Men’s sexual distress: the role of body image and vulnerable narcissistic traits

Abstract

Numerous studies have established the importance of body image self-consciousness in predicting sexual distress and dissatisfaction in women. However, there is a dearth of information analyzing whether the same relation applies to men. Sexual perfectionism is a sexual correlate that has shown diverse links with sexual-related outcomes. The aim of the present study was to determine the degree to which certain sexuality-related factors, such as body image self consciousness and sexual perfectionism, and certain personality traits, namely grandiose and vulnerable narcissistic traits, may be associated with sexual discomfort in men. An online survey including self-report measures of sexual correlates variables and narcissistic personality traits was administered to a sample of 212 men, who provided the data used to investigate these associations. We performed a stepwise regression analysis, including the sexual-specific variables in the first step and vulnerable and grandiose narcissism in the second step. Sexual distress was linked to vulnerable narcissistic features and body image self-consciousness, according to our research. The clinical implications of our findings emphasize the need of evaluating body image concerns and taking personality characteristics into account when addressing sexual difficulties in men.

LAY SUMMARY

Sexuality is affected by variables that are related to sex, such as the discomfort with one’s body in sexual contexts, or the expectations toward the sexual performance of the partner. We investigate the role these variables play in men’s sex life, and we also consider the impact of narcissistic personality traits.

Keywords:

• Body image
• narcissistic traits
• sexual perfectionism
• sexual distress
• males

Introduction

Sexuality and its correlates

Sexual health, defined as a state of physical, emotional, mental, and social well-being related to sexuality, rather than the absence of disease, dysfunction, or infirmity (WHO, 2010), has shown to contribute to overall health-related quality of life (Henderson et al., 2009; Robinson & Molzahn, 2007). For many people, pleasurable sexual experiences are a relevant component of their overall well-being. Thus, sexual dysfunctions or the lack of sexual satisfaction can potentially affect quality of life or well-being (Heiman, 2002; Nicolosi et al., 2004; van den Brink et al., 2018; Winter et al., 2020). Studies with female¹ participants have confirmed that sexual function plays an essential role in the persons’ overall well-being (Davison et al., 2009; Holmberg et al., 2010). Similarly, sexual dysfunction can affect physical and psychological health in men, as confirmed by a review of studies on cisgender men’s health (Tan et al., 2012). Moreover, reviews indicate that 15 to 41% of men are dissatisfied with their sex life (van den Brink et al., 2018). Given the role sexual satisfaction can play, it is worth identifying its determinants.

One important correlate of sexual functioning is body image: body self-consciousness (during sexual encounters) can ultimately impair sexual functioning (Cash et al., 2004; Sanchez & Kiefer, 2007; Levitan et al., 2009; Woertman & van den Brink, 2012). On the contrary, a more positive body image has been linked with greater sexual functioning in both men and women (Milhausen et al., 2015; Quinn-Nilas et al., 2016). Body image concerns in relation to sexual functioning have been explored mostly within women samples (for a review, see Woertman & van den Brink, 2012). For decades, it has been known that women are significantly more affected by the societal expectations of beauty and body standards, and body dissatisfaction is higher and more common among women than men (Fredrickson & Roberts, 1997; Levitan et al., 2019). However, there is an increasing number of men struggling with body image. Already in 1997, a U.S. national survey indicated that over half of men were dissatisfied with their weight, 45% were dissatisfied with their muscle tone, and 43% were dissatisfied with their overall appearance (Garner, 1997). More recently, studies found that - although body image dissatisfaction is more prevalent among women than men - men are also clearly affected by body dissatisfaction and socially imposed standards of masculinity and muscularity (Brennan et al., 2010). Experts also highlighted the implications of the increasing number of symptoms and manifestations of body image issues in men, inviting clinicians not to overlook this aspect. For example, Burlew and Shurts (2013) provided an overview of the symptoms of body image dissatisfaction/distress in men, suggesting that the variability of the clinical manifestations and their intensity makes it hard for clinicians to detect body image-related problems, and that cultural standards are an important factor in the development of body dissatisfaction.

Objectification theory provides theoretical underpinnings for understanding the relationship between body image and sexual function. Sexual objectification involves not seeing and treating the person as a whole, but rather reducing their status to that of an object that exists for the sexual pleasure of others (Papadaki, 2007; Tiggemann & Williams, 2012). This, according to some feminist theorists, is a potential harm for the humanity of the person (Papadaki, 2007; Dworkin, 1989). Indeed, women’s self-reported experiences of sexual objectification have been empirically linked to adverse outcomes, which include, but are not limited to, body monitoring, body shame, sexual dissatisfaction, internalization of the thin ideal, and disordered eating (Szymanski et al., 2011). Objectification theory has focused primarily on the female experience, arguing that girls and women are exposed to sexual objectification. For this reason, they might internalize this outsider view propagated by media and other sociocultural messages and begin to self-objectify by treating and evaluating themselves on the basis of appearance (Fredrickson & Roberts, 1997). Women are exposed to socio-cultural messages regarding appearance through sexually objectifying media, such as movies or advertisements that endorse the thin body ideal and depict unrealistic standards of women’s physical beauty (Szymanski et al., 2011). Nonetheless, societal messages that link one’s worth to appearance are ubiquitous and concern the male body as well, since the media also depicts stereotypically masculine and often highly unattainable bodies for men, encouraging the drive for muscularity (Davids et al., 2019). Research has shown that in the context of men’s sexual experiences, negative body attitudes were associated with greater sexual dissatisfaction (Peplau et al., 2009; Traeen et al., 2016; van den Brink et al., 2018). In a study by van den Brink and colleagues (2018), the authors investigated the relationships between body attitudes, body self-consciousness during physical intimacy, and sexual dissatisfaction in a sample of men. Their results, in line with previous findings, showed a significant association between body self-consciousness during physical intimacy and sexual dissatisfaction. More specifically, they identified body self-consciousness during physical intimacy as a mediator in the relationship between negative body attitudes and sexual dissatisfaction. In light of these results, authors have proposed to extend the objectification theory framework to capture the experiences with body image and sexual functioning of men (Davids et al., 2019; Winter et al., 2020). For instance, Sanchez and Kiefer (2007) suggested that the fundamental processes regarding self-consciousness related to sexual arousability and pleasure were similar for men and women.

Sexual perfectionism is another potential correlate that has been studied, although to a lesser degree, in relation to sexuality (Kluck et al., 2016; Kluck et al., 2018; Stoeber et al., 2013; Stoeber & Harvey, 2016). Perfectionism is conceptualized as a multidimensional construct that comprises dimensions of self-oriented, other-oriented, and socially prescribed perfectionism (Hewitt & Flett, 1991). In the sexual domain, Snell (1997) also differentiated between self-oriented, partner-oriented, partner-prescribed, and socially-prescribed forms of perfectionism. Partner-oriented perfectionism, in particular, represents the tendency to have very high expectations towards the partner’s sexual performance. Results regarding the link between this form of perfectionism and sexuality are contradicting. One of the first studies on the topic found higher levels of self-oriented, partner-prescribed and partner-oriented perfectionism to be associated with lower levels of sexual satisfaction in a sample of 74 heterosexual couples (Habke et al., 1999). Results from a more recent longitudinal study on women’s sexuality also show that partner-oriented sexual perfectionism negatively affects sexual satisfaction (Stoeber & Harvey, 2016). Thus, women who have perfectionistic expectations for their sexual partners may tend to be less satisfied with sex than women who do not have these expectations (Stoeber & Harvey, 2016). Stoeber et al., (2013) had previously found partner-oriented sexual perfectionism to show contradictory associations in their cross-sectional study with a sample of male and female university students. On the one hand, it was associated with fewer concerns about sexual mistakes, higher sexual esteem, sexual self-efficacy, and sexual optimism, and it showed a negative relationship with sexual anxiety. On the other hand, it showed positive relationships with self-blame concerning sexual problems, and with negative perfectionism cognitions during sex. One study associating partner-oriented sexual perfectionism with a positive sexual outcome is the work by Kluck and colleagues (2016), who found partner-oriented sexual perfectionism to be correlated with reduced self-consciousness about appearance during sex in a sample of nonclinical women. To our knowledge, there is no study assessing sexual perfectionism in a sample of nonclinical men. The different associations between partner-oriented sexual perfectionism and sexuality-related outcomes might be explained considering the different samples (couples, males and females, or females only), the different outcome variables, and the different study designs.

Narcissistic personality traits

Personality traits are an important standpoint for understanding and predicting the factors contributing to sexual outcomes (McNulty & Widman, 2013). Narcissistic traits, in particular, have long been linked to sexuality, as stated in a review by Levy et al. (2011). However, the conceptualization of narcissism has evolved throughout the last century, leaving behind its outdated definition as a form of libidinal investment characterized by a relatively exclusive focus on the self (Freud, 1914). Recently, narcissism is rather described as a complex and multifaceted construct. It includes both a normal need for validation and pathological aspects of personality functioning that are characterized by a deficit in self-esteem regulation, antagonism, and entitlement (Pincus et al., 2009). In the last decade, narcissism has been conceptualized as having two core manifestations: vulnerable and grandiose (Pincus et al., 2009). Vulnerable narcissism is characterized by negative affectivity, anger, and need for admiration (Lynam & Widiger, 2001; Pincus & Lukowitsky, 2010); it represents the most neurotic manifestation and is characterized by greater internalizing symptoms and psychological distress (Miller et al., 2018). Grandiose narcissism is more strongly associated with externalizing behaviors, especially anger and aggression following perceived slights or ego threats (Miller et al., 2018), self-enhancing and exploitative attitudes (Di Pierro et al., 2019).

This complex structure may contribute to explaining why empirical findings concerning narcissistic traits (and their relationship with other constructs) can be contradictory. Indeed, recent empirical findings suggest that the different phenotypic presentations of narcissism (vulnerable and grandiose) show different patterns of associations with other features, such as self-esteem (Di Pierro et al., 2016) and emotion regulation (Di Pierro et al., 2017). Contemporary conceptualizations of narcissism no longer flatten the construct on the sexual and libidinal domain, nonetheless sexual life in narcissists remains a topic of interest for both researchers and clinicians. Regarding sexuality, empirical studies have found narcissistic traits to be associated with reduced sexual satisfaction and functioning (McNulty & Widman, 2013; Gewirtz-Meydan & Finzi-Dottan, 2018). Some authors labeled a set of components of narcissistic personality styles that are activated within specific sexual situations as “sexual narcissism” (Widman & McNulty, 2010). Sexual narcissism refers to the antagonistic features, sexual exploitation, entitlement, low sexual empathy, and the inflated sense of sexual skills present in narcissistic personalities, which can have a significant impact on one’s relational and sexual life.

McNulty and Widman (2013), for instance, examined the implications of narcissism for sexual and relationship satisfaction. The authors argue that, since satisfying sexual exchanges involve empathy, care, and respect, people who are less likely to embody these qualities (such as people with nacissistic personality traits) may turn out to be less sexually satisfied. On the other hand, other studies found such traits to be positively correlated with sexual functioning (e.g. Klein et al., 2020). When grandiose and vulnerable narcissistic traits are investigated separately, they show different patterns of associations with sexuality-related outcomes, and it appears that vulnerable manifestations are specifically linked to reduced sexual satisfaction (Anzani et al., 2021) and sexual functioning (Pavanello Decaro et al., 2021), while grandiose manifestations are not. Although the majority of these works focused on women, we can expect vulnerable narcissistic traits - compared to grandiose ones - to be associated with more distress related to sexuality also in men.

Current study

The present study aims at investigating the link between body image self-consciousness in sexual encounters and partner-oriented sexual perfectionism with subjective sexual distress, in a sample of men. Although the majority of studies have focused on body image dissatisfaction in female samples, in light of recent research, we expect body image self-consciousness to negatively affect sexual life also in men. We also aimed at examining the possible impact of sexual perfectionism on sexuality. Published works concerning the role of partner-oriented sexual perfectionism in relation to sexual functioning and satisfaction have shown contradicting results: hence, we have no specific a-priori hypothesis regarding the association between partner-oriented sexual perfectionism and sexual distress. In the present study, we focus on self-reported sexual distress experienced by the respondent in relation to sexual problems, rather than functioning or satisfaction. On the one hand, this brings the focus to the subjective and perceived personal distress rather than the frequency or number of experienced symptoms. On the other hand, it allows for the collection of self-reported data, rather than requiring the clinical or diagnostic assessment that would be necessary to properly identify the sexual disfunction itself.

Furthermore, we aim at exploring whether pathological narcissistic traits (grandiose and vulnerable), show incremental validity, following the line of research that examines the contribution of personality traits in the prediction of sexual distress (Allen & Walter, 2018), beyond sexual-specific variables. In this sense, we hypothesize that pathological narcissism will explain sexual distress, above and beyond specific sexual-related variables (i.e. partner-oriented perfectionism and body image self-consciousness). In particular, we expect vulnerable traits to be uniquely associated with higher levels of sexual distress, while we do not expect grandiose traits to show the same link.

Methods

Participants were recruited through flyers, posted on social media and online resources, that contained a link to an online survey seeking to explore “the quality of sex life and its relationship with specific personality characteristics.” All participants provided informed consent. The study was approved by the Ethics Committee of the University of Milan-Bicocca. Two-hundred and seventy-six Italian men responded to the survey between April and June 2017, but 64 participants did not complete the entire questionnaire: the final sample was composed of 212 nonclinical cisgender men. Part of the data from this sample were previously used in another study with a different focus (Anzani et al., 2021). The mean age was 30.37 (SD = 7.77: range 18-54), other sample characteristics are outlined in Table 1.

Table 1. Descriptive statistics: socio-demographic characteristics of the sample.

Variable
Education level (N – %)	Lower than high school	9–4.2%
	High school diploma	103–48.6%
	University degree	76–35.8%
	Post-graduate education	24–11.3%
Marital status	Single	166–79%
	Married	35–16.7%
	Separated/divorced	9–4.5%
Relationship status	Single	67–31.6%
	Cohabiting couple	71–33.5%
	Non-cohabiting couple	74–34.9%
Sexual attraction	Exclusively to women	182–85.8 %
	Primarily to women, occasionally to men	8–3.8%
	Primarily to women, regularly to men	2–0.9%
	Equally to both genders	1–0.5%
	Primarily to men, regularly to women	2–0.9%
	Primarily to men occasionally to women	6–2.8%
	Exclusively to men	11–5.2%
	Neither men nor women	0–0%
Sexual identity	Heterosexual	188–88.7%
	Bisexual	7–3.3%
	Homosexual	15–7.1%
	Other	3–0.5%

Sexual functioning is measured with the distress items of the Sexual Complaint Screener for Men (SCS-M; Hatzichristou et al., 2010). The International Society for Sexual Medicine (ISSM) has recognized the need for a brief measurement scale for the assessment of sexual problems and created this comprehensive self-report tool that addresses all areas of sexual functioning, such as sexual interest/desire, arousal, premature and delayed ejaculation, sexual pain, anxiety relating to penis size and form, and sexual satisfaction during the last 6 months. A sample item is: “Some men experience lack of or low sexual interest/desire in sex. Has this happened to you during the last 6 months?” For every area, the respondent is asked to indicate how frequently they have experienced the problem. Furthermore, for each area, the respondent is asked to state how much personal distress that problem has created for them. For the purpose of this study, we created a sum score for the 7 items in which respondents provided information on how much personal distress that problem has created for them. The scale showed adequate internal consistency (Cronbach’s α = .71).

Body image concerns during physical intimacy were measured through the Male Body Image Self-Consciousness Scale (M-BISC; McDonagh et al., 2008). The self-report questionnaire is made up of 17 items, rated on a 5-point Likert scale (1 = strongly disagree − 5 = strongly agree). Higher scores indicate higher self-consciousness. A sample item is: “During sex, I would worry that my partner would think my chest is not muscular enough.” The scale showed good internal consistency (Cronbach’s α = .94).

Sexual perfectionism was measured with the partner-oriented sexual perfectionism subscale of the Multidimensional Sexual Perfectionism Questionnaire (Snell, 1997). The subscale is composed of 6 items; participants responded to all items on a 5-point scale (0 = disagree − 4 = completely agree). Higher scores indicate higher perfectionism. A sample item is: “I expect nothing less than perfection from my sexual partner.” The scale showed good internal consistency (Cronbach’s α = .87).

Pathological narcissistic traits were measured through the Pathological Narcissism Inventory (PNI; Pincus et al., 2009). The PNI is a self-report questionnaire which consists of 52 items rated on a 6-point Likert scale (0 = not at all like me − 5 = very much like me), and assesses both grandiose and vulnerable narcissistic traits. Narcissistic Grandiosity (NG) includes dimensions of Self-Sacrificing Self-Enhancement, Grandiose Fantasy, and Exploitativeness. Narcissistic Vulnerability (NV) includes dimensions of Entitlement Rage, Hiding the Self, Contingent Self-Esteem, and Devaluing. In the present study, both of the scales showed good internal consistency (Cronbach’s α for Vulnerable Narcissism = .89 and for Grandiose Narcissism = .93).

Statistical analyses

All analyses were performed using IBM SPSS version 27.0. After exploring Pearson correlations, and checking for multicollinearity among the predictors, we carried out a stepwise regression analysis to test the association of sexual variables and narcissistic traits with sexual distress. A stepwise regression analysis allowed us to first investigate the role of sexual-specific variables: in the first step we included body image self-consciousness and sexual perfectionism. Subsequently, we tested the association of vulnerable and grandiose narcissistic traits, as well as the sexual specific variables, in order to assess the potential incremental validity connected to personality traits.

Results

The correlations between variables are outlined in Table 2. Sexual distress was positively correlated with body image self-consciousness, grandiose narcissism, and vulnerable narcissism. Sexual distress was not significantly correlated with sexual perfectionism. Although grandiose narcissism appeared to be significantly correlated with sexual distress, when included in the regression model alongside vulnerable narcissism, thus controlling for the shared variance, it no longer showed an association with the outcome variable. The other variables correlating positively with the outcome variable were found to be significant predictors in the regression model.

Table 2. Descriptive statistics and Pearson’s correlations between body image self-consciousness, sexual perfectionism, narcissistic traits, sexual distress and age.

Variable	M	DS	1	2	3	4	5	6
1. Body image self-consciousness (BISC)	1.70	.76	1
2. Sexual perfectionism (MSPQ)	2.53	.95	.19**	1
3. Grandiose narcissism	3.53	.65	.22**	.28**	1
4. Vulnerable narcissism	3.08	.68	.48**	.31**	.64**	1
5. Sexual distress (SCS-M)	10.28	3.51	.30**	.05	.25**	.38**	1
6. Age	30.37	7.77	−.09	.03	−.31**	−.18**	.08	1

^* p < .05; ^**p < .01; ^***p < .001.

As to the stepwise multiple regression, the final model accounted for 17% of the variance in the dependent variable (R² = .17; p < .001). The inclusion of the variables assessing narcissistic traits significantly contributed to the increase of the total amount of variance explained (ΔR²= .08, ΔF(2, 206) = 9.69; p < .001). In the final model, a significant and positive effect of body image self-consciousness was found (see Table 3), showing that participants who felt dissatisfaction with their body in sexual contexts also reported higher sexual distress. Of the two predictors assessing narcissistic personality traits, only vulnerable narcissism was positively associated with sexual distress. These effects remained significant when we controlled for age and relational status, as displayed in the Supplementary Materials (see Table S1).

Table 3. Results from stepwise regression analysis.

		Model 1			Model 2
DV	IV	β	SE	t	β	SE	t
Sexual distress (SCS-M)	Body image self-consciousness (BISC)	.30	.31	4.45***	.16	.34	2.18*
	Sexual perfectionism (MSPQ)	−.004	.25	−.06	−.08	.25	−1.21
	Grandiose narcissism				.04	.45	.43
	Vulnerable narcissism				.30	.48	3.24***

DV = dependent variable; IV = independent variable; ^*p < .05; ^**p < .01; ^***p < .001.

We conducted a sensitivity power analysis in G-power (Faul et al., 2007) to define the minimum detectable effect size in a regression model with four predictors, given our sample size (N = 212), a power of .80, and a conventional alpha of .05. Results indicated that our model was sensitive enough to detect an effect size as small as f² = .057, a conventionally small-to-medium effect (Cohen, 1988).

Discussion

The main aim of this study was to assess the role that body image self-consciousness and partner-oriented sexual perfectionism play in predicting sexual distress and to test whether measures of grandiose and vulnerable narcissistic traits would account for incremental variance, thus contributing to sexual distress above and beyond sexual-specific variables.

We hypothesized that body image self-consciousness would be positively associated with sexual distress. This hypothesis was confirmed, with body image self-consciousness showing a positive and significant association with sexual distress. This means that, similarly to the extensive evidence on women’s samples (Woertman & van den Brink, 2012), experiencing concerns related to physical appearance in sexual contexts contributes to sexual distress also in men. A study by Meana and Nunnink (2006), focusing on the differences in cognitive distraction during sex between men and women, documented that men’s sexual dissatisfaction could be associated with negative body image and appearance-based distraction. As research suggests, the male body is depicted in the media as more muscular than in the past, increasing the pressure to conform to high bodily standards, and increasing the concerns and self-consciousness experienced by men towards their body (McDonagh et al., 2008; van den Brink et al., 2018). Being distracted by thoughts about the body and body monitoring while engaging in sexual relationships can have a negative influence on sexual functioning (Masters & Johnson, 1970; Silva et al., 2016), and particularly on the orgasmic response (Horvath et al., 2020). A recent review on the role that cognitive processing factors play concerning sexual functioning confirmed that they influence the way individuals respond to sexual episodes, fostering sexual difficulties (Tavares et al., 2020).

As for partner-oriented sexual perfectionism, it was not a significant predictor of sexual distress in our model. Previous research indicated that it is reductive to categorize sexual perfectionism as either adaptive or maladaptive when it comes to sexuality (Kluck et al., 2016). We argue that its contradictory and inconsistent associations with sexuality outcomes may be due to it being a variable that is centered exclusively on the other person. Indeed, it may not be adequate to capture the personal and subjective experience of distress. Future research might consider turning to, or including, the assessment of other components of sexual perfectionism such as self-oriented perfectionism, to assess their impact on sexual outcomes.

Furthermore, we argue that, when predicting sexual distress, there might be other variables at play, outside the realm of sexuality. Previous research has underlined the role of personality traits in sexuality (Allen & Walter, 2018), and, in line with this research trend, we assessed whether the presence of narcissistic personality traits was a significant predictor of sexual distress. We hypothesized that vulnerable (and not grandiose) traits of narcissism would be uniquely associated with sexual distress. This hypothesis was also confirmed by our data, which indicated that the higher the vulnerable narcissism, the higher the distress experienced in relation to sexual problems. On the contrary, no unique link was found between grandiose narcissism and sexual distress. This result is in line with previous studies that suggest that individuals with grandiose narcissistic traits experience less subjective distress than their vulnerable counterparts (Miller et al., 2017), and with studies that link vulnerable narcissism with negative outcomes regarding sexuality (Anzani et al., 2021). One possible explanation for the differential associations of grandiose and vulnerable narcissism to sexual distress is the role that neuroticism plays in vulnerable and grandiose narcissism (Miller et al., 2018), as well as in their operationalizations in the PNI. In fact, in a meta-analytic review, neuroticism was found to be the personality trait with the strongest positive association with sexual dissatisfaction and with symptoms of sexual dysfunctions (Allen & Walter, 2018). In this regard, it is important to note that neuroticism is at the core of vulnerable narcissism (Miller et al., 2018), while it is less salient in prototypically grandiose manifestations. At the same time and in spite of this, the scale of grandiose narcissism in the PNI, in particular, does include neurotic content (e.g. Miller et al., 2014), and PNI grandiosity was in fact positively correlated with sexual distress at the zero-order level. It is only when accounting for the shared variance between the two manifestations of pathological narcissism that grandiose narcissism became a non-significant predictor: this result mirrors recent evidence suggesting that the correlates of PNI grandiose narcissism align to the expectations more clearly when vulnerable narcissism is also controlled for in multivariate analyses (Crowe et al., 2019; Edershile et al., 2019). In other words, associations between narcissism and sexual distress are likely to mostly be driven by neuroticism/negative affectivity. This would explain why vulnerable narcissism, marked by high neuroticism, is uniquely linked to sexual distress; and why grandiose narcissism does not correlate with sexual distress if its “neurotic component” is partialled out.

Our findings should be interpreted in light of the study’s limitations. The first limitation are the small sample size and the lack of diversity in the sexual orientation of the sample. Recently, authors have argued that, when examining the body in relation to sexual functioning, men may differ based on their sexual orientation, and that within the gay community there is additional pressure on conforming to physical standards (Levitan et al., 2019; Pachankis et al., 2020). In addition, a study documented that gay (and lesbian) participants showed more self-reported cognitive distractions during sexual activity than heterosexual participants (Lacefield & Negy, 2012). Future research might make sure to include gay, bisexual, or pansexual participants. It might also be worth exploring, in future studies, how the experience of belonging to a gender identity minority may intersect with processes concerning body image and sexuality, since this line of research has thus far focused on the cisgender population. In addition, our study has a cross-sectional design, and the assessment of the variables of interest relies solely on self-report measures that are known to have the bias of self-serving and of social desirability, which are important aspects to consider when assessing narcissism. The PNI itself has been questioned in its ability to measure grandiose narcissism (Miller et al., 2016), although this is still debated (Wright, 2016) and emerging evidence indicates it may still be an adequate tool (Edershile et al., 2019). Future studies may investigate whether assessing the construct we analyzed through different study designs (such as mediation or moderation models, or other path analysis, or through structural equation modeling), can provide a further overview of the complex associations that occur among them. Finally, since our factors only explained a relatively low proportion of variance in sexual distress, future research should explore the role of additional relevant predictors.

One strength of our research is that it replicates the association between body image self-consciousness and sexual distress in men, an association previously investigated primarily in female samples. We argue that our results contribute to the understanding of the factors that impact and shape sexual distress, thus orienting future research toward further investigation of both sexual-related variables and personality traits. In particular, personality is related to different facets of sexuality (Allen & Walter, 2018) but research thus far has paid little attention to the role of narcissism. Yet, due to its underlying psychological processes, narcissism is believed to be a predictor of sexuality-related outcomes (McNulty & Widman, 2013).

Although based on a nonclinical sample, the results of the present research have clinical implications. Our results highlight the importance of assessing issues related to body image when working around sexual issues with men, as well as women. Furthermore, in clinical settings, it may be worth investigating the sexual functioning and satisfaction of the person, when pathological narcissistic traits, especially vulnerable ones, are present.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Throughout the text we refer to females or males, and to women or men, meaning individuals who were assigned a given sex at birth, and presumably have a gender identity that is aligned with that sex.