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Women who feel negatively about female genitalia find it harder to have an orgasm and are less likely to get regular gynecological exams, says a new study from Indiana University.

They are also often more critical of their own genitals - and other women's - than men are, according to the study, published in the current issue of the International Journal of Sexual Health.

The anxiety some women feel about their genitals is rooted in messages gleaned from parents and pop culture, said study author Debby Herbenick, a sexual health educator with The Kinsey Institute for Research in Sex, Gender and Reproduction.

"Individuals may adopt negative attitudes toward women's genitals as a result of cultural-level scripts that suggest that women's genitals are unclean or dirty," writes Dr. Herbenick, who is also associate director of Indiana's University's Center for Sexual Health Promotion in the School of Health, Physical Education and Recreation.

Such scripts come from words used in feminine-hygiene commercials, for example, and the practice of some parents and teachers who instruct young girls not to touch themselves "down there."

Recalling the euphemistic television ads for Massengill douche - the ones in which mothers and daughters stroll a beach or sail while chatting about vaginal freshness - Dr. Herbenick said: "These images of the women walking on the beach are pretty salient in our minds. Growing up, we've seen these commercials. Even if we never felt like we bought into those ideas, we've certainly heard of them, we know them, we know the taglines.

"Women who are shopping for condoms in drugstores may see these sex wipes or baby wipes on the shelf, and even if they're not buying them, there's a sense with products that we don't see for men that women's genitals are dirty and need to be cleaned."

The study involved 362 women and 241 men aged 18 to 23. Dr. Herbenick asked them to rate statements such as "Women's genitals are beautiful," "Women's genitals are ugly," and others.

Women were particularly concerned about "the way their genitals look, as well as the way they smell and taste," Dr. Herbenick said.

Men were generally more positive than women, a point that didn't surprise the author.

"Men are more relaxed and open and accepting of women's genitals. Women are assuming the worst, and they're anxious, and men are just happy to be invited to the party."

This is because "women are just a lot more critical of all of their body parts," she said.

But such negative attitudes can have a direct impact on orgasm, she found. The women who were positive about female genitalia found it much easier to climax while receiving cunnilingus, probably because they weren't as anxious about how they looked or smelled, Dr. Herbenick wrote.

The findings suggest that body-image concerns have now extended to the vagina.

With the exception of the increasingly common "sex wipe" - this is effectively a baby wipe for adult women - current marketing campaigns have swung away from hygiene and now focus largely on appearance, Dr. Herbenick said. She pointed to the growing popularity of female genital cosmetic surgery, Brazilian waxing and ads for grooming products.

The author attributes the shift to the proliferation of hard-core pornography, in which vulvas have been standardized as hairless and uniformly shaped.

"There's this focus on women's genitals and how they look," Dr. Herbenick said.

She found that fixation is also affecting how often women see their gynecologist. Some are avoiding their doctor when they are suffering from symptoms such as odour and discharge, precisely the best time to visit a doctor for an accurate diagnosis, Dr. said.

Younger women, meanwhile, hesitate to go in for their first exam because "they're worried about how they look," she said. Still others are "too afraid" to self-examine at home, for fear of what they might see.

Dr. Herbenick said the findings could be useful for sex therapists, and could also guide parents in helping their daughters feel more comfortable in their own skin. That could include teaching them accurate names for their genitals - instead of "down there."

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