Low body image is a serious problem that concerns both women and men alike. A study conducted, by Monteath and McCabe, found that 44% of women express negative feelings about their bodies. In a 2014 AOL Body Image Survey, 53% of men said they did not like having their pictures taken in swimwear. So, why are so many men and women suffering from a low body image and how does it affects our sex life?

A recent study published in the Journal of Sex Medicine, “The Association between Sexual Satisfaction and Body Image in Women,” showed a significant relationship between sexual satisfaction and all body image variables. Low body image is also known to cause sexual performance anxiety in both men and women.

A study published in Women’s Health and Fitness showed that women who are more satisfied with their body images reported more sexual activity, more orgasms, more instances of initiating sex, greater comfort undressing in front of their partners, more instances of having sex with the lights on, more willingness to try new sexual behaviors, and more instances of pleasing their partner sexually than those who are dissatisfied with their body images.

So what are women conscious about?

Weight is an obvious cause for low body image, but the flaws people find in themselves are endless. Other than weight issues, worries about their faces and the shapes and sizes of their breasts are common for women. Breast cancer surgery can also significantly hurt a women’s body image.

Can plastic surgery help?

I do not object to plastic surgery categorically, but I believe it is important to talk with the patient first and determine whether there is another method to make her feel better about her appearance. The important question is whether the low body image has an objective justification or if it is totally subjective. A woman might visit my clinic and complain that her breasts are sagging, but I, who have seen a lot of breasts, might view her breasts as completely normal.

The limit should be what is considered normal. For example, breasts that are not the same size are normal, and in my view they do not justify surgery. I would only recommend surgery for a woman with abnormal breasts—for example, those with extremely large or extremely small breasts. It is important to remember that surgery is expensive and that it can have complication due to infections.

How does pregnancy affect body image?

Pregnancy could lead to the development of low body image due to the weight gain that is usually apparent after pregnancy or to scarring from a caesarian section. Sometimes, the presence of the partner during labor can make some women believe their partners will find them unattractive because they “have seen them in an unflattering situation.” Only a small percentage of men suffer from a loss of sexual desire after witnessing their partners going through labor. With that said, I believe it is not mandatory to go through this experience together if the couple does not want to.

What are the main factors in men’s low body image?

The main factors are penis size, balding, being overweight, and facial issues. There has been a recent phenomenon of men who think their penises are too small. I have seen hundreds of patients in my career who have asked me about penis enlargement procedures. The reality is that almost all of these men were in the normal range. Really small penises are rare, but many men are simply not convinced.

If the penis is not smaller than the pinky finger, it is considered normal. For those who are still troubled, I recommend seeing a sex therapist or a urologist. If you still think your penis is too small even after it has been examined by a professional, I recommend seeking psychological treatment. In my opinion, penis enlargement surgeries are almost always completely redundant, unless the penis is really very small.