The term self-concept refers to the feelings and beliefs we have about ourselves. Our self­concept can influence our relationships and sexuality (Coleman, 2007; Foley, 2003). Research has found that self-esteem and self-confidence correlate with higher sexual satisfaction and lack of sexual problems (Galinsky & Sonenstein, 2011; Higgins et al., 2011). For example, a woman who feels comfortable with her body, believes she is entitled to sexual pleasure, and takes an active role in attaining sexual fulfillment is likely to have a more satisfying sexual relationship than a woman who lacks those feel­ings about herself (Nobre & Pinto-Gouveia, 2006; Sanchez et al., 2006). Conversely, a sexual problem can negatively affect self-concept (Althof et al., 2006). For example, in a study about Viagra use, prior to treatment, men with erectile disorder had lower scores on self-esteem tests than men without ED. After 10 weeks of taking Viagra, the men’s scores increased to equal the scores of the men without ED (Capellen et al., 2006).

Body image is an aspect of self-concept that can strongly affect sexuality. The more one is distracted by negative thoughts about one’s body, the less one will be able to go with physical and emotional pleasures during sexual activity (Seal & Meston, 2007). In West­ern cultures women’s bodies are looked at, evaluated, and sexualized more than men’s bod­ies, and thinness and beauty are often equated with sexual desirability. Women’s concerns about weight begin earlier than men’s do. Even when boys and girls have the same per­centage of body fat, girls express greater dissatisfaction with their body weight and body image than boys do (Rierdan et al., 1998; Wood et al., 1996). Eve Ensler, author of The Vagina Monologues, clarifies: "We Americans like to tell ourselves we are free, but we are imprisoned. We are controlled by a corporate media that decrees what we should look like and then determines what we have to buy in order to get and keep that look" (2006, p. 47).

Studies have found that comparing oneself to thin models can result in body image problems (Bergstrom et al., 2009). In the last decades, media images of women have become less and less representative of the average size of women and have contributed

Sexual Difficulties and Solutions

to the perceived importance of thinness (Gazzar, 2008). In the early 1980s the average model weighed 8% less than the average American woman; she now weighs 23% less (Jef­fery, 2006). In an unprecedented action in 2006, the internationally prominent Madrid Fashion Week imposed minimum weight criteria on models. The show banned too-thin models who did not meet the World Health Organization’s guidelines for healthy height – to-weight ratios. Over 30% of the models who had participated in the previous year’s show were disqualified, including top models such as Britain’s Kate Moss.

A woman’s self-consciousness about her nude body during physical intimacy with a male partner is quite common, and the more concerned women are about being nude with a partner, the less sexual satisfaction they report (Penhollow & Young, 2008; Pujois et al., 2010). A research study of college women in the Midwest found that 35% reported physical self-consciousness during physical intimacy with a male part­ner, agreeing to statements such as "If a partner were to put a hand on my buttocks, I would think, ‘My partner can feel my fat’" and "I would prefer having sex with my partner on top so that my partner is less likely to see my body.” Women who were less self-conscious about their bodies viewed themselves as good sexual partners, were more assertive with partners, and had more heterosexual experience than women who were more self-conscious—even when their bodies were similar in size (Wiederman, 2000). Familiarity and attachment with a partner may make a difference: Women who were in exclusive relationships reported less self-consciousness during sexual activity than did women who were not in exclusive relationships (Steer & Tiggemann, 2008).

Problematic concerns about body image may be greater among White heterosexual women than among women in some minority groups. Research indicates that African American women rate themselves more sexually attractive than White women do (Ban­croft et al., 2011). Further, other studies find that women in sexual relationships with other women feel more comfortable with their bodies than do women involved with men (Huxley et al., 2011).

Men are less likely to report body image concerns during sexual activity than women are (Nelson & Purdon, 2011). However, recent trends suggest that media images of men contribute to men’s insecurity about their bodies as well, and consequently men compro­mise their sex lives by concerns about their appearance. For example, college men who spend more time reading men’s magazines and watching music videos and prime-time TV are much less comfortable with their body hair and sweat than men who have less exposure to mass media (Schooler & Ward, 2006). Men in magazines and on television usually have no visible body hair. Male body hair is often a subject for jokes, as in the movie The 40-Year-Old Virgin, in which the protagonist tries to have his chest hair waxed off to be more appealing to his partners. Furthermore, men’s dissatisfaction with their own bodies was indicated by a study of body preference; most men preferred photos of bodies with 30 pounds more muscle than their own (O’Neill, 2000). One study found that men who were more satisfied with their strength, build, and exercise frequency and were more comfortable with being nude were also more sexually satisfied than men who felt less satisfied about these variables (Penhollow & Young, 2008).

Even though many partners do not put a priority on penis size, a man’s concern about the size of his penis can interfere with his arousal and enjoyment. In a survey of over 52,000 heterosexual men and women, only 55% of men were satisfied with their penis size, but 85% of women were satisfied with their sexual partners’ penis size (Lever et al., 2006). Unlike viewing typical-sized penises in classic artwork, such as Michelangelo’s nude sculpture David, watching pornography can contribute to a man’s distorted sense of what is "normal,” because male porn stars are selected for their oversized genitals.

A study of over 27,000 men ages 20 to 75 in eight countries (the United States, Britain, Germany, France, Italy, Spain, Mexico, and Brazil) provided a positive sign that

men perceive their masculinity differently from the way popular media typically portray it. Men were found to value many qualities more than their physical attractiveness and sexual prowess. Being honorable, self-reliant, and respected by friends and having good health and a positive relationship with their wives were deemed most important to them (Sand et al., 2005).

The Western world is not unique in its concerns about cultural definitions of beauty, as the following Sexuality and Diversity discussion explains.