychiatry, 13, 174–178.
69.
ZungW. W.RichardsC. B.ShortM. J. (1965). Self-Rating Depression Scale in an outpatient clinic: Further validation of the SDS. Archives of General Psychiatry, 13, 508–515.
70.
ZungW. W.ZungE. M. (1986). Use of the Zung Self-Rating Depression Scale in the elderly. Clinical Gerontologist: The Journal of Aging and Mental Health, 5, 137–148. 10.1300/J018v05n01_07
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
