Interview conducted by Claire Vasseur, Slow Sex & Love Life editorial team. Isabelle Fontaine is an editorial composite figure grounded in the current state of the art in clinical sexology. Editorial portrait — this interview is a synthetic reconstruction based on current knowledge in clinical sexology. For context, see our pillar pieces on slow sex and mindful sexuality.
Female pleasure remains one of the most poorly mapped territories in contemporary medicine. Not for lack of data — research has multiplied since the 1990s — but because what matters most plays out in a space that clinical protocols have long overlooked: the relationship a woman has with her own body.
Isabelle Fontaine has spent 14 years working with women who experience what sexology labels “desire disorders” or “difficulties with sexual response.” In the vast majority of cases, she says, the root of the problem is not anatomical. It is relational — and the relationship in question is first and foremost the one a woman has with herself, with this body she looks at, judges, and monitors, sometimes since childhood. That is where pleasure begins or stops. Mindful sexuality offers a path to inhabiting that body differently — but as Isabelle Fontaine explains, the work begins with a fundamental reconciliation.
How body image blocks female pleasure
Claire: Isabelle, you often say that female pleasure begins in the mind, not the body. What exactly do you mean by that — and how does this mechanism show up clinically?
Isabelle Fontaine: I would reframe it this way: female pleasure begins in the relationship a woman has with her body. Not "in the head" in the purely cognitive sense, but in something more subtle — the quality of presence to oneself during intimacy.
What we observe clinically, and what Barbara Fredrickson and Tomi-Ann Roberts formalised back in 1997 in their objectification theory, is a phenomenon they call self-objectifying body surveillance. A woman who perceives her body as inadequate — too soft, too large, not smooth enough, not conforming to an internalised standard — develops a habit of watching herself from the outside, as if she were both actor and spectator of her own body.
This dual presence carries an enormous cost. Attention is finite: what you give to evaluation, you take away from sensation. In an intimate context, this surveillance diverts attention away from the bodily signals that build erotic response — warmth, pressure, vibration, rhythm — towards a constant mental activity of self-assessment. Pleasure then has no room to settle.
Lori Brotto, a researcher at the University of British Columbia and one of the most rigorous voices in contemporary female sexology, has repeatedly documented this link: women with negative body image have significantly lower scores for desire, arousal, and sexual satisfaction, even when all other parameters are comparable.
The role of culture and media in building a negative body image
Claire: Where does this negative body image come from? Is it an individual matter, a family matter, or is there a broader cultural dimension you see in your practice?
Isabelle Fontaine: All three, simultaneously — and that is what makes the work complex. Body image is built in successive layers, from childhood onwards, through several channels.
The first is family. Messages received about the body in one's family of origin — comments on weight, comparisons between sisters, reactions to pubescent changes — leave lasting imprints. A young girl who regularly hears "you've put on weight" or "you're not like your cousin" develops an early bodily vigilance that can run through her entire adult life.
The second is media and culture. We live in a visual environment that produces idealised female bodies at a pace no previous generation has known. Social media has aggravated this phenomenon in a documented way since 2018: studies on the impact of Instagram on the body image of women aged 18 to 35 show a clear correlation between time spent scrolling visual feeds and body dissatisfaction. This is not a question of individual fragility — it is massive exposure to unattainable standards.
The third is relational. Past intimate experiences — gazes, comments, partners' attitudes — reinforce or soften what family and culture have constructed. A woman may have developed a relatively stable body image, then find it destabilised by a relationship in which her body was criticised or poorly valued.
In practice, I always work to identify these three layers before proposing anything. You cannot change a body image built over 30 years with a single meditation session.
Body reconnection practices outside a sexual context
Claire: You insist that the work begins outside a sexual context. Why that priority — and what practices do you recommend?
Isabelle Fontaine: Because you cannot learn to swim in white water. If a woman has a difficult relationship with her body, asking her first to change that relationship in the context of intimacy — which is already the most exposed, the most vulnerable context — is placing the difficulty at its maximum intensity. That is rarely effective, and often discouraging.
The work begins in daily life, in ordinary situations where the body is present without stakes: in the shower, while walking, while cooking. The objective is simple: bring attention back inside. What do I feel? What is the temperature of the water? How do my feet move against the floor? These are mundane sensory anchors, but they retrain the capacity to inhabit the body from the inside rather than viewing it from the outside.
The practices I recommend first, because they are well-documented and accessible:
Gentle or yin yoga — not performance yoga, not the postures photographed for social media, but a slow practice attuned to sensation, with no aesthetic objective. Several studies since 2015 (including those from Lori Brotto's group) show that eight weeks of gentle yoga significantly improve functional body image and subjective sexual response in women with arousal difficulties.
Sophrology and progressive relaxation — simple, low-cost approaches that develop the body's inner vocabulary.
Body-sensation journalling — keeping a journal of physical sensations, not emotions, not thoughts. "This morning, my shoulders were raised. My stomach was tight during the meeting. After the walk, my legs felt heavy and warm." This practice may seem trivial. It rebuilds an attentiveness to the self that has often been systematically redirected outward.
The transition to intimacy: transferring bodily presence
Claire: How does the transition happen from this daily work to intimate life? That is often where the women you work with get stuck, isn't it?
Isabelle Fontaine: Yes, and that is precisely why we do not skip this step. The transition happens through progressive thresholds — what cognitive-behavioural therapists call graduated exposure.
We start with exercises in bodily attention in the presence of the other person, but outside any explicitly sexual framework. Non-sexual mindful touch — massaging hands, the back, the feet — is a valuable entry point. It relearns being touched without stakes, without evaluation, without objective.
Mindfulness applied to sexuality, as Lori Brotto formalised it in her MBSR programme adapted for female sexology, follows exactly this logic: you first train attention in neutral contexts (breathing, body scan, eating mindfully), then progressively transfer this capacity to contexts of increasing intimacy.
The key is not to force the transition. Many women put pressure on themselves to "heal" their relationship with their body quickly in order to "be available" for their partner. This pressure reactivates exactly the body surveillance the work is trying to reduce. The pace must be dictated by the woman herself — not by the relational agenda.
Emily Nagoski, in Come As You Are, uses an image I often return to in practice: female desire is more like a garden than a light switch. You do not turn it on — you create the conditions in which it can grow. Bodily presence is one of those foundational conditions. Exploring [couple intimacy rituals](/en/couple-intimacy-rituals/) can help build that environment together.
The partner’s role in body image during intimacy
Claire: What role does the partner play in this dynamic? Can their attitude genuinely change the way a woman perceives her own body?
Isabelle Fontaine: Considerably so — and in both directions. This is one of the points I make a point of establishing clearly at the beginning of any couples work.
A gaze perceived as genuinely desiring — not performative, not conditional, but truly present — can modify a woman's bodily experience during intimacy, even if her self-image is fragile. It is not magic, it is not sufficient on its own, but it is real. Validation through a loving gaze can temporarily reduce the intensity of self-objectifying body surveillance.
Conversely, and this is where the partner must be brought into the work: critical comments, even old ones, even made without intent to harm, can install themselves durably in a woman's body image. An apparently innocuous remark about weight, skin texture, or the shape of a breast can become an object of internal surveillance for years. Men (or partners) often do not register the impact of these words — not because they are insensitive, but because their own relationship with the body works differently.
For a solid grounding in the anatomical and physiological mechanisms that underlie this experience, it is genuinely useful to spend time understanding female anatomy and pleasure — a starting point I regularly recommend to my clients and their partners alike.
Body-image work in a couple is therefore not work on "her" — it is work on "us." The partner is not the cause of the problem, but they can be a powerful lever of transformation.
Misconceptions about the “right body” for pleasure
Claire: There are many beliefs around the body and female pleasure — in particular the idea that you need a certain type of body to have a fulfilling sex life. How do you address that in practice?
Isabelle Fontaine: These beliefs are among the most persistent I encounter — and among the most destructive, because they often remain implicit, unspoken. Nobody explicitly states "I don't deserve pleasure because I don't match an ideal." But that is often what behaviour expresses: avoiding certain positions, refusing to be looked at, systematically turning off the light.
The scientific evidence is clear: there is no documented link between the morphological characteristics of a female body and its capacity to experience pleasure. Erotic response depends on the central nervous system, emotional state, and quality of presence — not on the size of a thigh or a stomach. These correlations simply do not exist in the clinical literature.
What I do observe, however, is that women who have a benevolent relationship with their body — not necessarily one of intense love, simply one of neutral acceptance — have a significantly more satisfying intimate life than those who maintain a war-like relationship with their body. This is not a question of aesthetics. It is a question of inner availability.
Exploring [slow sex](/en/slow-sex/) practices is often where this shift becomes tangible: when the focus moves away from performance or appearance and towards sensory presence, body image loses its power to block pleasure.
Body image after pregnancy or significant physical changes
Claire: Pregnancy, breastfeeding, menopause — these transitions often upend a woman's relationship with her body. How do you support women through these moments?
Isabelle Fontaine: These bodily transitions are moments of particular vulnerability, because they modify the body in ways that are often rapid and visible, within a culture that prizes permanence and physical self-control.
After a pregnancy, the body has undergone a profound transformation — weight gain, changes to the breasts, sometimes scarring, chronic fatigue. Many women tell me they no longer recognise themselves in their own body, and feel a kind of strangeness to themselves that complicates any intimate contact. Added to this is often the pressure of a "return to the pre-pregnancy body" — cultural pressure, sometimes relational — which is not only unrealistic but deeply harmful.
My work in these situations begins with one simple thing: naming what the body has accomplished. Not in a forced-positivity mode — "your body is magnificent because it carried life" — but in a factual register. This body did something extraordinary. It deserves to be looked at with curiosity and respect, not with the demand of a return to a previous form.
For transitions related to menopause or to physical changes linked to ageing, the work is different but shares the same foundation: developing a relationship with the body based on what it feels, not on what it represents. Women who navigate these transitions well are rarely those who have "accepted" their body in a resigned sense — they are those who have developed a benevolent curiosity towards their own sensations.
When to seek professional help
Claire: At what point would you tell a woman that self-guided practices are no longer enough and that she needs to see a professional?
Isabelle Fontaine: There are clear signals. The first is persistence: if difficulty with body image or pleasure has lasted more than six months, resists sincere attempts at change, and generates suffering or avoidance, professional support is indicated.
The second is intensity. An intrusive thought about one's body during intimacy that returns every time, an inability to remain present during physical contact, regular dissociation — "I wasn't really there" — these are indicators that the work exceeds what self-guided practices can address alone.
The third is relational impact. When body-image difficulties begin to affect the couple dynamic significantly — avoidance of intimacy, recurring tension, a sense of inadequacy that spills into other areas of life — the therapeutic setting provides a structure and safety that self-work cannot offer.
I consistently recommend looking for a practitioner trained in both cognitive-behavioural approaches and a somatic dimension — the combination is what produces the best outcomes in the current literature. Acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT) adapted to sexuality are two particularly well-documented frameworks for body-image difficulties and female desire. Exploring what [mindful sexuality](/en/mindful-sexuality/) looks like in practice can also help a woman decide whether she is ready to work on this alone or with support.
“You need to love your body to experience pleasure.” Mostly false. You simply need to stop being at war with it. Neutral acceptance — “this body is mine, I trust it” — is sufficient as a starting point. Love of the body can develop along the way, but it is not a prerequisite.
“Women who have had children experience less pleasure.” False. No clinical data supports this claim. Post-partum changes (muscle tone, sensitivity) are real but temporary and largely reversible. What impacts post-partum pleasure is above all fatigue, stress, and shifts in body image — not an irreversible anatomical change.
“Female pleasure is more complicated than male pleasure.” Partially true, but poorly framed. Female pleasure is more conditioned by emotional and relational context — that is not a complication, it is a characteristic. Emily Nagoski speaks of a “dual control system”: an accelerator (positive stimulation) and a brake (inhibitors). In women, the brakes are often more active — and body image is one of the primary brakes.
“A confident woman is always sexually fulfilled.” False. General self-confidence and intimate body image are two distinct dimensions. Many women who are highly assured professionally or socially experience significant difficulties in their relationship with their naked body, in intimacy.
“Mindfulness practices make no difference to female pleasure.” False. This is one of the best-documented areas in sexology over the past ten years. Lori Brotto’s protocols (mindfulness-based sex therapy) show significant improvements in desire, arousal, and satisfaction in women with sexual response difficulties after eight weeks of guided practice.
“Body-image work is only for women with an eating disorder.” False. Self-objectifying body surveillance is a phenomenon present in a large majority of women, independent of any eating disorder. It is an adaptive response to a culture that objectifies the female body — not a clinical symptom reserved for a minority.
“Talking about your relationship with your body in a therapeutic session is embarrassing and not very useful.” False. It is often the most liberating conversation women report having in a professional setting. The initial discomfort is real — but it reflects precisely the taboo that the session seeks to undo.
3 things to take away from this interview
- Negative body image diverts attention from sensation towards self-evaluation — mechanically reducing access to pleasure. This mechanism is documented, understandable, and changeable.
- Reconnection work begins outside of intimate contexts: in daily life, in simple sensory practices, before progressively transferring to intimacy.
- The partner is not external to this work: their gaze, their attitude, and their words are real levers of transformation — in one direction or the other.
To go deeper into the themes covered in this interview, explore our pillar resources on slow sex, mindful sexuality, and couple intimacy rituals. Practices like orgasmic meditation offer another lens on embodied presence and body reconnection. For a deeper understanding of female anatomy and sexual health, clitoris-moi.ch is a valuable scientific resource. For holistic health and wellbeing support, masante-messoins.fr offers complementary resources on women’s health.