Predicting Human Papillomavirus Infection in Women Based on Sexual Assertiveness, Body Image Shame, and Impulsiveness
Abstract
Background: Human papillomavirus (HPV) is among the most prevalent sexually transmitted infections worldwide. Understanding the psychological contributors to HPV infection is crucial for informing preventive strategies. We examined whether sexual assertiveness, body image shame, and impulsiveness predict HPV infection in women.
Methods: In this cross-sectional, predictive correlational study, 119 women aged 18 to 45 who underwent HPV testing in gynecology and oncology clinics in early 2024 were recruited via convenience sampling. Data were gathered using a demographic questionnaire and three standardized instruments: the Hurlbert Index of Sexual Assertiveness (HISA), the Body Image Shame Scale (BISS), and the Barratt Impulsiveness Scale (BIS). Logistic regression analysis was conducted using SPSS version 27.
Results: The participants had a mean age of 33.98 years, with 47.89% being single and 52.1% married. Among all participants, 40.3% tested positive for HPV. Body image shame and impulsiveness emerged as significant predictors of HPV infection risk (P < 0.001). External body image shame was identified as the most impactful subscale of body image shame, while cognitive impulsivity showed the strongest influence among the components of impulsiveness. However, the findings revealed no significant association between low sexual assertiveness and the risk of HPV infection (P > 0.05).
Conclusion: These findings highlight the role of psychological factors, especially body image shame and impulsiveness, in HPV risk. Integrating related interventions into public health measures like vaccination and screening may improve their effectiveness and enhance women’s sexual health outcomes.
2. De Brot L, Pellegrini B, Moretti ST, et al (2017). Infections with multiple high‐risk HPV types are associated with high‐grade and persistent low‐grade intraepi-thelial lesions of the cervix. Cancer Cyto-pathol, 125(2):138-43.
3. Soheili M, Keyvani H, Soheili M, Nasseri S (2021). Human papilloma virus: A review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Med J Islam Repub Iran, 35:65.
4. Lee H, Lee DH, Song YM, Lee K, Sung J, Ko G (2014). Risk factors associated with human papillomavirus infection status in a Korean cohort. Epidemiol In-fect, 142(8):1579-89.
5. Vinodhini K, Shanmughapriya S, Das BC, Natarajaseenivasan K (2012). Prevalence and risk factors of HPV infection among women from various provinces of the world. Arch Gynecol Obstet, 285(3):771-7.
6. Levál A (2012). Assessing infection risk and evaluating prevention strategies in the era of HPV-vaccines. Karolinska Institutet (Sweden),
7. Fahs B (2022). ‘I just tell myself it’s okay’: US women’s narratives about sexual safety and how they assess risk for sex-ually-transmitted infections. Psychology & Sexuality, 13(3):499-511.
8. Ngune I, Kalembo F, Loessl B, Kivuti-Bitok LW (2020). Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa. PLoS One, 15(8):e0237745.
9. French SE, Holland KJ (2013). Condom negotiation strategies as a mediator of the relationship between self-efficacy and condom use. J Sex Res, 50(1):48-59.
10. Littleton H, Breitkopf CR, Berenson A (2005). Body image and risky sexual be-haviors: An investigation in a tri-ethnic sample. Body Image, 2(2):193-8.
11. Schooler D, Ward LM, Merriwether A, Caruthers AS (2005). Cycles of shame: Menstrual shame, body shame, and sex-ual decision‐making. J Sex Res, 42(4):324-34.
12. Swami V, Weis L, Barron D, Furnham A (2017). Associations between positive body image, sexual liberalism, and un-conventional sexual practices in US adults. Arch Sex Behav, 46:2485-94.
13. Stanford MS, Mathias CW, Dougherty DM, et al (2009). Fifty years of the Barratt Impulsiveness Scale: An update and re-view. Personality and Individual Differences, 47(5):385-95.
14. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC (2001). Psychiat-ric aspects of impulsivity. Am J Psychiatry, 158(11):1783-93.
15. Kahn JA, Kaplowitz RA, Goodman E, Emans SJ (2002). The association be-tween impulsiveness and sexual risk be-haviors in adolescent and young adult women. J Adolesc Health, 30(4):229-32.
16. Hayaki J, Anderson BJ, Stein MD (2012). Sexual risk‐taking mediates the associa-tion between impulsivity and acquisition of sexually transmitted infections among hazardously drinking incarcer-ated women. Am J Addict, 21 Suppl 1(Suppl 1):S63-71.
17. Hurlbert DF (1991). The role of assertive-ness in female sexuality: A comparative study between sexually assertive and sexually nonassertive women. J Sex Mari-tal Ther, 17(3):183-90.
18. Sarabi P, Parvii F, Kakabaraee K (2019). The effectiveness of psychotherapy based on acceptance and commitment on sexual function, sexual guilt feeling, sexual self-consciousness, and sexual as-sertiveness among women with sexual dysfunction. Journal of Woman Cultural Psy-chology, 11(39):87–105.
19. Duarte C, Pinto‐Gouveia J, Ferreira C, Ba-tista D (2015). Body image as a source of shame: A new measure for the assess-ment of the multifaceted nature of body image shame. Clinical Psychol Psychother, 22(6):656-66.
20. Sadeghzadeh M (2021). Measuring Body-based Social Shame: The Psychometric Properties of Body Image Shame Scale (BISS) (in Iranian Female and Male Stu-dents). Cultural Psychology, 4(2):223-42.
21. Barratt ES, Stanford MS, Kent TA, Alan F (1997). Neuropsychological and cogni-tive psychophysiological substrates of impulsive aggression. Biol Psychiatry, 41(10):1045-61.
22. Salehi M, Beshlideh K, Kazemzade M (2020) Effectiveness of holographic re-processing therapy on cognitive emo-tion regulation strategies and impulsivity in women who attempted suicide in Ilam City. Quarterly Journal of Woman and Society, 11(43):171–92.
23. Faridi N, Vakilian K, Yousefi AA (2023). Effect of sexual empowerment counsel-ing on self-efficacy, assertive sexual communication, self-awareness, and sexual attitude, awareness of sexually transmitted diseases, and HIV in addict-ed women-an interventional study. Cur-rent Women's Health Reviews, 19(3):136-47.
24. Buffardi AL, Thomas KK, Holmes KK, Manhart LE (2008). Moving upstream: Ecosocial and psychosocial correlates of sexually transmitted infections among young adults in the United States. Am J Public Health, 98(6):1128-36.
| Files | ||
| Issue | Vol 54 No 9 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i9.19868 | |
| Keywords | ||
| Human papillomavirus Sexual assertiveness Body image shame Impulsiveness | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |



