Knowledge in the research fields of body image and sexuality has significantly increased in the last decade. In this review, data from 57 studies were compiled for a review of empirical evidence regarding the association between sexuality and body image among healthy women. The overall conclusion is that body image issues can affect all domains of sexual functioning. Cognitions and self-consciousness seem to be key factors in understanding the complex relationships between women's body image and sexuality. Body evaluations and cognitions not only interfere with sexual responses and experiences during sexual activity, but also with sexual behavior, sexual avoidance, and risky sexual behavior.

Previous studies found important associations between body image, sexual satisfaction, and perceived romantic relationship quality, but mainly focused on one individual's perceptions rather than both partners. To take the interdependency of romantic partners into account, the present study examined these associations in romantic couples with a dyadic approach. In a cross-sectional design, 151 Dutch heterosexual couples completed an online survey measuring body image, sexual satisfaction, and perceived relationship quality. Hypotheses were tested using the actor-partner interdependence model (APIM) and an APIM extended with a mediator (APIMeM), with couple members' body image as predictors, couple members' sexual satisfaction as mediators, and couple members' relationship quality as outcomes. Results indicated that within individuals, a more positive body image was linked to higher perceived romantic relationship quality through greater sexual satisfaction. No gender differences were found, implying that body image and sexual satisfaction are equally strongly associated with perceived relationship quality in women and men. Results revealed no associations of an individual's body image and sexual satisfaction with the partner's perceived relationship quality. These findings implicate that interventions focusing on developing and maintaining a positive body image may be helpful in building on a more satisfying sex life and higher perceived relationship quality. (PsycINFO Database Record

Previous research indicated that insecure attachment, that is, higher levels of attachment avoidance and attachment anxiety, is negatively associated with relationship satisfaction. The present study investigated the mediating role of gratitude toward the partner in this association. In a cross-sectional design, 362 participants (84% female, age range 18–70 years) involved in a romantic relationship completed an online questionnaire assessing attachment avoidance and anxiety, gratitude toward the partner, and relationship satisfaction. Data were analyzed by means of regression and bootstrap analyses. The regression analysis revealed significant negative total and direct effects of both avoidance and anxiety on relationship satisfaction. The bootstrap analyses revealed a significant negative indirect effect of avoidance, but not anxiety, on relationship satisfaction via gratitude toward the partner. Specifically, higher levels of avoidant attachment were related to less gratitude toward the partner, which in turn was associated with lower relationship satisfaction. These findings suggest that it might be valuable applying gratitude interventions to clients high in attachment avoidance attending couples therapy.

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Studies in the field of body image have primarily addressed its negative aspects, such as body dissatisfaction. The present study focused instead on women who are satisfied with their bodies and on how body satisfaction relates to sexual health. A sample of 319 Dutch female university students completed an online survey that included items about body image evaluation, body image investment, overweight preoccupation, body image affect during sexual activity, sexual frequency, sexual functioning, and sexual self-esteem. We found that the level of body dissatisfaction was minimal in our sample. The majority reported neutral or mildly positive body evaluations, and in 30% of the sample these evaluations were clearly positive. Comparisons between women who reported positive versus neutral body evaluations showed that the body-satisfied women had lower body mass indexes (BMIs) and reported less body image investment, less overweight preoccupation, and less body self-consciousness during sexual activity. With regard to sexual health, they reported higher sexual self-esteem and better sexual functioning. Furthermore, we found that body image self-consciousness was negatively associated with sexual functioning, sexual self-esteem, and frequency of sexual activity with a partner. Body satisfaction did not account for a portion of the relationship of body self-consciousness during sexual activity with sexual health.