Sexual Experiences and Body Dissatisfaction: An Interview with Dr. Emily Walsh
By Abigail Wells
What would you say if your doctors asked to describe your sexual experiences at your next annual physical? What if it was your therapist? For most of us, the automatic response would be to clam up and avoid discussing something so personal and socially taboo.
Body dissatisfaction, or negative feelings about one’s body, is so widespread that it is considered normal, ignoring the fact that it is an integral factor in the development of eating disorders. While many therapeutic approaches and eating disorder interventions look to reduce body dissatisfaction to treat and prevent these ailments, dissatisfaction is usually treatment resistant. Although limited research on primarily white, heterosexual individuals has shown a link between body dissatisfaction and quality of sexual experiences, there remains a lack of evidence in more diverse populations.
Dr. Emily Walsh is a clinical psychologist with a background in eating disorder research, intervention, and prevention. While she currently works in the Counseling Center at the Pratt Institute in New York, she completed her PhD in clinical psychology at UNC-Chapel Hill last spring. Her dissertation addressed this gap, further exploring the intricacies of the link between sexual experiences and body dissatisfaction in a wide group of participants.
Dr. Emily Walsh
In designing her study, Walsh chose two main components to examine this relationship on both a larger, more quantitative scale, as well as one that was more detailed and personal. The first asked participants from across the United States to complete an online survey with both self-report and long answer questions. The second consisted of a series of eleven interviews with the participants, in which they described in depth their own experiences, body dissatisfaction, and identity. In writing the questions, Walsh drew heavily from critical theory, considering the person as a whole, multifaceted being. She says this approach is “foundational” for psychology as it brings attention to the ways that identity influences experience.
Critical theory’s emphasis on identity also allowed her to look at the participants on a more individualized level. Instead of using the single categorical options for identity (i.e., selecting only one race, gender, sexual orientation option), she elected to allow her participants to “check all that apply.” According to Walsh, self-identification options like these both empower participants and give psychological researchers more information about the ways in which people choose to identify themselves. However, it did also pose a challenge to her analysis: How to separate such highly intertwined groups. Her answer? Don’t. Instead, she looked at different slices of participants, fully aware that most participants were counted multiple times. Although this made the results harder to analyze and generalize, it was closer to the reality of human-focused research – people don’t exist in a vacuum, and this approach took the multifaceted perspective that Walsh recommends for all psychological research.
Participants were organized to consider all facets of their identities in analysis.
Source: Walsh E. 2024. Exploration of the relationships between body attitudes and sexual experiences in a diverse sample of adults: A critical theory-guided, multi-method approach. United States -- North Carolina: The University of North Carolina at Chapel Hill.
From her “kaleidoscope” of participants, Walsh identified several significant constants across the groups. Overall, sexual experiences and body satisfaction were entangled, so that both of them could influence each other: positive body image correlated with positive sexual experiences, and vice versa. This relationship was heavily influenced by identity, and socio-cultural standards, especially as they pertained to identity, appeared particularly important when contextualizing this relationship. However, Walsh noted that even some of her own assumptions were overturned. She originally assumed that the relationship between sexual experiences and body dissatisfaction was primarily due to people’s sexual motivations, yet it was also present in samples that contradicted this premise. For example, while asexual participants were not driven by a desire towards sex, their body dissatisfaction and sexual experiences were still closely linked. Whether as a form of stress relief or as an awkward social situation, their dynamic revealed another possible manifestation of this relationship.
Similar environmental factors can affect both body image and sexual experiences.
Source: Walsh E. 2024. Exploration of the relationships between body attitudes and sexual experiences in a diverse sample of adults: A critical theory-guided, multi-method approach. United States -- North Carolina: The University of North Carolina at Chapel Hill.
While this work was strengthened by its rich diversity of participants, it had few cisgender, heterosexual men, leaving a gap in the analysis. Going forward, this could be an interesting element to consider, especially as Walsh’s citations included a surprising number of in-depth interviews in which sexual violence with cisgender heterosexual males played an integral role in the development of the relationship between sexual experiences and body dissatisfaction.
Walsh believes this work has potential for therapeutic application, both for couples-based and individual therapies. The relationship between sexual experience and body satisfaction goes both ways. For “people who are struggling with body image,” she had the following suggestion: “I would love providers to know – ask about sex! What are their sexual experiences?” This also has positive implications for eating disorder intervention development. Similarly, for people who are struggling with physical sexual issues, providers should consider body image when devising their treatment plan. Overall, she emphasized that she wants healthcare providers to keep in mind the tie when faced with similar scenarios. She believes that this relationship could be used to imagine a therapeutic approach to intuitive sexuality, parallel to intuitive eating interventions for disordered eating, encouraging people to both “reconnect to your body and your sexually sensing body” and to somatic cues.
In short, according to Dr. Walsh, sexual experiences are so deeply intertwined with personal image that they can affect the latter significantly and in a lasting way. So, as it turns out, sexual experiences may actually hold the secret for healthcare providers to consider, especially for patients at a higher risk of developing eating disorders. If your healthcare provider asks, don’t clam up. Answer.
References:
1. Interview with Dr. Emily Walsh, Ph.D. 09/29/2024
2. Walsh E. 2024. Exploration of the relationships between body attitudes and sexual experiences in a diverse sample of adults: A critical theory-guided, multi-method approach. United States -- North Carolina: The University of North Carolina at Chapel Hill.