How Genital Body Image Impacts Our Sex Life

By Dr. Uchenna Ossai

No one really tells us how to be sexual beings. Most of us learn through our poorly informed friends, uncomfortable parents, porn, or through a highly scientific sex-ed class that conveniently skips over the pelvic floor and concepts of pleasure and consent.

Our instincts, body expectations, and sexual scripts have been shaped and imprinted over several years of images and stories seen in romantic comedies, television, magazines, and even pornography. Unfortunately, pleasure and body confidence are not at the center of this “imprinting” process, which may explain why female sexual dysfunction has become the new “bestie” for women.

The Truth About Female Sexual Desire Disorders

Female sexual desire disorder occurs in approximately 60 percent of women and anorgasmia — the persistent inability to achieve orgasm despite responding to sexual stimulation — occurs in an estimated 35 percent of women.3-5

How we define, experience, and express our sexuality is rooted in the intersection of our individual culture, biology, race, ethnicity, gender, religion, interpersonal relationships, politics, education, etc. Sex is often boiled down to a group of acts that result in procreation, in a happy partner, or in orgasm, without taking into account all of the factors (mentioned above) that inform our sexual experience.

While the ability to cultivate female sexual pleasure is reliably undermined by gender norms, a focus on goal-oriented sex vs. pleasure-centric sex, and pelvic floor dysfunction, there is also another key player: genital and body image. Body dissatisfaction is like Oprah on Instagram: it’s a powerful influencer; particularly when it comes to female sexuality.

Society has taught people of all genders, particularly women, to equate sexiness with a body ideal that may or may not be reflected in what they see in the mirror.

Imagine trying to have sex while you are constantly worried about sucking in your belly, or positioning yourself in a certain way so your boobs don’t sag, or simply not wanting the lights on so your body can remain hidden. If that is the sexual script in your head, how are you supposed to enjoy sex?

There is no room for the pursuit of sexual pleasure when body dissatisfaction has such a large market share in your psyche.

For women with pelvic floor disorders, this body image component is largely overlooked. Think about it: if you have pelvic organ prolapse, you are more likely to have a negative view of your vulva and vagina as well as having a general fear of sex.

Not to mention the fact that women with urinary and fecal incontinence hold the burden of constant embarrassment and fear of “smelling,” and let’s not forget the increased difficulty reaching orgasm, pain or discomfort, as well as the diminished desire and arousal that accompany pelvic floor dysfunction for most women.1 A recent study confirmed that body image has a key role in the sexual function of women with urinary incontinence and pelvic organ prolapse and has the most impact on their motivation to participate in sex.1

Needless to say, a negative body image can be particularly damaging to sexual attitudes and behaviors, which in turn is strongly correlated to sexual dysfunction; this being particularly true for women with pelvic floor disorders.

Not Just Body Image… Genital Body Image Too!

Genital body image has been a long-time participant within the sexual functioning of women. The idea of needing to have not only a perfect body but also a perfectly tight vagina and pristine vulva leaves very little space for body diversity and self-acceptance, which has devastating effects on sexual desire, motivation, and ability to orgasm.

Over the past few years, we are also starting to see a new trend emerge as an answer to “the saggy vulva” — labiaplasty. Labiaplasty is an elective surgery meant to “improve the look of the vulva” by removing excess skin folds. While labiaplasty has no impact on the act of sex, many women opt to pay for this procedure as a means of improving their genital body image.2

According to the American Society of Plastic Surgeons, as well as my friend, who's the best plastic surgeon in Chicago, labiaplasty is the second-fastest-growing plastic surgery procedure, having increased by 23 percent from 2015 and 2016.2 That’s one year, folks!

These social and cultural pressures on women to have their genitals conform to a uniform standard of beauty is yet another barrier between women and pleasure.

Can Genital Body Positivity Be a Key to Pleasure?

The new wave of body positive storytelling is an inspiring, dynamic, and fast-growing cultural concept, but has this way of conceptualizing female bodies truly taken hold as a mainstay in our society? I think we are slowly moving in that direction.

The female body is a phenomenal entity that evolves from biopsychosocial and personal constructs that influence every aspect of our being; particularly the lens we use to view our own bodies. The path to sexual and body positivity is through getting “woke” about your own beliefs on body norms and then recognizing the profound diversity in the beauty of our lives and bodies.

The solution can never be “one size fits all,” because our flyness comes in all different shapes in sizes. Once we can accept the idea that beauty is fluid and tells the different stories of our life, we will be able to fully understand and love our bodies, and in turn, be able to realize optimal sexual pleasure.

Do you struggle with body image? Have you ever…

  • Felt anxious about clothes shopping or wearing certain clothes?
  • Dreaded going to an event (like a reunion or a wedding) — or even skipped the event altogether — because you felt too self-conscious about how you looked?
  • Found yourself not wanting to be in pictures or videos, or hiding behind other people in the picture to shield your body?
  • Scrolled through social media and felt worse and worse as you went?

If these sound familiar to you, you are not alone.

Based on our years of experience working with and talking to women — and going through our own body image struggles — we designed this free course to help you start improving your body image immediately and give you the tools you need to finally feel good in your own skin.

Get started today

Body Image Freedom: Revolutionize Your Body Image in Just 5 Days

Bust through negative beliefs, change your mindset, and start feeling awesome in your own skin with this information-packed 5-day course.

This free course includes videos, downloadable tools & resources, and podcast version so you can learn on the go.

About the author:  Dr. Uchenna Ossai

Dr. Uchenna “UC” Ossai is a sex-positive pelvic health physical therapist, sex educator, and an AASECT-certified sexuality counselor. UC has a weekly live-stream called “The Pelvic Health Hour” through O.School, and is also the founder of YouSeeLogic, a judgement-free platform dedicated to the sex education and empowerment of ”grown folk.” UC spends her days in the dual roles of pelvic health rehab manager and assistant professor, and her evenings educating the masses on everything that has to do with “sexytime” — check out her Instagram segment, “Bourbon Talez.” When it comes to sexual intelligence and great sex education, UC embraces always being unapologetically real and authentically kind.


  1. Roos AM, et al. Pelvic Floor Dysfunction: Women’s Sexual Dysfunction Unraveled. 2014. J of Sex Med. 11:743-752.
  3. Quinn-Nilas C, et al. The Relationship Between Body Image and Domains of Sexual Functioning Among Heterosexual, Emerging Adult Women. (2016) Sex Med. 4:182-189.
  4. Handelzalts JE, et al. The Impact of Genital Self-Image on Sexual Function in Women with Pelvic Floor Disorders. (2017) Eur J of Ob Gyn Reprod Bio. 211:164-168.
  5. McCool ME, et al. Prevalence of Female Sexual Dysfunction Among Premenopausal Women: A Systematic Review and Meta-Analysis of Observational Studies. (2016). Sexual Medicine Reviews. 4(3):197 – 212

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