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ORIGINAL PAPER
Relationships Between Body Image, Body Composition, Sexual
Functioning, and Sexual Satisfaction Among Heterosexual Young
Adults
Robin R. Milhausen •Andrea C. Buchholz •
Emily A. Opperman •Lindsay E. Benson
Received: 24 October 2012 / Revised: 27 June 2013/ Accepted: 12 October 2013
ÓSpringer Science+Business Media New York 2014
Abstract This study investigated the association between
body image and body-image self-consciousness on sexual
satisfaction, accounting for relationships between bodyfat and
body image, and between sexual functioning and sexual sat-
isfaction, while controlling for relationship satisfaction. Par-
ticipantswere 143, 18–25 year-oldCaucasian men and women
in heterosexual monogamous relationships, recruited from the
University of Guelph and surrounding community in Ontario,
Canada. Various domains of body image, body-image self-
consciousness, sexual satisfaction and functioning, and rela-
tionship satisfaction data were collected by questionnaires.
Body fat was measured using dual energy X-ray absorptiom-
etry. Among men, body image was positively associated with
sexual satisfaction, after controlling for relationship satisfac-
tion. Men withgreater body fat were morelikely to have poorer
behavioral and affective body image. Only body image spe-
cific to the sexual encounter influenced sexual functioning.
Among women,no domain of body image was associated with
sexual satisfaction, after controlling for relationship satisfac-
tion. Women with greater body fat were more likely to have
pooreraffectiveandsexual-encounter-specificbody image.As
percent total fat increased, sexual functioning decreased. Our
results suggest a complex pattern ofrelationships exists among
body image and body composition constructs and sexual and
relationship variable; and that these relationships are not the
same for men and women.
Keywords Sexual satisfaction Sexual functioning
Body fat Body image Young adults
Introduction
Body image is a multifaceted construct which incorporates an
individual’s subjective perceptions of, and attitudes towards,
his or her body (Banfield & McCabe, 2002; Cash, Morrow,
Hrabosky, & Perry, 2004; Cash & Pruzinsky, 2002). Body
image has been conceptualized as evaluative (an individual’s
appraisal of his or her body), affective (an individual’s feel-
ings about his or her body), and behavioral (e.g., individuals
with poor body image are more likely to avoid certain
activities or behaviors) (Banfield & McCabe, 2002; Rosen,
Srebnik, Saltzberg, & Wendt, 1991). Finally, body image has
been demonstrated to have a contextual element; body image
concerns and behaviors are more likely to arise in situations
when one’s body is on display or the focus of an activity
(Cash, 2002; Fredrickson, Roberts, Noll, Quinn, & Twenge,
1998; Wiederman, 2000).
Women have been shown to be more invested in (La
Rocque & Cioe, 2011), but less satisfied with, their appear-
ance (Conner, Johnson, & Grogan, 2004; Grogan, 1999), and
more self-conscious about their bodies in intimate situations
(La Rocque & Cioe, 2011) than are men. Almost one-half of a
nationally representative sample of US women reported
globally negative evaluations about their appearance and
exhibited preoccupation about their weight (Cash & Henry,
1995). Recent research indicates that body image concerns
are increasing among men (Blashill, 2011; McArdle & Hill,
2007). An American survey reported that 43 % of men were
dissatisfied with their overall appearance, 45 % were dissat-
isfied with their muscle tone, and more than half were dis-
satisfied with their overall appearance (Garner, 1997).
R. R. Milhausen A. C. Buchholz (&)E. A. Opperman
L. E. Benson
Department of Family Relations and Applied Nutrition,
MacDonald Institute, University of Guelph, Guelph,
ON N1G 2W1, Canada
e-mail: abuchhol@uoguelph.ca
123
Arch Sex Behav
DOI 10.1007/s10508-014-0328-9
In both men and women, negative body image has been
associatedwith a plethora of negative physical, psychological
and relational outcomes (Davison & McCabe, 2005; Zur-
briggen, Ramsey, & Jaworski, 2011). Body image-related
constructs (e.g., body shame, inaccurate weight perceptions,
lower ratings of attractiveness) have been associated with
increased sexual risk-taking (Akers et al., 2009; Littleton,
Radecki-Breitkof, & Berenson, 2005), lower sexual self-
esteem (Calogero & Thompson, 2009), lower frequency of
sexual behavior (Faith & Share,1993), decreased sexualdesire
(Koch, Mansfield, Thurau, & Carey, 2005), and sexual dys-
function overall (Nobre & Pinto-Gouveia, 2006). Given that
sexual satisfaction is associated with better overall health,
well-being, and quality of life (Gallicchio et al., 2007;Hen-
derson, Lahavot, & Simoni, 2009; Laumann, Paik, & Rosen,
1999), and relationship functioning and stability (Sprecher,
2002; Stephenson & Meston, 2010), research assessing body
image-related predictors and correlates of sexual satisfaction
could have important implications for overall health and well-
being. The body of research on body image and sexual satis-
faction provides strong evidence for assessing multiple
domains of body image and for considering the ways in which
more global measures of body image might influence body
image concerns during a sexual encounter.
A number of variables impact body image, sexual satisfac-
tion, or both. A key physical factor is body composition. A
higher body mass index (BMI, weight in kg divided by height in
m
2
), has been associated with body dissatisfaction (Satinsky,
Reece, Dennis, Sanders, & Bardzell, 2012), particularly in
women (Algars et al., 2009). Though body image and body
composition are associated, body image concerns can persist
despite healthy or socially sanctioned body weight; and body
appreciation can occur among individuals of larger body sizes
(Satinsky et al., 2012). Research assessing BMI and body image
as predictors of sexual outcomes suggest that body image is a
stronger predictor than actual body size (Weaver & Byers,
2006). Of the few studies that have assessed the relationship
between body composition and sexual satisfaction, two reported
that, as BMI increased, sexual satisfaction decreased (Addis
et al., 2006; Esposito et al., 2007); and one found no relationship
between BMI and sexual satisfaction (Bajos, Wellings, La-
borde, & Moreau, 2010). Given conflicting findings, measured
body composition—rather than a proxy thereof (such as BMI)—
should be included in studies of body image and sexual satis-
faction and direct and indirect relationships should be tested.
Another critical variable to consider when investigating
body image and sexual satisfaction is sexual functioning.
Decrements in sexual functioning have been associated with
decreases in sexual satisfaction in men and women (Frank,
Anderson, & Rubinstein, 1978; King, Holt, & Nazareth, 2007;
MacNeil & Byers, 1997; Pujols, Meston, & Seal, 2010). Fur-
ther, satisfaction is often considered a domain orcomponent of
measures of sexual functioning (e.g., Female Sexual Function
Index [FSFI], Rosen et al., 2000; Male Sexual Function Inven-
tory [MSFI], O’Leary et al., 1995). Indeed, in several investi-
gations of body image and sexual satisfaction, sexual function-
ing emerged as the strongest predictor of sexual satisfaction
(Pujols et al., 2010; Purdon & Holdaway, 2006). Body image
might impact sexual satisfaction directly as discussed above
or indirectly through sexual functioning. As such, this variable
should be included in potential pathways investigating body
image and sexual satisfaction.
One of the strongest predictors of sexual satisfaction is
relationship satisfaction. Byers, Demmons, and Lawrance
(1998) demonstrated that relationship satisfaction accounted
for 67 % of the variance in sexual satisfaction in partnered
men and women. Individuals with greater relationship satis-
faction tend to report greater sexual satisfaction (Byers, 2005;
Sprecher, 2002). Once relationship satisfaction was entered
into the model, Steer and Tiggemann (2008) found that body
image constructs (self objectification, self-surveillance, body
shame, appearance anxiety, body image self-consciousness
in a sexual encounter) were no longer significant predictors of
sexual functioning in their sample of college women. As
such, studies of body image and sexual satisfaction should
control for relationship satisfaction.
Despite research demonstrating links between body image,
body composition, relationship satisfaction, sexual functioning,
and sexual satisfaction, no study to date has incorporated all of
these variables in a single investigation of both men and women.
Research that does consider subsets of these constructs is limited
by a number of conceptual, measurement, and sampling issues.
Chief among these limitations has been the measurement of
body image. Several studies (with the exception of Weaver and
Byers, 2006), have investigated a single domain of body image,
incorporating only evaluative measures (e.g., body dissatisfac-
tion); affective measures (e.g., negative emotions about physical
appearance); or behavioral measures (e.g., avoiding situations
because of body image concerns) (Davison & McCabe, 2005).
Assessing body image concerns that occur distally and more
proximally (e.g., body image self-consciousness during a sexual
encounter) would give models predicting sexual satisfaction
more explanatory power. Doing so in both men and women is
important as much of the research on body image has involved
only women (Davison & McCabe, 2005). However, different
patterns of variables influence sexual satisfaction among men
and women (Warehime & Bass, 2008), highlighting the
importance of considering both genders while conducting
analyses separately.
Another important limitation is the lack of inclusion of
measuredbody composition.Instead, proxy measures (weight,
BMI) are often used (Addis et al., 2006; Colegero & Thomp-
son, 2009;Davison&McCabe,2005; Esposito et al., 2007;
Hoyt & Kogan, 2001; Pujols et al., 2010;Satinskyetal.,2012)
as they are quick, inexpensive, and easy to obtain. However,
the relationships between weight, BMI, and body fat change
Arch Sex Behav
123
with age, gender, and ethnicity (Mascie-Taylor & Goto,2007).
These relationships may further be confounded by use of self-
reported weight and height; women tend to under-report
weight and men tend to over-report height (Stommel &
Schoenborn, 2009). Not surprisingly, weight and BMI have
been found to under- or overestimate fat mass in various
populations (Pasco, Nicholson, Brennan & Kotowicz, 2012).
Given research demonstrating associations between BMI,
body image, and sexual satisfaction, measured body compo-
sition should be included in models of these relationships.
Only one study to date has taken into account the role of
relationship satisfaction on associations between body com-
position, body image, and sexual satisfaction (conceptualized
as a part of sexual functioning) and, in this analysis, relation-
ship satisfaction was the only significant predictor of sexual
functioning (Steer & Tiggemann, 2008). Thus, relationship
satisfaction should be assessed as a covariate in analyses with
sexual satisfaction as an outcome.
Finally, previous research on body image and sexual satis-
faction has largely used multiple regression or analysis of var-
iance approaches (Holt & Lyness, 2007; Penhollow & Young,
2008; Pujols et al., 2010; Weaver & Byers, 2006), neither of
which allows for all pathways between variables to be tested
simultaneously. This research suggests that relationships
between body composition, various domains of body image,
relationship satisfaction, sexual satisfaction, and sexual func-
tioning are complex. Given these complexities, structural
equation modeling (SEM) is an appropriate analytic technique.
Thus, the purpose of the current study was to simultaneously
investigate the direct effects of behavioral and affective body
image and sexual self-consciousness on sexual satisfaction,
taking into account the relationships between body composition
and body image and the relationships between sexual func-
tioning and sexual satisfaction, while controlling for relation-
ship satisfaction. We extend the current literature on body image
andsexualsatisfactionbyincluding: male and female partici-
pants, multiple domains of body image, measured body com-
position, and relevant mediating and control variables.
Method
Sex, Health and YOU (SHAY) was a health and sexuality
study investigating the relationships between body compo-
sition, body image, relationship satisfaction, sexual func-
tioning, and sexual satisfaction among young Caucasian
women and men. The design was cross-sectional and obser-
vational. There were two data collection periods: January to
June 2009 and September 2009 to April 2010.
The study was reviewed and approved by the Research
Ethics Board at the University of Guelph. Participants pro-
vided written informed consent prior to enrolment and were
provided with a $10 gift card upon study completion. Each
participant was entered into a draw to win one of five three-
month memberships to a local athletic facility.
Participants
Participants were recruited from the University of Guelph and
surrounding local community in southwestern Ontario,
Canada. A variety of posters were designed to attract young
men and women of various body types by using varying color
schemes, a range of headings, and including images of cou-
ples with diverse body types. Posters were placed across
campus and in various community settings (i.e., coffee shops,
grocery store bulletin boards). Advertisements were placed
online on free local classified sites and in the local new spaper.
Recruitment messages were sent to various campus listservs
and delivered in large undergraduate classes.
Potential participants contacted the study coordinator via
email. Theywere sent information on the study’s purposeand a
screening questionnaire to assess eligibility. Participants were
considered eligible if they were: Caucasian, between 18 and
25 years of age, heterosexual, in a romantic relationship with
one partner;and had engaged insexual intercourseat least once
in the past month. Participants were required to be Caucasian
due to markedethnic differences in theamount and distribution
of body fat (Wagner & Heyward, 2000) and body image (Ard,
Greene,Malpede, & Jefferson,2007;Grabe&Hyde,2006).As
age has been shown to impact body image and sexuality con-
structs (Davison & McCabe, 2005), a narrow age range was
selected for this investigation. Participants must have self-
identified as heterosexual due to the influence of sexual ori-
entation on body image and satisfaction (Conner et al., 2004;
Siever, 1994). Lastly, participants had to have engaged in
sexual intercourse (penile-vaginal penetration) at least once in
the month prior to participation. One month is an adequate
length of time to provide an accurate assessment of current
sexual function in individuals (Graham & Bancroft, 2005).
Participants were considered ineligible if they were currently
taking anti-depressant medications, as these may influence
sexual function (Werneke, Northey, & Bhugra, 2006).
A total of 171 individuals participated in the study; four
were excludedfrom the analyses because they did not meet the
inclusion criteria: age[25 (n=1) and not Caucasian (n=1).
Though we had hoped to include underweight individuals in
the study, only two with a BMI\18.5 participated; these two
participants were removed from the analysis. An additional 24
participants were excluded from the analyses due to missing
C10 % data. The final dataset comprised 75 women and 68
men. Participant characteristics are shown in Table 1.
Procedure
Eligible participants were invited to the University’s Body
Composition and Metabolism Lab. Study visits were between 1
Arch Sex Behav
123
and2hindurationdependingontheamountoftimeittook
participants to complete the questionnaires. Participants began
by completing a series of structured questionnaires described in
detail below. Upon completion, one set of anthropometric
measurements was taken by one of two study coordinators.
Height was measured to the nearest millimetre using a wall-
mounted stadiometer (Seca, Hamburg, Germany). Weight was
measured initially using a beam balance scale (Seca, Hamburg,
Germany); however, after this scale developed some technical
malfunctions, the BOD POD
Ò
scale (COSMED USA, Concord,
CA) was used. Both scales wereplaced on the same hard surface.
Weight was recorded digitally to the nearest .001 kg with the
BOD POD scale and to the nearest .01 kg with the beam balance
scale. The coefficient of variation between these two scales was
3.36 %.
Lastly, participants underwent body composition (i.e., body
fat) measurement using dual energy X-ray absorptiometry
(DXA; Hologic Discovery Wi, Bedford, MA), wearing only a
hospital gown and undergarments. Prior to scanning, female
participants were asked by the medical radiation technologist
(MRT) whether there was any chance of pregnancy and the date
of their last menstrual period. If the participant could not pro-
vide this information, they did not undergo body composition
testing. These participants (N=2)wereaskedtoreturnfortheir
DXA scan after their next menstrual period. Participants were
asked to lie on the scanning bed for approximately 6 min.
During this time, X-rays of two different energies were emitted
from below the participant and were detected by a moving
‘‘arm’’above, from head to toe. All scans were completed by the
same MRT. The DXA was calibrated before use on the morning
of each study day using a standard calibration block of ther-
moplastic acrylic resin, according to the manufacturer’s
instructions. The MRT’s coefficient of variation for whole body
percent fat mass was .76 ±.57. DXA is a sophisticated, lab-
based method, found to be reliable and valid in measuring body
composition (Albanese, Diessel, & Genant, 2003).
Measures
Demographic and Health History
Age, gender, race, year and program of study, relationship
status, and selected lifestyle habits (e.g., smoking, alcohol
use) were assessed.
Sexual Satisfaction
The Index Of Sexual Satisfaction (ISS) (Hudson, Harrison, &
Crosscup, 1981) was used to ass ess sexual satisfaction. The ISS
measures the magnitude of a problem in the sexual component
of a dyadic relationship, as seen by the participant. The ISS is a
25-item self-report scale eliciting responses on a 7-point Likert
scale ranging from‘‘none of the time’’ (0) to‘‘all of the time’’(6).
Scores were calculated using a scoring algorithm; the ISS yields
Table 1 Gender differences in participant characteristics (N=143)
Female (N=75) Male (N=68)
Range M (SD) Range M (SD)
Age* 18–25 20.7 (1.8) 18–25 21.4 (2.0)
BMI 18.6–45.5 25.3 (5.1) 19.9–33.8 25.0 (3.3)
Percent total fat** 17.9–47.7 31.1 (7.5) 7.9–31.6 17.2 (5.5)
Percent (N) Percent (N)
Healthy weight (BMI 18-24.9 kg/m
2
)
a
54.7 (41) 58.2 (39)
Healthy weight (20–35 % body fat for females, 8–22% for males) 69.3 (52) 83.8 (57)
Overweight/obese (BMI[25 kg/m
2
)
a
45.3 (34) 41.8 (28)
Obese ([35 % body fat for females, [22 % for males)
b*
30.7 (23) 16.2 (11)
Work status
In university 70 93.3 58 85.3
In college 1 1.3 0 0
Not working 2 2.7 1 1.5
Working 2 2.7 9 13.2
Asterisks indicate significant gender differences on a variable
BMI body mass index
*p\.05; ** p\.001
a
BMI categories according to World Health Organization (2000)
b
Body fat levels adapted from Lohman and Going (1998)
Arch Sex Behav
123
scores from 0 to 100. Higher scores reflect greater sexual dis-
satisfaction. The ISS has excellent reliability over three heter-
ogeneous samples (a=.91 to .93) and test–retest reliability at
1 week is .93. The ISS has good internal consistency (a=.91)
and excellent known groups validity, distinguishing between
those couples with and without problems in their sexual rela-
tionship. The avalues for women and men in this sample
demonstrated good internal consistency with values of .90 and
.86, respectively, indicating that the scale demonstrated good
internal consistency (Field, 2005).
Sexual Function
The FSFI (Rosen et al., 2000) provides a framework to assess
and treat female sexual dysfunction. It was developed to mea-
sure six relevant domains of sexual function in women: desire,
arousal, lubrication, orgasm, satisfaction, and pain using 19 items
answered on a 5-point Likert scale. The full scale can be used to
obtain a score of women’s sexual dysfunction or domains may be
used independently. To score the individual domains, the items
are summed and multiplied by a domain factor. The six domains
are summed to obtain a full scale score (possible scores range
from2to36).However,giventhecurrent investigation sets forth
sexual function as a predictor of sexual satisfaction, the sexual
satisfaction domain was removed from the calculation of the total
score to avoid inflating the relationship between these two con-
structs (as per Pujols et al., 2010). The total score on the FSFI for
this analysis, comprised of scores on the desire, arousal, lubri-
cation, orgasm, and pain subscales, is referred to as the‘‘modified
FSFI.’’ Thus, in the current analysis, scores on the modified FSFI
in the current sample ranged from 12.3 to 26.4 (absolute range
1.2–30), with higher scores indicating greater sexual function.
The FSFI has high inter-item correlations in all six domains
(Cronbach’s aC.82) and high test–retest reliability (r=.79–.86
for domains; r=.88 for total scale). The index also has high
discriminant and divergent validity. The modified FSFI within
the current sample had an avalue of .75.
The MSFI (O’Leary et al., 1995) is a measure used to
evaluate men on treatments or with conditions that may affect
sexual function. The MSFI covers three functional domains:
sexual drive, erectile function, and ejaculatory function, as
well as problem assessment of these functional domains, and
a single item assessing overall satisfaction. It contains 11
items answered on a 5-point Likert scale (0–4) (absolute
range, 0–44). Higher scores indicate greater sexual function.
The MSFI has demonstrated moderate to high internal con-
sistency (a=.62 to .95 for domains) and high test–test reli-
ability after 1 week (r=.79 to .89 for domains). A total score
for the MSFI items was calculated by summing the first 10
items (not including the satisfaction item for reasons stated
above), thus we will refer to the measure as the ‘‘modified
MSFI’’ subsequently. Scores on the revised measure could
range between 0 and 40; scores in the current sample fell
between 27 and 40. The alpha for the modified MSFI scale in
the current sample was .68.
Body Image
Three different measures of body image were used. Affective
body image was assessed by the Appearance subscale of the
body esteem scale for adolescents and adults (BESAA)
(Mendelson, Mendelson, & White, 2001), which is comprised
of a 10-item self report questionnaire that assesses feelings
about appearance (e.g.,‘‘I like what I look like in pictures’’).
Participants were required to answer questions on a 5-point
Likert-type scale ranging from 0 (never) to 4 (always); scores
were created by calculating the mean of items on the subscale.
Higher scores on the subscale are indicative of more positive
affective body image; therefore, all negative questions were
reversed scored. In previous research, the BESAA has shown
good internal consistency with Cronbach’s alphas ranging from
.75 to .91. Additionally, the BESAA has shown strong test–retest
reliability and convergent and discriminant validity. The avalues
for women and men in the current sample were .93 and .79.
In completing the Body Image Avoidance Questionnaire
(BIAQ) (Rosen et al., 1991), which measures the degree or
extent to which behaviors are affected by feelings about one’s
body, participants responded to 19 statements (e.g., ‘‘I wear
baggy clothes’’) on a Likert-type scale ranging from 0 (never)
to 5 (always). The BIAQ yields scores ranging from 0 to 95;
higher scores are indicative of more body image avoidance.
The BIAQ has strong test–retest reliability and concurrent
validity, and has shown good internal consistency with a
Cronbach’s alpha of .89. It has also been used in a previous
study which examined the relationship between body image
and sexual functioning (Weaver & Byers, 2006). In the cur-
rent sample, the avalues for women and men were .73 and .62.
The Body Image Self-Consciousness Scale (BISCS)
(Wiederman, 2000) is a 15-item measure developed to
measure women’s body image self-consciousness during
physically intimate interactions. Participants were required
to respond to statements such as, ‘‘While having sex, I am
(would be) concerned that my hips and thighs would flatten
out and appear larger than they actually are’’ on a 6-point
Likert-type scale ranging from 0 (never) to 5 (always). The
BISCS produces an overall body image self-consciousness
score which is a summation of all of the questions. Scores
range from 0 to 75 and higher scores are indicative of greater
body image self-consciousness. The BISCS has shown strong
internal consistency with a Cronbach’s alpha of .93 and
strong discriminant and convergent with validity. Though the
BISCS was developed specifically for women, the measure
has been used in previous research studying the impact of
body image on sexual functioning and sexual behaviors
Arch Sex Behav
123
among both genders (Aubrey, 2006; Sanchez & Kiefer, 2007;
Wiederman, 2000). In the current sample, the Cronbach’s a
for the BISCS was .97 among women and .81 among men.
Relationship Satisfaction
The Global Measure of Relationship Satisfaction (GMREL)
(Lawrance & Byers, 1998) assessed satisfaction with the
overall relationship. It is based on the Interpersonal Exchange
Model of Sexual Satisfaction which proposes that relationship
quality affects sexual satisfaction (Lawrance & Byers, 1995).
The measure contains five 7-point bipolar scales: good–bad,
pleasant–unpleasant, positive–negative, satisfying–unsatis-
fying, and valuable–worthless. Scores range from 5 to 35;
higher scores indicate greater relationship satisfaction. The
GMREL has demonstrated high internal consistency (a=.95
at Time 1 and .96 atTime 2). In current sample, the avalues for
women and men were.96 and .93, respectively, demonstrating
good internal consistency with this sample.
Statistical Analysis
First, data were screened to check for missing data. Partici-
pants who were missing 10 % or more of the items on any
scales in the study were excluded from the analysis (N=24).
Participants who were missing fewer than 10 % of items on a
scale had responses to these items imputed with the mean
from other items on that scale. Following this, The SPSS
(Version 19.0, Chicago, IL) was used to calculate descriptive
statistics and Pearson correlation coefficients.
SEM (Kaplan, 2000) in the Analysis of Moment Structures
Program (Version 19.0, Chicago, IL) was used to test the
proposed model. The same model was tested for male and
female participants (Fig. 1). In short, we proposed that body
image (conceptualized as affective, behavioral, and specific
to a sexual encounter) would directly influence sexual satis-
faction, and that body composition would impact sexual
satisfaction through the body image constructs. As well, we
predicted sexual functioning would serve as a mediator
between body image and sexual satisfaction. Finally, we
controlled for the influence of relationship satisfaction by
adding paths between this variable and all other variables
(with the exception of body composition) in the model. As per
Kline’s (1998) recommendations for sample size, our sample
of 68 men and 75 women was sufficient for this analysis.
The chi square index (v
2
), standardized root mean squared
residual (SRMR), root mean squared error of approximation
(RMSEA), comparative fit index (CFI), and Tucker–Lewis
index (TLI, or NNFI) of model fit were selected to evaluate
the models (Hoyle & Panter, 1995; Hu & Bentler, 1999). The
v
2
statistic is an absolute index that tests the hypothesis that
the CFA model specified is a perfect fit to the data (Hu &
Bentler, 1995). Although frequently reported, the v
2
test is
highly sensitive to sample size (Hu & Bentler, 1995), and a
smaller, non significant value indicates a good fit (Byrne,
2010). The SRMR indicates the average discrepancy between
Fig. 1 Conceptual model
Arch Sex Behav
123
observed and predicted correlations, with values of 0.08 or
less indicating a good fit (Hu & Bentler, 1999). The RMSEA
indicates the badness of fit per degree of freedom in the speci-
fied model; values less than .06 indicate a strong model fit,
while values up to .10 are acceptable if other fit indexes are
high (Hu & Bentler, 1999). Finally, the CFI and TLI provide
incremental indices of model fit that indicate the improve-
ment of model fit relative to a baseline null model in which
manifest variables are not related (Hu & Bentler, 1995). For
these fit indices, values of .90 or greater indicate a good model
fit, with values of .80 and greater indicating a fair fit (Browne
& Cudek, 1993; Byrne, 2001; Hu & Bentler, 1999).
Results
Affective body image measured by the BESAA appearance
subscale was significantly different between genders (p\.001),
indicating that men had more positive affective body image
than women. However, scores indicated that both men and
women were often satisfied with their appearance. Women
reported greater body image self-consciousness specific to
sexual encounters (as measuredbytheBISCS)thandidmen
(p\.001). Scores on the BIAQ, assessing behavioral body
image indicated that men were less likely to allow feelings
about their appearance influence their behaviors. Men and
women were not significantly different when comparing sexual
satisfaction as measured by the ISS. Relationship satisfaction,
as measured by the GMREL was also similar for both genders.
Detailed sexual, body image, and relationship characteristics of
participants are shown in Table 2.
Model Testing
Men
The hypothesized model (see Fig.1) had an acceptable level of
fit, v
2
(2) =.354, p=.84, SRMR =.65, RMSEA =.00 (90 %
CI: .00–.14), CFI =1.00, TLI =1.34. However, to further
improve model fit, the model was rerun with only paths sig-
nificant at the .05 level (N=6) and paths approaching sig-
nificance (.05\p\.10, N=3). Results from the reduced
model indicated an acceptable fit with no modifications neces-
sary, v
2
(12) =7.10, p=.85, SRMR =1.77, RMSEA =.00 (90 %
CI: .00–.01), CFI =1.00, TLI =1.17. The model accounted for
39 % of the variance in sexual satisfaction among men. Figure 2
shows the model, bivariate correlation coefficients, and stan-
dardized path coefficients for men.
Men’s sexual satisfaction was predicted by body image
avoidance (BIAQ), affective body image (BESAA), and rela-
tionship satisfaction. Body image concerns specific to the sexual
encounter (BISCS) was no longer a significant predictor of
sexual satisfaction in the reduced model (p=.12). Percent
body fat, measured by DXA, predicted body image avoidance
and affective body image. Though body image self-conscious-
ness predicted sexual functioning in men, sexual functioning
did not predict sexual satisfaction. In other words, sexual func-
tioning did not mediate the relationship between body image and
sexual satisfaction in men. Relationship satisfaction was a signifi-
cant predictor of sexual satisfaction.
Women
The hypothesized model had an acceptable level of fit, v
2
(2) =
5.06, p=.08, SRMR =2.31, RMSEA =.14 (90 % CI: .00–.31),
CFI =.98, TLI =.78. However, to further improve model fit,
the model was rerun with only paths significant at the .05 level
(N=6) and paths approaching significance (.05\p\.10,
N=2). The reduced model demonstrated acceptable model
fit with no modifications necessary, v
2
(13) =12.97, p=.45,
SRMR =5.95, RMSEA =.00 (90 % CI: .00–.12), CFI=
1.00, TLI =1.00. The model accounted for 35 % of the vari-
ance in sexual satisfaction among women. Figure 3shows the
model, bivariate correlation coefficients, and standardized
path coefficients for women.
Sexual satisfaction in women was only predicted by rela-
tionship satisfaction and sexual functioning. None of the
body image variables predicted sexual satisfaction or sexual
function. Relationship satisfaction predicted affective body
image (BESAA) and sexual satisfaction. Affective body image
predicted body image avoidance (BIAQ) and body image con-
cerns specific to the sexual encounter (BISCS). Finally, percent
total body fat significantly predicted affective body image, body
image concerns specific to the sexual encounter, and sexual
function.
Discussion
This study contributes to a growing body of literature
examining relationships between body image, sexual satis-
faction, relationship satisfaction, body composition, and
sexual function. Among men, all three domains of body
image (behavioral, affective, and specific to the sexual
encounter) were associated with sexual satisfaction, after
controlling for relationship satisfaction. Men with greater
body fat were more likely to have poor behavioral and
affective body image. Only body image specific to the sexual
encounter influenced sexual functioning. Relationship sat-
isfaction, but not sexual functioning, was associated with
sexual satisfaction. For women, no domain of body image
was associated with sexual satisfaction, after controlling for
relationship satisfaction. As both relationship satisfaction
and sexual functioning increased, sexual satisfaction also
Arch Sex Behav
123
increased. Participants with greater body fat were mor e likely
to have poor affective body image and body image specific to
the sexual encounter. As percent total fat increased, sexual
functioning decreased.
Interestingly, both the men’s (39 %) and women’s (35 %)
models accounted for nearly the same amount of variance in
sexual satisfaction. Despite this global similarity, multiple
domains of body image were associated with sexual satis-
faction in men, and to a similar degree, whereas no body
image variable was associated with sexual satisfaction in
women. Previous research has demonstrated that body image
impacts sexual satisfaction in men (Penhollow & Young,
2008). Holt and Lyness (2007) found that, in men, higher
body image was associated with high sexual satisfaction.
They also reported a trend towards a stronger relationship
between body image and sexual satisfaction in men versus
women. These findings support ours, in that body image
concerns during physically intimate interactions negatively
affected sexual satisfaction.
Several studies parallel ours in terms of the lack of rela-
tionship between body image and sexual satisfaction in women
(Davison & McCabe, 2005;Kochetal.,2005; Meana & Nun-
nick, 2006; Weaver & Byers, 2006). Women’s body image
concerns may be so normative (termed‘‘normative discontent’’
Table 2 Sexual, body image and relationship characteristics (N=143)
Female (N=75) Male (N=68)
Range M (SD) Range M (SD)
ISS score
a
.7–48.0 18.0 (10.5) 0–52.1 15.7 (8.7)
GMREL score
b
13.0–35.0 29.5 (5.8) 18.0–35.0 29.5 (4.5)
FSFI score
c
16.3–32.4 25.9 (3.2)
Modifed FSFI score
d
12.3–26.4 20.8 (2.7)
Modified MSFI score
e
27–40 35.8 (3.5)
BESAA Appearance score
f
** .3–3.8 2.5 (.8) 1.6–4.0 2.9 (.5)
BIAQ score
g
** 12.0–44.0 23.2 (7.5) 9.0–53.0 19.1 (6.6)
BISCS score
h
** 0–72.0 14.0 (15.9) 0–24.0 4.4 (5.0)
Relationship duration (months) 1–73 25.0 (15.9) 1.0–108.0 24.5 (21.9)
Frequency Percent Frequency Percent
Relationship status
Casually dating 2 2.7 7 10.0
Seriously dating 59 78.7 47 68.4
Living with partner (not married) 11 14.7 10 15.2
Married 3 4.0 4 6.3
Sexual frequency
Once a month 0 0 2 2.9
2–3 times per month 6 8.0 5 7.4
At least once a week 26 34.7 19 27.9
Several times a week 40 53.3 36 52.9
At least once a day 3 4.0 6 8.8
** p\.001
a
ISS (Index of Sexual Satisfaction): Scores range from 0 to100; higher scores reflect greater sexual dissatisfaction. Clinical cut off scores:\30 free of a
clinically significant problem,[30 clinically significant problem in this area,[70 are nearly always experiencing severe distress
b
GMREL (Global Measure of Relationship Satisfaction): Scores range from 5 to 35; higher scores indicate greater relationship satisfaction
c
FSFI (Female Sexual Function Index): Scores range from 2 to 36; higher scores indicate greater sexual functioning. Clinical cut off score: B26.55 at
risk for sexual dysfunction
d
Modified FSFI: Scores range from 1.2 to 30; higher scores indicate greater sexual functioning
e
Modified MSFI (Modified Male Sexual Function Inventory, sexual satisfaction item removed): Scores range from 0 to 40, higher scores indicate
greater sexual function; no clinical cut off score
f
BESAA Appearance (Body Esteem Scale for Adolescents and Adults, Appearance Subscale): Scores range from 0 to 4; higher scores indicate a more
positive affective body image
g
BIAQ (Body Image Avoidance Questionnaire): Scores range from 0 to 95; higher scores indicate more body image avoidance
h
BISCS (Body Image Self-Consciousness Scale): Scores range from 0 to 75; higher scores represent greater body image self-consciousness
Arch Sex Behav
123
by Rodin, Silberstein, and Striegel-Moore (1984)) that they are
not significantly negatively associated with other parts of
women’s lives, including sexual satisfaction (Davison &
McCabe, 2005). Perhaps most similar to our findings, Steer and
Tiggemann (2008) found that body image self-consciousness
during sexual activities fully mediated the relationship between
body shame and appearance anxiety and sexual functioning
(including sexual satisfaction). However, once relationship
satisfaction was introduced to the model, this relationship was
no longer significant. A satisfying relationship may have a pro-
tective effect, mitigating any negative influence of body image
on sexual satisfaction (Steer & Tiggemann, 2008). Alternatively,
women’s body image concerns may be assuaged by a partner
who may endorse her attractiveness. Other research contradicts
our findings (Holt & Lyness, 2007;Leopold,2003;Pujolsetal.,
2010). However, not all of these studies required women to be in a
relationship and none included relationship satisfaction as a
variable. It has been suggested that relationship satisfa ction is the
most significant predictor of sexual satisfaction and, if not
included as a variable in the model, conclusions cannot be drawn
(Byers, Demmon, & Lawrance, 1998; Penhollow & Young,
2008; Sprecher, 2002).
In the men’s model, relationship satisfaction was the
strongest predictor of sexual satisfaction and sexual function
was not significantly related to sexual satisfaction whereas, in
the women’s model, relationship satisfaction and sexual
function both strongly predicted sexual satisfaction. Byers
et al. (1998) found relationship satisfaction to account for 67 %
of the variancein sexual satisfaction for men and women.Not
surprisingly, men and women with higher relationship satis-
factionreported greater sexual satisfaction (Byers, 2005;Byers
et al., 1998; Sprecher, 2002; Young, Denny, Luquis, & Young,
1998).Individualswho havehigherrelationshipsatisfactionare
often more committed to the relationship and reported higher
levels of love (Sprecher, 2002) and may be more committed to
working towards satisfaction in many areas of the dyad. Indi-
viduals in such relationships may be so satisfied that they have
high appraisal for other areas of the relationship, including
sexual satisfaction.
Our findings for women were consistent with previous lit-
erature, in which women who experienced sexual dysfunction
or an increasing number of sexual problems or concerns
reported lower levels of sexual satisfaction (King et al., 2007;
MacNeil & Byers, 1997; Pujols et al., 2010). The findings for
men were not consistent with previous literature, which has
reported that as the number of sexual problems or concerns
increased, sexual satisfaction decreased (Frank et al., 1978;
MacNeil & Byers, 1997). The men in our sample had high
sexual function, which may be a reflectionof their young age,
and, as such, it may be that their sexual function was not suf-
ficiently impaired so as to impact sexual satisfaction.
Body fat was associated with sexual functioning in women,
accounting for 7 % of the variance in sexual satisfaction. Body
fat worked through body image to influence sexual satisfaction in
Fig. 2 Path analysis for men
Arch Sex Behav
123
men, but not in women. It was not surprising that body fat pre-
dicted affective body image in both genders as weight and/or
percent body fat plays a major role in perceptions of appearance
(O’Brien, Hunter, Halberstadt & Anderson, 2007). Affective
body image is largely determined by individual values and socio-
cultural norms in which a thin, lean body is privileged (Pen-
hollow & Young, 2008). For women, body fat accounted for a
tremendous amount of the variance (52 %) in body image spe-
cific to the sexual encounter. Women with greater body fat were
more likely to be self-conscious of their bodies during sexual
interactions. Despite this, self-consciousness during a sexual
encounter did not impact women’s sexual functioning or satis-
faction, perhaps the protective nature of being in a satisfying
romantic relationship. Body composition predicted behavioral
body image in men, accounting for 6 % of the variance. Excess
body fat was associated with engaging in behaviors which
diverted attention from their appearance; this, in turn, was
ssociated with decrements in sexual satisfaction. Men may only
participate in specific sexual activities where they feel attractive
or in which they perceive their bodies to look more appealing.
This parallels previous research, as Kolotkin et al. (2006) found
that in men, obesity predicted an avoidance of sexual encounters.
Implications
Though in our study, body image exerted larger influence on
sexual satisfaction than did body composition, both body
composition and body image may be important to attend to
when aiming to enhance sexual satisfaction and well-being in
men and women. Interventions which target health (i.e., fit-
ness, healthy eating) and self-esteem may have a positive
impact on sexual outcomes. If individuals appreciate their
bodies at all shapes and sizes and feel good about themselves,
their health and well-being may benefit (Cash & Hicks,
1990). In our and other research (Byers et al., 1998), rela-
tionship satisfaction exerted the strongest influence on sexual
satisfaction for both men and women. Therefore, interven-
tions (clinical or educational) to improve sexual satisfaction
should always aim to address relationship problems.
Strengths and Limitations
This study was an interdisciplinary effort including compre-
hensive and validated measures to collect information on mul-
tiple domains of body image, sexual satisfaction, sexual function,
relationship satisfaction, and body composition in a large sample
of men and women. Participants had to currently be in romantic
relationships and to recently have had sexual intercourse; this
allowed more accurate reporting of sexual and relationship sat-
isfaction and any experience of sexual problems. We used DXA,
a sophisticated measure of body composition, versus a proxy
measure such as BMI. The same technologist operated the DXA
throughout, eliminating inter-rater error. Lastly, we extended the
current literature by using structural equation modelling to
Fig. 3 Path analysis for women
Arch Sex Behav
123
simultaneously investigate the relationships between several
variables in both men and women.
While ourresearch extendsthe literature, limitations related
to samplingbias bear mention.First, individuals whovolunteer
to participate in sexuality research are more sexually experi-
enced, holdmore liberal sexualattitudes, and are morepositive
about sex than non-volunteers (Boynton, 2003;Saunders,
Fisher, Hewitt, & Clayton, 1985). Secondly, and despite our
best efforts,individuals witha BMIgreater than 25 kg/m
2
were
underrepresented. There are fewer overweight/obese individ-
uals in the 18–25 versus older age groups (Statistics Canada,
2010), potentially explaining some of our difficulty. However,
the mean BMI for both genders was consistent with the World
Health Organization (2000) classification for overweight. We
did find a relationship between body composition and body
image; a more equal representation of various body weights
mayhavereinforcedthisfinding.Thirdly,it has beensuggested
that it is not socially acceptable for men to express concern
about theirappearance; thus, men maybe less likely to respond
honestly when reporting on body image (Hargreaves & Tig-
gemann, 2006;LaRocque&Cioe,2011; Martins et al., 2007).
Additionally, many body image measures, including the ones
we used, were developed with and for women but have been
used with samples of men. In our study,the BIAQ (Rosen et al.,
1991), developed with a female sample, had lower reliability
among our male participants, potentially making it more dif-
ficult to assess relationships between this construct and our
sexuality outcomes. Finally, we acknowledge that our results
may not be generalizable beyond our current sample charac-
teristics; specifically to non-Caucasian ethnicities, people
outsideof the 18–25 age group,individuals who do notidentify
as heterosexual, thosenot currently sexuallyactive or in couple
relationships, or those in longer term romantic relationships.
Future Research
In Canada, approximately two-thirds of adults aged 40–79 are
overweight/obese versus 44 % of adults under 40, justifying
the need to extend this research to an older cohort (Statistics
Canada, 2010). Future research should undertake purposive
sampling to recruit equal numbers of healthy weight and
overweight/obese participants. Furthermore, future research
should compare BMI and body fat to determine if BMI is an
adequate measure of body composition for those lacking
DXA technology. It would be useful to study adult women as
pregnancy and menopause can have a lasting impact on both
body image and body composition, and sexual and relation-
ship variables (Koch et al., 2005; Tiggemann, 2004). Future
research should also be extended to gay, lesbian, and bisexual
individuals and those from various ethnic backgrounds.
Given our finding of a strong association between relation-
ship satisfaction and sexual satisfaction, we recommend that
future studies of sexual satisfaction include relationship
satisfaction as a predictor or control variable. Lastly, the
current investigation did not identify which domains of sex-
ual functioning were most impacted by body image concerns;
future work should continue to investigate this relationship.
Acknowledgments We thank the participants for participating in SHAY,
Duncan Parviainen, Megan Skinner, and Emily Quenneville for assistance
with recruiting and data collection; Sarah Murray for study coordination, data
collection, and assistance with data analysis; and R obyn Pitman for assistance
with data analysis. This study was funded by the Social Sciences and
Humanities Research Council.
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