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.