Question

I have not been able to get any enjoyment from sex. I am a disabled woman, but I don't think that has anything to do with it. I just can't seem to get into sex at all. Could you give me advice on what I need to do?

Answer

Having difficulties with sexual desire is a common problem, one that can be quite frustrating. I have a couple of thoughts for you.

First, I would start to think about how long you have felt this way. Have you always had little interest in sex, or is this a more recent feeling? In order to determine what may be the cause(s) of your low desire, these are important questions to ask yourself.

Our sexual desire can be affected by many things. Changes in desire are usually associated with physical or hormonal changes and/or psychological distress. Changes in hormonal levels can be affected by age and/or medical conditions. Sexual desire can also be affected greatly by our psychological well-being. Feelings of sadness, depression, stress and anxiety can definitely decrease our interest in the bedroom!

Your question says you are not able to enjoy sex. Therefore, besides sexual desire, I would also be interested in knowing whether or not you are experiencing difficulties with physical sexual arousal. That is, when you are sexually stimulated, do you experience physical signs of arousal (e.g., nipple erection, vaginal lubrication)? This physiological signs may differ from person to person, depending upon what disability a person has. Start to pay attention to your body when you are engaging in sexual activity, and see if you notice these changes. If not, your problem could be physical.

Here are some thoughts on how to start to tackle this issue:

1. Make an appointment with your gynecologist to rule out any medical problems or changes in your levels of hormones. It can be hard to bring up this topic with your doctor, but he or she hears this type of discussion quite frequently. Don't let embarrassment prevent you from getting important information.

2. Think about what things may have happened in your life around the time your desire began to decrease. See if you can link it to any type of sad or anxiety-provoking event. you may want to consider seeing a sex therapist or counselor for a few sessions to begin working through any issues that may come up for you. This will help you get "back on track" to rediscovering the sexual person you are.

3. Try doing things that have made you feel sexy in the past (e.g., wearing sexy clothes, using perfume, lighting candles), and see if this puts you in the mood. Sometimes small changes in our behavior can help swing us back into feeling sexy again. The point of these exercises is to start to get in touch with your thoughts and feelings around your sexuality.

4. Read erotic books, play with sex toys and/or watch erotic films and pay attention to what feels good or arouses you. You may just have not experienced the "right" stimulus for you, yet.

All people are sexual, regardless of whether they are disabled or able-bodied, and all people must decide for themselves what works best for them. Keep an open mind, investigate your options and keep experimenting with new things. Your body and mind will thank you!

Dr. Linda Mona, a licensed clinical psychologist specializing in disability and sexuality issues and a disabled woman living with a mobility impairment.

Published in Sex Roles: A Journal of Research

The term body image is typically used to refer to perceptions and attitudes individuals hold about their bodies, although some authors argue that body image is a broader term, which encompasses behavioral aspects, such as weight loss attempts, and other indicators of investment in appearance (Banfield & McCabe, 2002). Women are generally considered to hold a more negative body image than men (Feingold & Mazzella, 1998). As a result, body dissatisfaction among women has been labeled a "normative discontent" (Rodin, Silberstein, & Striegel-Moore, 1985). However, through the use of gender-sensitive instruments that conceptualize body image concerns in terms of a desire to gain muscle, as well as to lose weight, previous beliefs that men are largely resilient to concerns about their appearance have been challenged, and there is now considerable evidence to suggest that young men are also dissatisfied with their bodies (Abell & Richards, 1996; Drewnowski & Yee, 1987).

A broad conceptualization of body image may prove important in understanding the nature of the construct among men, who appear to be less inclined than women to report holding negative attitudes toward their bodies, but do report a strong motivation to improve the appearance of their bodies (Davison, 2002). It may also be helpful to consider body image broadly when investigating its role throughout adulthood. Although the majority of research is limited to college samples, body image concerns appear to extend into later life (Montepare, 1996), and different age-related changes have been found among both men and women (Halliwell & Dittmar, 2003; Harmatz, Gronendyke, & Thomas, 1985). However, few researchers have systematically explored the development of different aspects of body image throughout the period of adulthood.

Although there has been a large body of research on the prevalence of body image concerns and potential factors associated with the development of body image, few researchers have systematically investigated the role body image plays in the day-to-day lives of individuals, beyond disturbed eating behaviors. In the present study, we addressed this gap by exploring the association between body image and psychological, social, and sexual functioning among adult men and women. An innovative aspect of this study is the conceptualization of body image from a number of different aspects, making use of multiple gender-sensitive instruments, in order to understand the differential roles played by various aspects of body image. In addition, this study extends our understanding of the role of body image for adult men and women throughout the community, rather than focusing only on college students.

The associations between a disturbance in body image and psychological, social, and sexual dysfunction for different populations are currently not well understood. Previous researchers have demonstrated a relationship between body image and self-esteem among women in early adulthood (Abell & Richards, 1996; Monteath & McCabe, 1997) and in later years (Paxton & Phythian, 1999). This has led some authors to conceptualize women's body image as a component of a multidimensional global self-esteem (Marsh, 1997; O'Brien & Epstein, 1988). There are also preliminary indications that young women who report dissatisfaction with their physiques are at a greater risk of experiencing symptoms of depression or anxiety (Koenig & Wasserman, 1995; Mintz & Betz, 1986), although this relationship is less well understood among older women. There are inconsistencies in the literature, however, and it appears that results may be dependent on the particular aspect of body image measured. For example, self-esteem has been found to be unrelated to weight concerns among young women (Silberstein, Striegel-Moore, Timko, & Rodin, 1986), but strongly related to overall physical appearance (Harter, 1999). Researchers have not previously attempted to determine systematically which body image measures are most closely associated with different facets of psychological functioning. The importance of body image for the psychological functioning of men is particularly unclear, as inconsistent findings among young men stem in part from the use of different instruments, which vary in their sensitivity to measure aspects of body image most relevant to the lives of men. Of particular concern is the absence of research on the relationship between body image and self-esteem, depression, and anxiety among men from the general population.

A gap also exists in our knowledge of whether a disturbance in body image is relevant to interpersonal functioning. In the 1960s and 1970s, social psychologists demonstrated the positive impact of being considered physically attractive by others on desirability as a potential dating or romantic partner (Berscheid, Dion, Walster, & Walster, 1971; Walster, Aronson, & Abrahams, 1966). Less commonly researched, however, are the social implications of an individual's own rating of his or her attractiveness or other aspects of body image. There are preliminary indications in research with college students of an association between being concerned about one's appearance and impaired social functioning. College students who perceive themselves as unattractive have been shown to be more likely to avoid cross-sex interactions (Mitchell & Orr, 1976), to engage in less intimate social interactions with members of the same and other sex (Nezlek, 1988), and to experience higher levels of social anxiety (Feingold, 1992). Negative body image may also be related to problematic sexual functioning. Researchers have found that college students with poor views of their bodies are more likely than others to avoid sexual activities (Faith & Schare, 1993), to perceive themselves as unskilled sexual partners (Holmes, Chamberlin, & Young, 1994), and to report dissatisfaction with their sex lives (Hoyt & Kogan, 2001). However, other researchers have failed to find a relationship between body image and sexual functioning; Wiederman and Hurst (1997), for example, suggested that sexuality was related to objective attractiveness among women, but not to self-ratings of their appearance.

Remarkably few researchers have made explicit reference to the social context when investigating body image, which has resulted in the impression that body image evaluations and behaviors occur in social isolation. Recently, however, there is a growing awareness of the social nature of body image among female college students through their engagement in comparisons of their own appearance with that of others; such comparisons appear to be associated with negative evaluations of their bodies (Stormer & Thompson, 1996; Thompson, Heinberg, & Tantleff, 1991). In addition, researchers have found that a concern about others evaluating one's body negatively, a variable termed social physique anxiety, is related to low levels of body satisfaction (Hart, Leary, & Rejeski, 1989). This suggests that evaluations individuals make of their bodies are related to the evaluations that they expect others may make. However, the relative importance of social aspects of body image compared to individual aspects of body image evaluations and related behaviors has not been examined. It is currently unclear whether being dissatisfied with one's physique, considering oneself unattractive, rating one's appearance as important, applying effort to improve or conceal one's body, appearance comparisons, or social physique anxiety are of greatest relevance to people's psychological, social, and sexual functioning.

There are a number of other limitations in the literature. Few researchers have examined a range of body image constructs in order to understand which aspects of body image are most relevant to particular psychological, social, and sexual functioning variables. The diversity of different evaluative and behavioral body image constructs may account for some of the inconsistent research findings. Past research has also primarily focused on college students, typically women; very few studies have included participants from the general community. As a consequence, conclusions about the role of body image in the lives of men and women cannot be made. The relevance of body image may vary with age and gender, although researchers have previously failed to address this question.

The present study was designed to investigate systematically the role of body image in the lives of men and women throughout adulthood. A cross-sectional design was employed, due to the practicalities of obtaining a sample large enough to consider body image separately among men and women of different age groups. The lack of previous research in this area supports the contribution made by exploratory designs of this kind. Multiple measures of body image, including evaluative, investment, and social aspects, were compared, in order to determine which aspects of body image were most strongly predictive of psychological (i.e., self-esteem, depression, anxiety disorders), social (i.e., relations with members of the same and other sex, social anxiety), and sexual (i.e., sexual optimism, sexual self-efficacy, sexual satisfaction) functioning. It was hypothesized that negative body image would be associated with poor functioning in these areas. Stronger relationships between body image and psychological, social, and sexual functioning were expected for women, and for younger participants, given the emphasis in the literature on the importance of body image for these groups.

METHOD

Participants

The participants were 211 men and 226 women, who ranged in age from 18 to 86 years (M = 42.26 years, SD = 17.11). This age range was divided into three groups, and each participant was assigned to one of the following age groups: young adulthood, 18-29 years (n = 129), middle adulthood, 30-49 years (n = 153), and late adulthood, 50-86 years (n = 145). This division was carried out to create equal groups to meet the requirements of parametric statistical analyses. Reported occupations and postal addresses suggest that participants represented a wide range of socioeconomic backgrounds from metropolitan and rural areas. Over 80% of participants indicated they were originally from Australia; the remainder were predominantly from Western European countries. Nearly all (95.78%) participants identified themselves as heterosexual, and over 70% were in current relationships. The weight and height of the sample corresponded well with national Australian data for men and women (Australian Bureau of Statistics, 1998). These data are documented for men and women, and each age group separately in Table I.

Materials

Body Image Measures

Participants completed two subscales from the Body Image and Body Change Questionnaire (Ricciardelli & McCabe, 2001) that are related to Body Image Satisfaction and Body Image Importance. Each scale contained 10 items. An example item of body image satisfaction is "How satisfied are you with your weight?," and an example item of body image importance is "How important to you is the shape of your body, compared to other things in your life?" Responses were on a 5-point Likert scale from 1 = extremely dissatisfied/unimportant to 5 = extremely satisfied/important. Scores on each scale ranged from 10 to 50; a high score represents a high level of satisfaction with the body or a rating of appearance as highly important. These scales emerged from both exploratory and confirmatory factor analysis, and they have demonstrated high levels of internal consistency, satisfactory test-retest reliability, and concurrent and discriminant validity in previous studies with adolescents (Ricciardelli & McCabe, 2001). In the present sample, internal reliability (Cronbach's alpha) for each scale was high among both women and men ([alpha] > .90).

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Participants rated their physical attractiveness using a scale specifically designed for this study, the Physical Attractiveness Scale, which measures how attractive they perceived themselves, for example, in terms of general appearance, facial attractiveness, and sexual attractiveness. This scale contains six items, an example of which is "Compared to other men, I am ..." Participants responded on a 5-point Likert scale from 1 = extremely unattractive to 5 = extremely attractive. Scores ranged from 6 to 30; a high score indicates a high self-rating of attractiveness. Internal reliability was high among both men and women ([alpha] > .90).

Two body image behaviors, body concealment (the tendency to conceal one's body from the gaze of others and to avoid discussion about body size and shape) and body improvement (engagement in attempts to improve one's body), were assessed using an instrument constructed for this study, the Body Image Behavior Scales. Items were derived in part from two extant instruments, the Body Image Avoidance Questionnaire (Rosen, Srebnik, Saltzberg, & Wendt, 1991) and the Attention to Body Shape Scale (Beebe, 1995), which were selected through exploratory and confirmatory factor analysis. The Body Concealment Scale consists of five items, an example item of which is "I avoid wearing 'revealing' clothes, like shorts or bathing suits." The Body Improvement Scale consists of three items, an example of which is "I exercise in order to get a better body." Participants responded on a 6-point Likert scale from 1 = never to 6 = always. Scores on the body concealment scale ranged from 5 to 30; a high score indicates a high engagement in attempts to conceal the body. Scores on the body improvement scale ranged from 3 to 18; a high score indicates a high engagement in attempts to improve the body. Internal reliability for each scale was high among both men and women ([alpha] > .80).

Concern about others evaluating one's body was assessed using the Social Physique Anxiety Scale (Hart et al., 1989). This scale contains 12 items, an example of which is "In the presence of others, I feel apprehensive about my physique/figure." Following the recommendation of Eklund, Kelley, and Wilson (1997), item 2 was modified (to improve performance) to "I worry about wearing clothes that might make me look too thin or overweight." Participants rated how true each of the items were using a 5-point Likert scale, from 1 = not at all true to 5 = extremely true. Scores ranged from 12 to 60; a high score indicates a high level of concern about others evaluating one's body (the responses to some items were reverse scored). Internal and test-retest reliability have been found to be adequate with a number of adult samples (Hart et al., 1989; Martin, Rejeski, Leary, McAuley, & Bane, 1997; Motl & Conroy, 2000; Petrie, Diehl, Rogers, & Johnson, 1996). Internal reliability was high among both men and women in the present sample ([alpha] > .80).

Participants indicated their level of appearance comparison by completing the Physical Appearance Comparison Scale (Thompson et al., 1991). This scale contains five items, an example of which is "At parties or other social events, I compare my physical appearance to the physical appearance of others." Responses were made on a 5-point Likert scale, from 1 = never to 5 = always. Scores ranged from 5 to 25; a high score indicates a strong tendency to compare one's own appearance with that of others. Although psychometric characteristics were found to be adequate with a university sample (Thompson et al., 1991), item 4 correlated with others at a low level in the present community sample (squared multiple correlation .70) and women ([alpha] > .80).

Psychological Functioning Measures

Participants completed the Rosenberg Self-Esteem Scale (Rosenberg, 1965). This scale contains 10 items, an example of which is "I feel that I have a number of good qualities." Responses were made on a 4-point Likert scale, from 1 = strongly disagree to 4 = strongly agree. Scores ranged from 4 to 40; a high score indicates high self-esteem (the responses to some items were reverse scored). This instrument has been widely used in research, and has demonstrated good psychometric properties (Rosenberg, 1979). Internal reliability was high among both men and women in the present sample ([alpha] > .80).

Participants also completed two subscales from the Depression Anxiety Stress Sub Scales (Lovibond & Lovibond, 1995). The Depression Scale contains 14 items related to symptoms of depression, an example of which is "I felt downhearted and blue." The Anxiety Scale contains 14 items related to symptoms of anxiety, an example of which is "I felt I was close to panic." Participants were asked to indicate the extent to which they had experienced each symptom over the previous week. Responses were made on a 4-point Likert scale from 0 = did not apply to me to 3 = applied to me very much or most of the time. Scores on each scale ranged from 0 to 42; a high score indicates a high level of depression or anxiety. These subscales are reliable measures of negative affective states among nonclinical college populations (Lovibond & Lovibond, 1995). Minor modifications were made to four items to improve comprehension in a community sample, with the aim of retaining the original meaning of items. To illustrate, the item "I found it difficult to work up the initiative to do things" was modified to "I found it difficult to work up the energy to do things." Internal reliability for each scale was high among both men and women ([alpha] > .90) in the present study.

Social Functioning Measures

Participants completed the social anxiety factor of the revised Self-Consciousness Scale (Scheier & Carver, 1985). This subscale contains six items, an example of which is "It takes me time to get over my shyness in new situations." Responses were made on a 4-point Likert scale, from 1 = not at all like me to 4 = a lot like me. Scores ranged from 6 to 24; a high score represents a high level of social anxiety (the responses to one item were reverse scored). The revised Self-Consciousness Scale has demonstrated good psychometric properties with samples from the general population (Scheier & Carver, 1985). Internal reliability was moderate among men ([alpha] > .70) and high among women ([alpha] > .80) in the present study.

Social functioning was also assessed by the Same-Sex Relations and Opposite-Sex Relations subscales of the Self-Description Questionnaire III (Marsh, 1989). Each subscale contains 10 items. An example of same-sex relations is "I have few friends of the same sex that I can really count on," and an example of opposite-sex relations is "I make friends easily with members of the opposite sex." Responses to each subscale were made on an 8-point Likert scale, from 1 = definitely false to 8 = definitely true. Scores ranged from 10 to 80; a high score indicates positive same-sex or opposite-sex relations (the responses to some items were reverse scored). These subscales have been found to have adequate internal consistency and reliability in previous studies (Marsh, 1989), and internal reliability for each scale was high among both men and women in the present study ([alpha] > .80).

Sexual Functioning Measures

Sexual functioning was measured with three subscales from the Multidimensional Sexual Self-Concept Questionnaire (Snell, 1995). The Sexual Self-Efficacy Scale contains five items, an example of which is "I have the ability to take care of any sexual needs and desires that I may have." The Sexual Optimism Scale contains five items, an example of which is "I expect that the sexual aspects of my life will be positive and rewarding in the future." The Sexual Satisfaction Scale contains five items, an example of which is "I am satisfied with the way my sexual needs are currently being met." Responses to items on each scale were made on a 5-point Likert scale from 1 = not at all true to 5 = very true. Scores on each scale ranged from 5 to 25; a high score represents a high level of the construct--high sexual self-efficacy, high sexual optimism, and high sexual satisfaction (the responses to some items were reverse scored). Internal consistency of the scales has previously been found to be high, and research has produced reasonable evidence for their validity (Snell, 2001). Internal reliability for each scale was high among both men and women ([alpha] > .80) in the present study.

Procedure

Participants were recruited from the general community; they were selected at random from the White Pages telephone directory of metropolitan Melbourne and a variety of rural areas in Victoria, Australia. Questionnaires were distributed by mail to individuals who agreed to participate, and were completed at home and returned via mail to the researchers. A total of 157 individuals indicated they did not want to participate in the study and received no further contact from the researchers. Of the 720 questionnaires distributed, 437 were returned, which resulted in a response rate of 60.69% among those who agreed to receive a questionnaire, and an overall response rate of 49.83% among those contacted. There was no incentive provided for individuals to participate in the study, and responses were anonymous. Completion of the questionnaire took approximately 20-30 min.

RESULTS

In order to address the hypotheses outlined earlier, multivariate analyses of variance were conducted to determine the nature of sex and age differences in body image. Regression analyses were then conducted to determine which aspects of body image (if any) predicted the psychological, social, and sexual functioning of both men and women in each age group. Because of the number of analyses being conducted p < .01 was used to define significant results (Coakes & Steed, 1999).

Gender and Age Differences in Body Image

Differences in body image between men and women and among the different age groups were examined using a 2-way MANOVA, after controlling for the effects of Body Mass Index (BMI). Independent variables were gender and age group, and dependent variables were physical attractiveness, body image satisfaction, body image importance, body concealment, body improvement, social physique anxiety, and appearance comparison. Body image was found to be significantly different for men and women, F(7, 368) = 22.48, p < .001, and for different age groups, F(14, 738) = 6.00, p < .001. There was no significant interaction effect. The univariate F-tests for each dependent variable were examined in order to determine which body image variables contributed to the significant multivariate effects.

Women reported a lower level of body image satisfaction, F(1, 381) = 35.92, p < .001, and a higher level of social physique anxiety, F(1, 381) = 64.87, p < .001, than men did (see Table II). Women also reported concealing their bodies more frequently than men did, F(1, 381) = 130.38, p < .001, and they were more likely than men to engage in appearance comparisons, F(1, 381) = 25.61, p < .001. However, there were no differences between men and women in their ratings of physical attractiveness, body image importance, or level of engagement in efforts to improve their bodies.

After we controlled for the effects of BMI, we found significant differences between age groups in body image satisfaction, F(2, 381) = 11.74, p < .001, and body concealment, F(2, 381) = 5.52, p < .01; men and women in their 30s and 40s reported lower satisfaction with their bodies, and more frequent attempts to conceal their bodies, than did other participants (see Table II). Social physique anxiety scores also differed significantly between age groups, F(2, 381) = 18.97, p < .001; individuals in late adulthood reported a lower level of concern about others evaluating their bodies than did the younger participants. In addition, level of engagement in appearance comparison differed significantly between age groups, F(2, 381) = 12.34, p < .001; individuals in late adulthood were less likely than others to make appearance comparisons. Ratings of physical attractiveness, body image importance, and body improvement did not differ significantly between participants of different age groups.

Hierarchical multiple regression analyses were conducted in order to determine which aspects of body image most strongly predicted each psychological (i.e., self-esteem, depression, anxiety), social (i.e., same-sex relations, opposite-sex relations, social anxiety), and sexual functioning (i.e., sexual self-efficacy, sexual optimism, sexual satisfaction) variable. Separate analyses were conducted for men and women in each age group, as it was considered likely that the relationships would vary with both gender and age. In order to reduce the large number of independent body image variables for inclusion in each analysis, only those variables that significantly correlated with the dependent variable for each group were entered into the analysis. It was decided to control for the effects of self-esteem, depression, anxiety, and BMI, if they correlated significantly with the dependent variable. In addition, perceived relations with the other sex were considered as a potential control variable in analyses to predict sexual functioning. Control variables were entered as independent variables on the first step of each analysis, and body image variables were included as additional independent variables on the second step. The level of significance is typically corrected when there are a high number of contrasts. However, given the exploratory nature of these analyses, it was decided to consider effects significant at an alpha less than .05.

Results indicated that inclusion of body image variables at the second step significantly increased the prediction of self-esteem beyond that predicted by control variables among men in early adulthood, F change (5, 55) = 2.88, p < .05, middle adulthood, F change (4, 50) = 5.36, p < .001, and late adulthood, F change (4, 59) = 4.66, p < .01. The unique body image predictors of high self-esteem were positive ratings of physical attractiveness and a low rating of body image importance among men in early adulthood, a low level of body concealment among men in middle adulthood, and a low tendency to compare their appearance with others and high body image satisfaction among men in late adulthood (see Table III). Body image variables also significantly increased the prediction of self-esteem among women in early adulthood, F change (3, 50) = 4.60, p < .01, middle adulthood, F change (6, 84) = 5.41, p < .001, and late adulthood, F change (3, 56) = 4.37, p < .01. Although there were no unique body image predictors of self-esteem for women in early adulthood, low social physique anxiety and a low rating of body image importance predicted self-esteem among women in middle adulthood, and positive ratings of physical attractiveness predicted high self-esteem among women in late adulthood.

Inclusion of body image variables failed significantly to increase the prediction of depression or anxiety beyond the effect of control variables among most groups. However, body image variables entered at the second step significantly increased the prediction of depression among women in late adulthood, F change (4, 46) = 4.57, p < .01; high social physique anxiety acted as a unique body image predictor (see Table III). Body image variables entered at the second step significantly increased the prediction of anxiety among men in late adulthood, F change (2, 62) = 6.65, p < .01; a high level of appearance comparison acted as a unique body image predictor. For the predictor of anxiety among women in late adulthood, F change (4, 56) = 4.16, p < .01, although no specific body image predictor was found to explain unique variance.

Body image variables significantly increased the prediction of social anxiety at the second step, beyond the effect of control variables, among men in middle adulthood, F change (2, 52) = 4.54, p < .05; the unique body image predictor was a high level of appearance comparison (see Table IV). Inclusion of body image variables did not significantly increase the prediction of social anxiety among men in early or late adulthood, beyond the effect of control variables. Among women, inclusion of body image variables significantly increased the prediction of social anxiety during late adulthood, F change (6, 51) = 3.63, p < .01, but not at other ages. The unique body image predictors of social anxiety among women in late adulthood were high social physique anxiety and a high level of body improvement.

Inclusion of body image variables, entered as a group at the second step, did not significantly increase the prediction of same-sex relations among men in early or late adulthood, or among women of any age group, beyond the effect of control variables. However, a significant increase in the prediction of same-sex relations was found among men in middle adulthood, F change (5, 49) = 2.61, p < .05. Positive same-sex relations were uniquely predicted by positive ratings of physical attractiveness among this group (see Table IV). Inclusion of body image variables at this step significantly increased the prediction of positive cross-sex relations among men in young adulthood, F change (2, 57) = 4.17, p < .05; a low level of body concealment acted as a unique body image predictor, but did not increase the prediction of cross-sex relations beyond the effect of control variables among any other group.

Inclusion of body image variables, entered as a group at the second step, did not significantly increase the prediction of sexual self-efficacy or sexual satisfaction among women in any age group, or among men in early or late adulthood, beyond the effect of control variables. Among men in middle adulthood, however, inclusion of body image variables significantly increased the prediction of sexual self-efficacy, F change (5, 46) = 3.69, p < .01, and sexual satisfaction, F change (4, 49) = 6.27, p < .001; high body image satisfaction acted as the unique body image variable in both instances (see Table IV). A low tendency to compare their appearance to that of others and a low level of body concealment also predicted sexual satisfaction.

The group of body image variables, entered at the second step, did not significantly increase the prediction of sexual optimism among men or women in early or late adulthood beyond the effect of control variables. Inclusion of body image variables significantly increased the prediction of sexual optimism among men in middle adulthood, however, F change (4, 48) = 6.69, p < .001; low social physique anxiety acted as a unique body image predictor (see Table IV). Although body image variables increased the prediction of sexual optimism as a group among women in middle adulthood, F change (6, 81) = 2.72, p < .05, there were no unique body image predictors.

DISCUSSION

In the present study we considered a number of aspects of body image among men and women across different stages of adulthood. Body image concerns were generally found to be more prevalent among women than men; women reported lower satisfaction with their bodies and a greater tendency to conceal their bodies. Women appeared to be more focused on the social aspects of body image; they compared their appearance to that of others more frequently than men did, and they reported higher levels of social physique anxiety, which indicates that they were more concerned about others evaluating their appearance negatively. However, there were no gender differences in ratings of physical attractiveness or the perceived importance of appearance in the lives of men and women, and men were just as likely as women to report engaging in efforts to improve their bodies.

Body image concerns were relatively consistent throughout adulthood, which supports previous indications of the high prevalence of body image concerns among individuals beyond their college-aged years (Allaz, Bernstein, Rouget, Archinard, & Morabia, 1998; Ben-Tovim & Walker, 1994; Pliner, Chaiken, & Flett, 1990). There were some developmental trends, however, as men and women in their 30s and 40s were more vulnerable than other groups to dissatisfaction with their bodies and engaged in more attempts to conceal their bodies, for example, with nonrevealing clothing. This highlights the importance of attending to body image among adults beyond early adulthood, which is typically considered the most vulnerable period for body image disturbance. A developmental shift was also apparent in later years, most particularly in relation to the social aspects of body image. Although men and women over 50 years of age tended to make evaluations of their own appearance that were just as negative as those of younger participants, and did not perceive their appearance to be any less important than younger participants did, they reported less concern about others evaluating their bodies, and they were less likely to compare their appearance with that of others.

This exploratory study was designed to examine the relationships between different aspects of body image and psychological, social, and sexual functioning, rather than simply to document the existence or prevalence of body image concerns. Previous research, based on correlational analyses, has tended to conclude that a negative body image is associated with impaired psychological and interpersonal functioning. However, we used hierarchical regression analyses that controlled for the effects of possible moderator variables (self-esteem, depression, anxiety, BMI, and cross-sex relations), and found that body image variables did not contribute to a unique understanding of psychological, social, and sexual functioning among most groups.

An exception was found for self-esteem as a dependent variable. Self-esteem was predicted by body image variables among all groups. There were few gender differences in the overall strength of the association between body image and self-esteem, a finding that supports a number of previous studies of college students (e.g., Abell & Richards, 1996; Stowers & Durm, 1996), but is inconsistent with the conclusions of other researchers (e.g., Tiggemann, 1994) and the findings from a recent review (Powell & Hendricks, 1999). In the present study, although men at all stages of adulthood were less likely than women to hold a global negative body image, once developed, a poor body image was as strongly related to the general self-concept of men as it was of women. However, the particular aspect of body image most relevant to self-esteem differed according to age and gender. For example, physical attractiveness played an important role among men in early adulthood, but was more relevant to women's self-esteem in later years. Gender differences in the types of body image variables relevant to self-esteem may explain some of the inconsistencies in the literature, given that previous researchers exploring the relationship between body image and self-esteem have typically employed a single measure of body image.

The absence of relationships between body image and other aspects of psychological, social, and sexual functioning among most groups in this study appears to be best explained by shared relationships with self-esteem. To illustrate, although depression and body image variables were generally correlated, consistent with earlier research (Denniston, Roth, & Gilroy, 1992; Mable, Balance, & Galgan, 1986; Sarwer, Wadden, & Foster, 1998), associations were no longer present among most groups when we controlled for self-esteem. This is a surprising finding, given the attention paid by researchers to the importance of body image in understanding depression among women. In contrast to conceptualizations of body dissatisfaction as either a symptom or source of depression (Boggiano & Barrett, 1991; Koenig & Wasserman, 1995; McCarthy, 1990), it may be better understood in this context as an aspect of self-esteem (Allgood-Merten, Lewinsohn, & Hops, 1990). Thus, although men and women with a negative body image were more likely than others to report negative social and sexual functioning and to experience symptoms of depression and anxiety, this appeared to be due to the presence of a negative general self-concept.

This conclusion is made tentatively, given that it is contrary to much of the literature, and may be considered a preliminary finding. However, with the exception of depression, the relationships between body image and psychological, social, and sexual functioning have received little previous empirical investigation, even among samples of young women. In the limited research available authors failed to consider the role of self-esteem, with the exception of Allgood-Merten et al. (1990) whose conclusions support those of the present study. The current methodology does not allow for a direct evaluation of the relationships for men and women of different age groups, due to limitations in sample sizes. Replication of the findings is recommended, particularly using methods of analyses that allow for modeling of relationships, with particular attention paid to the role of self-esteem. For example, self-esteem may act as an important mediating factor between body image and day-to-day functioning.

Of interest in this study is the finding that body image played a role in psychological functioning among men and women over 50 years of age, in contrast to other adults. This was the only group for whom body image contributed to a unique understanding of depression and anxiety, beyond the shared association with self-esteem. Social aspects of body image were most relevant, as men in late adulthood who engaged in a high level of appearance comparison reported higher levels of anxiety and self-esteem than did men who were not concerned about how they looked in comparison to others. In addition, women in late adulthood who were highly concerned about how others may evaluate their appearance were more likely than other women their age to report symptoms of depression and social anxiety. Thus, although in general older men and women were less concerned about the social aspect of body image than younger individuals, the minority who did hold such concerns experienced symptoms of negative psychological adjustment.

Although body image was found to play a less important role in social and sexual functioning than previously proposed, it did appear to have particular relevance to the social and sexual functioning of men during middle adulthood, that is, men between the ages of 30 and 50 years. Men undergo a number of changes at this stage of their lives, in their interpersonal relationships, their roles at work, their families, and also in their physiques. It is during this developmental period when the negative physical effects of aging tend to become particularly apparent; men continue to gain body fat up until the age of 50 years, particularly around the abdomen area (Bemben, Massey, Bemben, Boileau, & Misner, 1998). Men do not typically express concerns about these changes directly, and they report a more positive body image than similarly aged women, both in this study and in previous research (Feingold & Mazzella, 1998). However, it appears that a minority of men, who present with the type of body image disturbance more typically observed among women, such as low satisfaction with their appearance, high social physique anxiety, attempts to conceal their bodies from others, and a tendency to compare their appearance to others, are more likely to experience significant difficulties in their interpersonal functioning, most noticeably in the sexual arena. Social aspects of body image played a particularly important role in middle-aged men's interpersonal functioning. To illustrate, high social physique anxiety was a particularly strong predictor of low sexual optimism, which suggests that middle-aged men who were concerned about others evaluating their bodies were likely to expect unrewarding future sexual interactions.

In contrast to the findings with men, women who expressed dissatisfaction with their bodies, and women who worried about how they "shaped up" in comparison with others and how others may perceive their bodies, experienced relatively few problems in their psychological, social, or sexual functioning beyond poor general self-esteem. The well-established, normative nature of women's views of their bodies may result in their body image concerns having only a limited negative association with other aspects of women's lives. This point has been made previously in relation to women's views of their sexuality (Wiederman & Hurst, 1997), but can be extended to include more general psychological and social functioning.

This research has demonstrated the importance of considering multiple measures of body image, given that different measures were associated with different aspects of psychological, social, and sexual functioning. Social aspects of body image, particularly concerns about how others may evaluate one's body, are a particular area that requires further research. The results of the present research also demonstrated the importance of investigating the effects of body image separately for men and women and for different age groups. This is the first study to demonstrate that body image may play different roles in the lives of different adult populations. Replication of these findings is required, particularly in longitudinal research, in order to explore potential underlying mechanisms to explain the role of body image in the psychological, social, and sexual functioning of men and women at different stages of adult development. The current sample was divided into three broad age categories, on the basis of sample size. Future researchers exploring the development of body image in adulthood should consider theoretically developed stages of adult development when selecting appropriate age categories to investigate. For example, body image may play a different role in the lives of adults 50-65 years than for adults in later years. Smaller, more homogeneous groups may demonstrate differences in the development of body image and highlight specific associations of body image and day-to-day functioning at different ages.

This study was limited by the use of correlational data. Small sample sizes in each group precluded the use of more sophisticated techniques, such as structural equation modeling, which may be employed in future research with larger samples to model relationships between body image and psychological, social, and sexual functioning variables. An investigation of these relationships was beyond the scope of this article, and they were not accounted for in the present analysis, which was focused on understanding which specific aspects of body image were of most relevance to particular aspects of day-to-day functioning. Future researchers may gainfully model the nature of the relationships between different aspects of body image for different populations. It is hoped that increased acknowledgment of the complexity of the body image construct, particularly in relation to the varied roles it plays in the lives of adult men and women, will stimulate further theoretical and empirical development in this area.

Continue to part 2 to see the tables

next: Relationships Between Men's and Women's Body Image and Their Psychological, Social, and Sexual Functioning Part 2

Although it contradicts all the cultural beliefs about the way men are, men can lose their libido too. The solution: Just do it.

It contradicts all the cultural beliefs we have about the way men are and/or are supposed to be, but the dirty little secret is... American men are flagging in their desire for sex.

"Men are so ashamed of speaking up about low sexual desire," observes Michele Weiner-Davis, a marriage therapist from the Chicago area. It violates their own sense of masculinity. But "low desire in men is America's best-kept secret," she says, and estimates that it affects "at least 20 to 25%" of adult males.

For women, the figure is thought to be much higher, somewhere between 40 and 50%. A woman ducking out of sex, the headache thing, "is as American as apple pie," says Weiner-Davis. It's a staple of every comedian's routine.

But it strikes terror into the heart of a guy to even think he might not be interested, because his sense of self is usually tied up in his virility. So no one has real information on just how many men are affected.

Nevertheless, there appears to be a great and growing gap between the reality of the current state of male desire and the cultural mythology surrounding it. Men are more and more having it less and less. Weiner-Davis is seeing it among the couples who turn up at her door for help.

And their low sex drive often has little to do with hormones or biology and a lot to do with the women in their lives. Men today, often enough, are angry at their wives.

The first inkling that something unusual was going on in the bedroom occurred some years ago, Weiner-Davis reports. "I was working with a couple that wasn't making much progress in their relationship. The husband, a high-powered attorney, said in an offhand way, 'I guess we don't really touch that much.' My immediate thought was that the wife wasn't interested. But he said, 'No, actually it's me who isn't interested.'"

When she asked him what that was about, he said, "You know, my wife is so critical of me. And she hurts my feelings. She finds fault in everything that I do. I just don't want to be anywhere near her."

What's happening, Weiner-Davis says, is the couples are working hard in the office. And women are also working hard at home. And they are getting on their husband's cases. "In theory, she says, "women are equipped with the language to ask for change. But they don't; instead, they bitch."

They don't express appreciation for what their husbands see as their own contribution of hard work to the family. And it's emasculating.

Instead of saying "I'd really like to spend more time with you," or "I really enjoy your company and the last time we went to a movie together I really had a good time," the husbands more often hear: "You never want to do anything."

And that can shut off sexual desire as quickly as a terrorist attack.

Whether lack of desire originates with husband or wife, the end result is the same. There is a lack of physical contact, which is experienced by the other partner as the ultimate rejection.

"When one partner is yearning for more physical closeness and touch, and the other spouse is too preoccupied, too stressed or too angry, it's a big deal," Weiner-Davis insists. The sex-starved marriage is really all about feeling wanted.

In the presence of a mismatch of desire, all intimacy drops out on all levels in addition to the sexual. Couples stop having meaningful conversations. They wind up at risk of infidelity and divorce.

So, not surprisingly, Weiner-Davis has some counsel for couples in relationships marked by mismatched desire. It basically comes down to what she calls the Nike approach: JUST DO IT!!! This is her advice for the low-desire spouse, and admittedly it's provocative.

She points out that the quickest way to change feelings is to take action, that most people have to make things happen. We know this, and take action, in other areas of our life, like exercise. But somehow we make sexuality a forbidden zone, outside the laws of mortals.

For most people, desire doesn't just happen by itself. The way to get people moving is to take action. As the Italians say, the appetite comes while eating.

And in response to action, miraculously the other spouse becomes happy, feels much more wanted, and more committed to the relationship. And he or she begins to do things without being asked. Both people get more of what they want.

Things you need to be aware of to prevent sexual violence; including date rape and sexual assault.

When we think about alternatives to vulnerability, we must be careful not to assume that there is always something a person "could have done" to prevent an assault. This is blaming the victim. When a person is sexually assaulted, it is the assaulter who is to blame.

In addition, sexual assaults, including those committed by acquaintances, may be violent and unexpected. This means that even when a person is able to assert what s/he wants, there is no guarantee that his/her feelings will be respected.

There are no formulas that can guarantee our safety from sexual assault. In a situation that is becoming coercive or violent, the moment is often too confusing to plan an escape, and people react in various ways. Some will fight back. Others will not fight back for any number of reasons such as fear, self-blame, or not wanting to hurt someone who may be a close friend. While fighting and giving up are both extreme reactions, it is important to realize that any reaction is legitimate. Again, the burden of responsibility must be on the attacker, not the victim.

Remember that date rape is a crime. It is never acceptable to use force in sexual situations, no matter what the circumstances.

Be Aware

• Be an active partner in a relationship. Arranging where to meet, what to do, and when to be intimate should all be shared decisions.
• Listen carefully. Take the time to hear what the other person is saying. If you feel s/he is not being direct or is giving you a "mixed message", ask for a clarification.
• Know your sexual intentions and limits. You have the right to say "No" to any unwanted sexual contact. If you are uncertain about what you want, ask the person to respect your feelings.
• Communicate your limits firmly and directly. If you say "No", say it like you mean it. Don't give mixed messages. Back up your words with a firm tone of voice and clear body language.
• Don't assume that your date will automatically know how you feel, or will eventually "get the message" without your having to tell him or her.
• Don't fall for the common stereotype that when a person says "No" it really means "Yes". "No" means "No". If someone says "No" to sexual contact, believe it and stop.
• Be aware that having sex with someone who is mentally or physically incapable of giving consent is rape. If you have sex with someone who is drugged, intoxicated, passed out, incapable of saying "No", or unaware of what is happening, you are guilty of rape.
• Don't make assumptions about a person's behavior. Don't automatically assume that someone wants to have sex just because s/he drinks heavily, dresses provocatively, or agrees to go to your room. Don't assume that just because the other person has had sex with you previously s/he is willing to have sex with you again. Also don't assume that just because the person consents to kissing or other sexual intimacies s/he is willing to have sexual intercourse.
• Listen to your gut feelings. If you feel uncomfortable or think you may be at risk, leave the situation immediately and go to a safe place.
• Be especially careful in group situations. Be prepared to resist pressure from friends to participate in violent or criminal acts.
• Attend large parties with friends you can trust. Agree to "look out" for one another. Try to leave with a group, rather than alone or with someone you don't know very well.
• Don't be afraid to "make waves" if you feel threatened. If you feel you are being pressured or coerced into sexual activity against your will, don't hesitate to state your feelings and get out of the situation. Better a few minutes of social awkwardness or embarrassment than the trauma of sexual assault.

Be Active

• Get involved if you believe someone is at risk. If you see a person in trouble at a party or a friend using force or pressuring another person, don't be afraid to intervene. You may save someone from the trauma of sexual assault and your friend from the ordeal of criminal prosecution.
• Confront others' rape jokes and remarks; explain to others why these jokes are not funny and the harm they can cause.
• Confront other people's harassment--verbal or physical. Harassment is not experienced as flattery, but as a threat.
• Educate others about what rape really is. Help them to clear up any misconceptions they might have.
• Ask someone who you don't recognize what they are doing in your dorm or residence, or who it is they are looking for.
• Confront potential rape scenes. When you see a someone verbally harassing another person, stand by to see if s/he the person being harassed needs help. If a someone is hitting or holding a person against his or her will, do something immediately to help.
• When walking in groups or even alone be conscious as you approach another person. Be aware of how afraid that person might feel, and give him or her space on the street if possible.
• Be supportive of person's actions to control their own lives and make their own decisions. Don't be afraid to express these ideas.
• If someone you know has expressed violent feelings or demonstrated violent behavior in a particular relationship, try to help him or her find an appropriate person with whom to talk (such as a counselor, RA, clergy, etc).

The biggest myths about self-injury stem from misinformation. It is very easy to misunderstand self-injury if you do not suffer with the problem yourself. Even many self-injurers do not understand exactly why they cut themselves or engage in other types of self-harm. Because of the nature of self-injury, people tend to jump to very quick conclusions.

The Biggest Self-Injury Myth

Self Injury is NOT a series of failed suicide attempts, as this article on self-harm and suicide explains. This is one of the biggest self-injury myths. Those who self injure do so more to "cope" than as a way out, a way of dying. It is true that many self-injurers contemplate suicide as an extreme option. Many do suffer with the same kinds of illnesses (ie, bipolar, depression, borderline personality disorder) that those who commit suicide do. However, self-injury is not done with the intention of killing oneself. You can read about the causes of self-injury here.

Self Injury is NOT pure attention seeking - while it may be right that those who do self injure may need attention, calling attention to oneself is not usually one of the reasons why people self-injure. Those who do self injure often do so in such secretive ways that those very close to them have no idea of their problem; which is why their reaction to self-injury disclosure or discovery is one of shock and dismay. Interpreting self-injury as attention seeking can only make things worse for the self-injurer.

Some Self Injury is minor - goes this myth about self-injury, so it's not that big a deal. Physically minor self-injury does NOT mean that it is not serious. The severity of the person's feelings and reasons behind self-harm cannot be determined by the severity of a cut, burn, etc.

Last of Our Self-Injury Myths

Our final self-injury myth focuses on the mental stability of the self-injurer. After all, the reasoning goes, who in their right mind would want to harm themselves?

Self Injurers are NOT crazy - while many self-injurers have psychological problems, such as depression, self-injury does not always accompany another psychiatric disorder. Self-injury is a problem in its own right and may be regarded by those who have very limited or no experience with self-mutilation to be a sign of craziness. To other people, it may be 'crazy' - to a self-injurer, it is the way they live.

To get further insight into the mind of the self-injurer, read these self-injury stories.

TORONTO (MRI) - Although menopause symptoms can affect a women's sex life, they appear to matter less than several other factors, including relationships and attitudes towards sex, a new study suggests.

The study, published in the journal Menopause, focused on six "domains of sexual function" and how they influence a women's sex life. More than 3,100 pre-menopausal and early perimenopausal (nearing menopause) women of diverse backgrounds in the United States participated.

"Relationship variables, attitudes towards sex and aging, vaginal dryness, and cultural background have a greater impact on most aspects of sexual function than the transition to early perimenopause," concluded researcher Nancy Avis and colleagues.

Study participants were between the ages of 42 and 52 and were multicultural, with white, black, Hispanic, Chinese, and Japanese women in the group. The women were not using hormones.

Some of these women had started perimenopause and experienced unpredictable menstrual cycles, while others had regular cycles.

The researchers found that although vaginal dryness, a symptom of menopause, can result in painful sex, other factors must also be involved.

"We found that early perimenopausal woman reported greater pain with intercourse than premenopausal women," the researchers report.

"But the two groups did not differ in terms of frequency of sexual intercourse, desire, arousal or physical or emotional satisfaction."

Results showed that perimenopausal woman were nearly 40 percent more likely to experience frequent pain during intercourse than pre-menopausal women, even after vaginal dryness was taken into consideration.

The researchers also found that women who tended to derive frequent pleasure from sex were generally not married, felt sex was important, were usually happy in a long-term relationship, and used contraception.

Almost 60 percent of the women said they felt some form of sexual desire at least once a week.

The generational divide between baby-boomer parents and their teenage offspring is sharpening over sex.

Oral sex, that is.

More than half of 15- to 19-year-olds are doing it, according to a groundbreaking study by the Centers for Disease Control and Prevention.

The researchers did not ask about the circumstances in which oral sex occurred, but the report does provide the first federal data that offer a peek into the sex lives of American teenagers.

To adults, "oral sex is extremely intimate, and to some of these young people, apparently it isn't as much," says Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy.

"What we're learning here is that adolescents are redefining what is intimate."

Among teens, oral sex is often viewed so casually that it needn't even occur within the confines of a relationship. Some teens say it can take place at parties, possibly with multiple partners. But they say the more likely scenario is oral sex within an existing relationship. (Related story: "Technical virginity" becomes part of teens' equation)

Still, some experts are increasingly worrying that a generation that approaches intimate behavior so casually might have difficulty forming healthy intimate relationships later on.

"My parents' generation sort of viewed oral sex as something almost greater than sex. Like once you've had sex, something more intimate is oral sex," says Carly Donnelly, 17, a high school senior from Cockeysville, Md.

"Now that some kids are using oral sex as something that's more casual, it's shocking to (parents)."

David Walsh, a psychologist and author of the teen-behavior book Why Do They Act That Way? says the brain is wired to develop intense physical and emotional attraction during the teenage years as part of the maturing process. But he's disturbed by the casual way sex is often portrayed in the media, which he says gives teens a distorted view of true intimacy.

Sex - even oral sex - just becomes kind of a recreational activity that is separate from a close, personal relationship," he says.

"When the physical part of the relationship races ahead of everything else, it can almost become the focus of the relationship," Walsh says, "and they're not then developing all of the really important skills like trust and communication and all those things that are the key ingredients for a healthy, long-lasting relationship."

"Intimacy has been so devalued," says Doris Fuller of Sandpoint, Idaho, who, with her two teenage children, wrote the 2004 book Promise You Won't Freak Out, which discusses topics such as teen oral sex.

"What will the impact be on their ultimately more lasting relationships? I don't think we know yet."

Casual attitude is worrying

Child psychology professor W. Andrew Collins of the University of Minnesota says a relationship "that's only about sex is not a high-quality relationship."

In a 28-year study, Collins and his colleagues followed 180 individuals from birth. His yet-to-be-published research, presented at a conference in April, suggests that emotionally fulfilling high school relationships do help teens learn important relationship skills.

The researchers did not specifically ask about oral sex, he says. But relationships that are focused more on sex tend to be "less sustained, often not monogamous and with lower levels of satisfaction."

Terri Fisher, an associate professor of psychology at Ohio State University, says oral sex used to be considered "exotic." After the sexual revolution of the 1960s, it was viewed as a more intimate sexual act than sexual intercourse, but now, in young people's minds, it's "a more casual act."

Beyond shock, many parents aren't sure what to think when they discover their children's nonchalant approach to oral sex.

"It doesn't cross your mind because it's not something you have done," Fuller says. "Most parents weren't doing this (as teenagers) in the way these kids are."

But if parents are looking for reasons to freak out, the health risk of oral sex apparently isn't one of them. Teenagers and experts agree that oral sex is less risky than intercourse because there's no threat of pregnancy and less chance of contracting a sexually transmitted disease or HIV.

"The fact that teenagers have oral sex doesn't upset me much from a public health perspective," says J. Dennis Fortenberry, a physician who specializes in adolescent medicine at the Indiana University School of Medicine.

"From my perspective, relatively few teenagers only have oral sex. And so for the most part, oral sex, as for adults, is typically incorporated into a pattern of sexual behaviors that may vary depending upon the type of relationship and the timing of a relationship."

---

Data don't tell the whole story

A study published in the journal Pediatrics in April supports the view that adolescents believe oral sex is safer than intercourse, with less risk to their physical and emotional health.

The study of ethnically diverse high school freshmen from California found that almost 20% had tried oral sex, compared with 13.5% who said they had intercourse.

More of these teens believed oral sex was more acceptable for their age group than intercourse, even if the partners are not dating.

"The problem with surveys is they don't tell you the intimacy sequence," Brown says. "The vast majority who had intercourse also had oral sex. We don't know which came first."

The federal study, based on data collected in 2002 and released last month, found that 55% of 15- to 19-year-old boys and 54% of girls reported getting or giving oral sex, compared with 49% of boys and 53% of girls the same ages who reported having had intercourse.

Though the study provides data, researchers say, it doesn't help them understand the role oral sex plays in the overall relationship; nor does it explain the fact that today's teens are changing the sequence of sexual behaviors so that oral sex has skipped ahead of intercourse.

"All of us in the field are still trying to get a handle on how much of this is going on and trying to understand it from a young person's point of view," says Stephanie Sanders, associate director of The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University, which investigates sexual behavior and sexual health.

"Clearly, we need more information about what young people think is appropriate behavior, under what circumstances and with whom," Sanders says. "Now we know a little more about what they're doing but not what they're thinking."

The $16 million study, which took six years to develop, complete and analyze, surveyed almost 13,000 teens, men and women ages 15-44 on a variety of sexual behaviors.

Researchers say that the large sample size, an increased societal openness about sexual issues and the fact that the survey was administered via headphones and computer instead of face to face all give them confidence that, for the first time, they have truthful data on these very personal behaviors.

"There is strong evidence that people are more willing to tell computers things, such as divulge taboo behaviors, than (they are to tell) a person," Sanders says.

More analysis needed

Researchers cannot conclude that the percentage of teens having oral sex is greater than in the past. There is no comparison data for girls, and numbers for boys are about the same as they were a decade ago in the National Survey of Adolescent Males: Currently, 38.8% have given oral sex vs. 38.6% in 1995; 51.5% have received it vs. 49.4% in 1995.

Further analyses of the federal data by the private, non-profit National Campaign to Prevent Teen Pregnancy and the non-partisan research group Child Trends find almost 25% of teens who say they are virgins have had oral sex. Child Trends also reviewed socioeconomic and other data and found that those who are white and from middle- and upper-income families with higher levels of education are more likely to have oral sex.

Historically, oral sex has been more common among the more highly educated, Sanders says.

Is intimacy imperiled?

The survey also found that almost 90% of teens who have had sexual intercourse also had oral sex. Among adults 25-44, 90% of men and 88% of women have had heterosexual oral sex.

"If we are indeed headed as a culture to have a total disconnect between intimate sexual behavior and emotional connection, we're not forming the basis for healthy adult relationships," says James Wagoner, president of Advocates for Youth, a reproductive-health organization in Washington.

Oral sex might affect teenagers' self-esteem most of all, says Paul Coleman, a Poughkeepsie, N.Y., psychologist and author of The Complete Idiot's Guide to Intimacy.

"Somebody is going to feel hurt or abused or manipulated," he says. "Not all encounters will turn out favorably. ... Teenagers are not mature enough to know all the ramifications of what they're doing.

"It's pretending to say it's just sexual and nothing else. That's an arbitrary slicing up of the intimacy pie. It's not healthy."

A survey of more than 1,000 teens conducted with the National Campaign to Prevent Teen Pregnancy resulted in The Real Truth About Teens & Sex, a book by Sabrina Weill, a former editor in chief at Seventeen magazine. She says casual teen attitudes toward sex - particularly oral sex - reflect their confusion about what is normal behavior. She believes teens are facing an intimacy crisis that could haunt them in future relationships.

"When teenagers fool around before they're ready or have a very casual attitude toward sex, they proceed toward adulthood with a lack of understanding about intimacy," Weill says. "What it means to be intimate is not clearly spelled out for young people by their parents and people they trust."

Although governmental and educational campaigns urge teens to delay sex, some suggest teens have replaced sexual intercourse with oral sex.

"If you say to teenagers 'no sex before marriage,' they may interpret that in a variety of ways," says Fisher.

Talk is crucial

Experts say parents need to talk to their kids about sex sooner rather than later. Oral sex needs to be part of the discussion because these teens are growing up in a far more sexually open society.

Anecdotal reports for years have focused on teens "hooking up" casually. Depending on the group, teens say it can mean kissing, making out or having sex.

"Friends with benefits" is another way of referring to non-dating relationships, with a form of sex as a "benefit."

But not all teens treat sex so casually, say teens from suburban Baltimore who were interviewed by USA TODAY as part of an informal focus group.

Alex Trazkovich, 17, a high school senior from Reisterstown, Md., says parents don't hear enough about teen relationships where there is a lot of emotional involvement.

"They hear about teens going to the parties and having lots and lots of sex," he says. "It happens, but it's not something that happens all the time. It's more of an extreme behavior."

Teens and oral sex

Heterosexual oral sex among teenagers ages 15 to 19 varies by age and gender, with older teens more likely to engage in intercourse.

percentage of teens who have had intercourse and their ages:

• Boys
  15 - 25.1%
  16 - 37.5%
  17 - 46.9%
  18 - 62.4%
  19 - 68.9%
• Girls
  15 - 26.0%
  16 - 39.6%
  17 - 49.0%
  18 - 70.3%
  19 - 77.4%

percentage of teens who have had oral sex and their ages:

• Boys
  15 - 35.1%
  16 - 42.0%
  17 - 55.7%
  18 - 65.4%
  19 - 74.2%
• Girls
  15 - 26.0%
  16 - 42.4%
  17 - 55.5%
  18 - 70.2%
  19 - 74.4%

Source: 2002 National Survey of Family Growth, Centers for Disease Control of Prevention

Source: USA Today. Written: 10/19/05.

Because AIDS is a disease that affects so many people, most cities have established counseling centers that specialize in answering questions about HIV. In addition, there are many groups around the country that specialize in offering groups for people like you who want to learn more about HIV. There are also hotlines where people can talk about their problems over the phone.

Why do some people say that people with AIDS deserve the disease?

AIDS can be a very frightening disease, and many people find it hard to talk about AIDS because it nears talking about sex and drugs, things that we are usually taught to be afraid or ashamed of. People who say that anyone deserves AIDS are simply ignorant and afraid. They think that only drug addicts, people who have a lot of indiscriminate sex, and other people they consider "bad" get AIDS, and they like to think that they are better than people who participate in high-risk behavior. They also thin k that they don't know anyone affected by AIDS and that AIDS will never affect them. They are wrong. Anyone can get AIDS, and almost everyone knows of somebody that has been affected by HIV.

People with AIDS are not bad people, and They are not being "punished" for anything they did. They are people who have contracted a disease. AIDS does not pick certain people to infect because of who they are. It can infect captains of baseball teams, farmers, ministers, firefighters, models, class valedictorians, or anyone else. You don't have to be a drug addict to get AIDS; you only have to use an infected needle once. You don't have to have sex with a lot of people to get AIDS; you only have to pick the wrong person once. The only people who should be ashamed are the ones who say that anyone deserves to have AIDS.

Someone I know has AIDS, and now my friends don't want me to talk to him?

The best way to deal with people who don't understand AIDS is to give them the facts. Remember that they are afraid of AIDS because they don't understand what it's all about. Help them to learn more about HIV and AIDS. As more and more people begin to understand AIDS, the fear around the disease will go away.

How can I tell them it's okay?

You just did. The best a friend can do when someone is in a time of crisis like that is to just be around and comfort him/her. Don't ignore them or act strange around them. Remember, people with HIV are still the same people as they used to be.

My brother is HIV-positive, and I'm afraid to tell anyone How can I deal with my feelings?

For everyone who has HIV disease, there are fathers, mothers, sisters, brothers, friends, and lovers who are dealing with that person's illness. These people all need to be able to talk about what they are feeling. There are many organizations around the country that help the families and friends of HIV-positive people and people with AIDS deal with their feelings. The best way to deal with your feelings about AIDS is to talk about them with other people who have experienced the same thing. The worst thing you can do is bottle all your feelings up inside and pretend that nothing is wrong.

My six-year-old sister wants to know about AIDS. What should I tell her?

AIDS is in the news a lot these days, and children are becoming aware of it at a very early age. Many young children are frightened because they don't understand AIDS. They think they can get it like they get a cold, or that they can get it from a blood test. They need to be told that these things are not dangerous. Young children do not have to be told all the details involved with sex in order to understand AIDS. Telling them that AIDS is a disease that people get by doing certain things is usually enough. Children really want to know how they can't get AIDS. They should be reassured that they do not have to worry about blood tests, or having their teeth cleaned, or of people with AIDS sneezing near them, playing with them, or kissing them.

What should I say when someone tells me she or he is infected with HIV?

When a friend tells you that she or he has been infected with HIV, that person has chosen to trust you with very important information. Unless your friend asks you to, do not tell anyone else about his/her other condition. Because of ignorance about AIDS, discrimination still exists, and even though you have the facts, not everyone will respond as you would hope they would.

One of the biggest problems faced by people with AIDS is the psychological stress of having to tell people that they are infected with HIV and worrying about whether people will reject them. This can often be harder than dealing with the disease itself. The most important thing you can do for a friend who tells you he or she is HIV-positive is to tell your friend, "I am here for you when you need me."

You must also learn to understand your friend's disease. Find out all you can about AIDS so that you can recognize when your friend needs rest or needs help with something. This might mean staying in on a Friday night and watching television because your friend is tired, when you would rather have gone to a movie or gone dancing. It might mean attending support groups with your friend or going along on visits to the doctor.

This doesn't mean that you have to treat your friend like an invalid or a dying patient. You don't have to always ask if your friend is all right or be a nurse. The person is still the same person you loved before she or he was infected. You can still hug and kiss your friend and share food and drinks. Your friend will still enjoy ball games and fishing trips, concerts and shopping, and will still want to do these things with you.

You meet someone and it seems like love at first sight, but is it a healthy relationship? This article, for teens, talks about healthy and unhealthy relationships and the warning signs of trouble in a relationship.

Sometimes it feels impossible to find someone who's right for you — and who thinks you're right for him or her! So when it happens, you're usually so psyched that you don't even mind when your little brother finishes all the ice cream or your English teacher chooses the one day when you didn't do your reading to give you a pop quiz.

It's totally normal to look at the world through rose-colored glasses in the early stages of a relationship. But for some people, those rose-colored glasses turn into blinders that keep them from seeing that a relationship isn't as healthy as it should be.

What Makes a Healthy Relationship?

Hopefully, you and your significant other are treating each other well. Not sure if that's the case? Take a step back from the dizzying sensation of being swept off your feet and think about whether your relationship has these qualities:

• Mutual respect. Does he or she get how cool you are and why? (Watch out if the answer to the first part is yes but only because you're acting like someone you're not!) The key is that your BF or GF is into you for who you are — for your great sense of humor, your love of reality TV, etc. Does your partner listen when you say you're not comfortable doing something and then back off right away? Respect in a relationship means that each person values who the other is and understands — and would never challenge — the other person's boundaries.
• Trust. You're talking with a guy from French class and your boyfriend walks by. Does he completely lose his cool or keep walking because he knows you'd never cheat on him? It's OK to get a little jealous sometimes — jealousy is a natural emotion. But how a person reacts when feeling jealous is what matters. There's no way you can have a healthy relationship if you don't trust each other.
• Honesty. This one goes hand-in-hand with trust because it's tough to trust someone when one of you isn't being honest. Have you ever caught your girlfriend in a major lie? Like she told you that she had to work on Friday night but it turned out she was at the movies with her friends? The next time she says she has to work, you'll have a lot more trouble believing her and the trust will be on shaky ground.
• Support. It's not just in bad times that your partner should support you. Some people are great when your whole world is falling apart but can't take being there when things are going right (and vice versa). In a healthy relationship, your significant other is there with a shoulder to cry on when you find out your parents are getting divorced and to celebrate with you when you get the lead in a play.
• Fairness/equality. You need to have give-and-take in your relationship, too. Do you take turns choosing which new movie to see? As a couple, do you hang out with your partner's friends as often as you hang out with yours? It's not like you have to keep a running count and make sure things are exactly even, of course. But you'll know if it isn't a pretty fair balance. Things get bad really fast when a relationship turns into a power struggle, with one person fighting to get his or her way all the time.
• Separate identities. In a healthy relationship, everyone needs to make compromises. But that doesn't mean you should feel like you're losing out on being yourself. When you started going out, you both had your own lives (families, friends, interests, hobbies, etc.) and that shouldn't change. Neither of you should have to pretend to like something you don't, or give up seeing your friends, or drop out of activities you love. And you also should feel free to keep developing new talents or interests, making new friends, and moving forward.
• Good communication. You've probably heard lots of stuff about how men and women don't seem to speak the same language. We all know how many different meanings the little phrase "no, nothing's wrong" can have, depending on who's saying it! But what's important is to ask if you're not sure what he or she means, and speak honestly and openly so that the miscommunication is avoided in the first place. Never keep a feeling bottled up because you're afraid it's not what your BF or GF wants to hear or because you worry about sounding silly. And if you need some time to think something through before you're ready to talk about it, the right person will give you some space to do that if you ask for it.

What's an Unhealthy Relationship?

A relationship is unhealthy when it involves mean, disrespectful, controlling, or abusive behavior. Some people live in homes with parents who fight a lot or abuse each other — emotionally, verbally, or physically. For some people who have grown up around this kind of behavior it can almost seem normal or OK. It's not! Many of us learn from watching and imitating the people close to us. So someone who has lived around violent or disrespectful behavior may not have learned how to treat others with kindness and respect or how to expect the same treatment.

Qualities like kindness and respect are absolute requirements for a healthy relationship. Someone who doesn't yet have this part down may need to work on it with a trained therapist before he or she is ready for a relationship. Meanwhile, even though you might feel bad or feel for someone who's been mistreated, you need to take care of yourself — it's not healthy to stay in a relationship that involves abusive behavior of any kind.

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Warning Signs

When a boyfriend or girlfriend uses verbal insults, mean language, nasty putdowns, gets physical by hitting or slapping, or forces someone into sexual activity, it's an important warning sign of verbal, emotional, or physical abuse.

Ask yourself, does my boyfriend or girlfriend:

• get angry when I don't drop everything for him or her?
• criticize the way I look or dress, and say I'll never be able to find anyone else who would date me?
• keep me from seeing friends or from talking to any other guys or girls?
• want me to quit an activity, even though I love it?
• ever raise a hand when angry, like he or she is about to hit me?
• try to force me to go further sexually than I want to?

These aren't the only questions you can ask yourself. If you can think of any way in which your boyfriend or girlfriend is trying to control you, make you feel bad about yourself, isolate you from the rest of your world, or — this is a big one — harm you physically or sexually, then it's time to get out, fast. Let a trusted friend or family member know what's going on and make sure you're safe.

It can be tempting to make excuses or misinterpret violence, possessiveness, or anger as an expression of love. But even if you know that the person hurting you loves you, it is not healthy. No one deserves to be hit, shoved, or forced into anything he or she doesn't want to do.

Why Are Some Relationships So Difficult?

Ever heard about how it's hard for someone to love you when you don't love yourself? It's a big relationship roadblock when one or both people struggle with self-esteem problems. Your girlfriend or boyfriend isn't there to make you feel good about yourself if you can't do that on your own. Focus on being happy with yourself, and don't take on the responsibility of worrying about someone else's happiness.

What if you feel that your girlfriend or boyfriend needs too much from you? If the relationship feels like a burden or a drag instead of a joy, it might be time to think about whether it's a healthy match for you. Someone who's not happy or secure may have trouble being a healthy relationship partner.

Also, intense relationships can be hard for some teenagers. Some are so focused on their own developing feelings and responsibilities that they don't have the emotional energy it takes to respond to someone else's feelings and needs in a close relationship. Don't worry if you're just not ready yet. You will be, and you can take all the time you need.

Ever notice that some teen relationships don't last very long? It's no wonder — you're still growing and changing every day, and it can be tough to put two people together whose identities are both still in the process of forming. You two might seem perfect for each other at first, but that can change. If you try to hold on to the relationship anyway, there's a good chance it will turn sour. Better to part as friends than to stay in something that you've outgrown or that no longer feels right for one or both of you. And before you go looking for amour from that hottie from French class, respect your current beau by breaking things off before you make your move.

Relationships can be one of the best — and most challenging — parts of your world. They can be full of fun, romance, excitement, intense feelings, and occasional heartache, too. Whether you're single or in a relationship, remember that it's good to be choosy about who you get close to. If you're still waiting, take your time and get to know plenty of people.

Think about the qualities you value in a friendship and see how they match up with the ingredients of a healthy relationship. Work on developing those good qualities in yourself — they make you a lot more attractive to others. And if you're already part of a pair, make sure the relationship you're in brings out the best in both of you.

Effective communication between parents and kids isn't always easy. The following tips should help parents communicate more effectively with their children.

Be available for your children

• Notice times when your kids are most likely to talk--for example, at bedtime, before dinner, in the car--and be available.
• Start the conversation; it lets your kids know you care about what's happening in their lives.
• Find time each week for a one-on-one activity with each child, and avoid scheduling other activities during that time.
• Learn about your children's interests--for example, favorite music and activities--and show interest in them.
• Initiate conversations by sharing what you have been thinking about rather than beginning a conversation with a question.

Let your kids know you're listening

• When your children are talking about concerns, stop whatever you are doing and listen.
• Express interest in what they are saying without being intrusive.
• Listen to their point of view, even if it's difficult to hear.
• Let them complete their point before you respond.
• Repeat what you heard them say to ensure that you understand them correctly.

Respond in a way your children will hear

• Soften strong reactions; kids will tune you out if you appear angry or defensive.
• Express your opinion without putting down theirs; acknowledge that it's okay to disagree.
• Resist arguing about who is right. Instead say, "I know you disagree with me, but this is what I think."
• Focus on your child's feelings rather than your own during your conversation.

Remember:

• Ask your children what they may want or need from you in a conversation, such as advice, simply listening, help in dealing with feelings, or help solving a problem.
• Kids learn by imitating. Most often, they will follow your lead in how they deal with anger, solve problems, and work through difficult feelings.
• Talk to your children--don't lecture, criticize, threaten, or say hurtful things.
• Kids learn from their own choices. As long as the consequences are not dangerous, don't feel you have to step in.
• Realize your children may test you by telling you a small part of what is bothering them. Listen carefully to what they say, encourage them to talk, and they may share the rest of the story.

Parenting is hard work

Listening and talking is the key to a healthy connection between you and your children. But parenting is hard work and maintaining a good connection with teens can be challenging, especially since parents are dealing with many other pressures. If you are having problems over an extended period of time, you might want to consider consulting with a mental health professional to find out how they can help.

Source: American Psychological Association