The State of Art Education Initiative

Positive Body Image, Self-Esteem Important for Sexual Function

Reviewed by the medical professionals of the ISSM’s Communication Committee


There are significant connections among sexual self-esteem, sexual communication, body image, and female sexual function, new research from China suggests.

The Journal of Sexual Medicine published the study as an article in press in January 2021.

The effects of sexual self-esteem and communication on body image and sexual function had been “underexplored,” the researchers said.

They noted that culture in China could influence women’s feelings about their sexuality. Older women may view sex as taboo and see their sexual role as a passive one. In contrast, younger women tend to be more open about sexuality and talk about sex more readily. Some women may find that their sexual attitudes are shaped by both traditional and modern perspectives.

For the study, researchers had 510 women complete an online survey. The participants’ ages ranged from 18 to 53, with an average age of 28. All of the women had been in an intimate relationship for at least a year; over half had been in their relationship for one to four years. The majority (96%) were heterosexual.

The survey included items assessing body appreciation, body image, self-confidence during sex, sexual self-esteem, sexual communication with their partner, and willingness to share sexual dislikes with their partner. They also completed the Female Sexual Function Index (FSFI), which assesses sexual desire, arousal, lubrication, orgasm, satisfaction, and pain over the previous four weeks.

Based on their FSFI scores, about 14% of the women were at risk for sexual dysfunction.

Women with positive body appreciation tended to have better sexual function and higher sexual self-esteem. They were also more likely to discuss their sexual relationship with their partner.

“Specifically, women who love and respect their body may feel more confident to be with a sexual partner and rate themselves well, and this may lead them to feel more willing to communicate sexual issues with their partner and/or experience less difficulty and embarrassment when talking about sex,” the authors wrote.

In contrast, women who felt self-conscious about their bodies during sex were more likely to have sexual problems, including poor arousal and lubrication. Their sexual self-esteem was lower, and they had less sexual communication with their partner.

Their study did have some limitations, the authors said. For example, associations could be bidirectional. Better sexual function might lead to better self-esteem, body image, and communication. Results might be different for women who were not in steady relationships. Also, the participants’ average age was 28. Older women, who might be more sexually conservative, might respond differently to the surveys.

The authors recommended that women and healthcare professionals focus on improving their body image, sexual self-esteem, and communication strategies.


  • The Journal of Sexual Medicine – “Effect of Sexual Esteem and Sexual Communication on the Relationship Between Body Image and Sexual Function in Chinese Heterosexual Women”
    Wu, Ting, MD and Yong Zheng, PhD
    (Full-text article in press. Published: January 21, 2021)
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