Introduction
Female sexual function is often defined as a function related to sexual desire, mental and physical stimulation, orgasm and pain that is an important part of a female’s life, which is associated with the relationship of quality and psychological well-being (Gunst, Ventus, Kärnä, Salo, & Jern, 2017). Sexual desire and arousal disorders are very common among female sexual dysfunction. Despite the high prevalence of female sexual disorders, their sexual problems have been neglected. A few types research has examined the psychological and physical aspects of sexual dysfunction in female and fewer treatments for these sexual disorders has been proposed than male with sexual problems (C. Rosen et al., 2000).
Dysfunction can occur in any of the four sexual response stages, although some types of research indicate that its high frequency in the first stage. C. Rosen et al. (2000) identified a range of factors that may contribute to creating and maintaining of sexual dysfunctions. The most fundamental psychological factor that focuses on both person and relationship is the sexual performance anxiety (McCabe, 2005). Sexual anxiety is defined as a tendency to experience the tension, discomfort, and anxiety about the sexual aspects of life (Snell, Fisher, & Walters, 1993). However, the sexual anxiety is the central component of other more public structures such as sexual self-concept and sexual distress (Andersen & Cyranowski, 1994). Sexual performance anxiety occurs among male and female who experience obsessive-concerns with sexual performance (Masters & Johnson, 1970). The performance anxiety is associated with the excessive need to satisfy the partner’s consent in the sexual relationship. Focusing on performance rather than enjoyment and personal satisfaction, it increases the level of performance anxiety as subsequent failures and acts as a barrier to the proper sexual function of the individual. Performance anxiety leads to the formation and maintenance of erectile dysfunction and other sexual disorders in male as well. Hawton, Gath, and Day (1994) showed that performance anxiety was experienced with erectile dysfunction in male and with orgasmic disorders in female. Female with orgasmic problems may feel that their husbands tried to arouse them or they should experience orgasms in order to attract partner satisfaction. In this case, they may monitor their arousal levels, and feel anxiety and worry if they feel that they are not aroused quickly enough (McCabe, 2005).
On the other hand, the sexual dysfunction may occur due to various physical or mental issues. Some of researches reveal that one of the most important psychological factors that affect female’s sexual health is the body image (Felix et al., 2017). Body image is an important concept for examining satisfaction or dissatisfaction with the sexual relationship. For example, worrying about physical appearance leads to decreasing the self- esteem, desire, and pleasure (Wiederman, 2000). Sexual problems caused by body image are not classified as sexual disorders, but these concerns may prevent female from engaging in sexual pleasure (Stuerz, Piza, Niermann, & Kinzl, 2008), that can have a negative effect on sexual satisfaction and function (de Brito et al., 2012).
Recent types of research have shown that certain elements of body image are more effective on female’s sexual experiences. Therefore, researchers have recently focused on the studies on their genital image as one of the body components that is involved in female sexual concerns. The idea of self-genital image has originated from the genital identity. That is now the subset of body image and includes the person feelings and attitudes about his genitalia (Felix et al., 2017). The concept of self-genital image was first introduced by Waltner (1986), who invented the genital identity. The studies showed that self- genital image is a better predictor of female sexual problems. In addition, a positive self-genital image has been correlated with increasing confidence, more satisfied sexual experiences, and more sexual pleasure (Pakpour, Zeidi, Ziaeiha, & Burri, 2014).
The studies on body image have focused on beauty, weight, skin color extensively, and often have ignored questions about self-genital image (Grabe, Ward, & Hyde, 2008). Neglecting of this issue is an important point, because the studies show that female are conflicting with negative self-genital image (L. A. Berman, Berman, Miles, Pollets, & Powell, 2003; Herbenick et al., 2011). Generally, female report more negative feelings about their genitals than male (Reinholtz & Muehlenhard, 1995), as researchers began to develop instruments such as the Female Genital Self Image Scale (FGSIS) (Herbenick et al., 2011), and a Genital Appearance Satisfaction (GAS) Scale (Bramwell & Morland, 2009) to measure the relationship between the self-genital image and body satisfaction. Since genital organs are the center of sexual experiences, dissatisfaction with the appearance of the genitalia causes people to feel dissatisfied with their ability to provide sexual pleasure for their partner in sexual function (Amos & McCabe, 2016). The appearance management turns one person into an observer during sexual intercourse and leads to a reduction or discontinuation of attention to physical feelings. The process of considering physical feelings is a good experience, and it makes when a person is completely immersed in a valuable task and loses his self-awareness temporarily. Person thoughts about the physical appearance of the body lead to the lack of concentration on his senses during sexual intercourse. Some psychologists attribute the lack of arousal and sexual pleasure in female to poor inner consciousness and self-awareness of the body image (D. M. Bishop, 2015) so that sexual problems are accompanied by increasing cognitive distraction during sexual activity (Nobre & Pinto-Gouveia, 2006). This distraction may cause problems for female in regard to sexual feelings of their bodies and damage the sexual desire experience that often appears from sexual arousal (Basson, 2000), because they do not pay attention to emerging arousal, or judge their answers negatively. Hence, mind-awareness can prevent this cognitive distraction. Mind-awareness is an intellectual practice of observing the present moment thoughts, excitements, emotions, and physical feelings in a non-judgmental way (S. R. Bishop et al., 2004), so it regards as an intuitive treatment for sexual problems. Although a few studies have been conducted on mind-awareness and its relation to sexual satisfaction, the studies have focused on each structure separately. Accordingly, it is possible that aspects related to mind-awareness be associated with greater satisfaction of sexual relationship positively. Those with a higher mind-awareness have a better relationship with their partner and experience more satisfying sexual relationship (Khaddouma, Gordon, & Bolden, 2015). People with a higher mind-awareness may achieve better sexual life and better sexual function than those with lower mind-awareness. Sex therapists often observe that the main cause of sexual dysfunction is their inability to focus on arousing stimuli (Lazaridou & Kalogianni, 2013).
Awareness of the moment is defined as continuous monitoring of experience or focuses on current experience rather than mental activity with past and future events (Cardaciotto, Herbert, Forman, Moitra, & Farrow, 2008). Research on the effects of awareness of the moment has increased as a part of developing research in the field of mind-awareness, dozens of studies have reported that awareness of the moment as a general state is related to psychological benefits such as decreasing anxiety and depression symptoms, reducing stress, increasing mood, and improving well-being (Donald, Atkins, Parker, Christie, & Ryan, 2016). Negative thoughts and feelings often arise from negative mental ruminations about the past or anxiety about the future. Preserving the focus on the present moment requires developing exercises that increase awareness (Brody, Scherer, Turner, Annett, & Dalen, 2018).
Many people are trying to escape these thoughts, feelings, and physical sensations associated with it when facing with anxiety. Unfortunately, strategies that some people take to avoid their anxiety often make this anxiety worse (Chambers, Gullone, & Allen, 2009). Although Masters and Johnson (1970) probably did not have any knowledge of mind-awareness, but Masters and Johnson’s sensory focus technique and mind-awareness meditation are similar (Weiner & Avery-Clark, 2014). Anxiety may perceive and direct an individual’s automatic thoughts that create and maintain disorders of desire, pain, arousal, and orgasm. As a result, the processes related to anxiety often create useless beliefs about one and sexual desires. Fortunately, mind-awareness can be a catalyst for changing the relationship context that a person has with her own experiences and by reducing the fusion between him and the thoughts associated with anxiety lead to more emotional regulation (Kimmes, Mallory, Cameron, & Köse, 2015).
As a result, we concluded the various factors influences on sexual function and leads to strengthening or interfering with it. Therefore, in this study, we have tried to predict sexual function through genital image and sexual anxiety. Moreover, we have studied the mediator role of awareness of the moment.