Without a doubt, American s**ual education needs a lot of work. Only 25 states even mandate that it be taught in public schools, and only 13 states require those s** ed programs to be medically accurate. In 2016, a study published by the Guttmacher Institute found today’s teens are actually receiving less education on topics like contraception and STI prevention than they did in years past.

In addition to improving access to this kind of basic s**ual health information, a new paper published by the American Journal of S**uality Education suggests we also need to expand the very definition of s**ual health. One big addition that the researchers behind the paper recommend: make body image a core part of the curriculum.

How body image affects s**ual well-being.

We don’t often think of body image as being directly related to our s** lives, much less our s**ual health, but a growing body of research shows the two are actually intimately related. Led by Virginia Ramseyer Winter, Ph.D., MSW, director of the University of Missouri Center for Body Image Research and Policy, the researchers outlined dozens of past studies that demonstrate this connection.

Most prominently, several studies have found negative body image is often associated with increased participation in risky s**ual behaviors among girls and women, including not using any contraceptives, having more unprotected s** with casual partners, and tending to be drunk before s**. Meanwhile, women who are more satisfied with their bodies are more likely to use condoms and less likely to have unprotected s** after drinking, Dr. Ramseyer Winter’s team reported: “Increased body image satisfaction acted as a protective factor for this population.”

Why would having poor body image lead girls to having more unsafe s**? One 2002 study that surveyed 522 black teen girls suggests part of the problem is the s**ual beliefs and attitudes that tend to come with having a negative view of one’s own body: These girls tended to deal with a nagging fear of being abandoned while asking their partners about using condoms, and they also worried about things like not having a lot of “options” for s**ual partners and not having a lot of control in their relationships. They also tended to have generally low self-esteem and more symptoms of depression.

It seems that this concoction of negative beliefs about one’s own s**ual and personal worth can lead to difficulties with communicating, the researchers explained: “Self-objectification and poor body image may interfere with a young woman’s ability to advocate or negotiate on her behalf regarding her s**ual health.” But Dr. Ramseyer Winter’s past studies have demonstrated the opposite is also true: Women who feel better about their bodies tend to be more comfortable talking about s** in general, which likely allows them to better negotiate their s**ual boundaries and needs and thus make better decisions regarding their s**ual health.

In other words, being able to comfortably talk about s** is crucial to being able to advocate for oneself in bed, and that comfort is usually closely related to how comfortable a person is with their own body. That makes sense—s** involves a person being naked and exposed, and if the idea of their body being viewed like that is frightening to them, it’ll be harder to confidently talk about s** without all those negative feelings getting in the way.

Indeed, just this month another study found that your perception of your partner’s appreciation of your body can affect your own s**ual functioning. If you perceive your partner as loving your body, you have more s**ual desire, arousal, lubrication, orgasms, satisfaction, and relationship satisfaction.

Why we need a larger definition of “s**ual health.”

Part of the problem is our conceptualization of s**ual education as primarily a means of preventing negative health outcomes without talking much about how to promote good s**ual outcomes—things like more s**ual pleasure, confidence, and overall well-being.

“Instead of considering overall improved s**ual health of the individual, s**uality education curricula tend to focus most heavily on reducing unplanned or teen pregnancy and s**ually transmitted infections,” the researchers point out in the paper. “While results from curricula with the aforementioned focuses provide significant immediate results showing improved condom use or abstinence, the results are not significant over time. To work toward a model of s**ual health that is more than the absence of negative s**ual-health-related outcomes, we must approach s** education from a theoretical perspective that is congruent with this definition.”

The researchers recommended an assessment of current s** ed curriculum and the addition of body image as a core topic for all kids. While people of all genders struggle with body insecurities, the researchers noted that girls tend to be more prone to “self-objectification,” or internalizing other people’s views of their physical appearance, which makes them particularly susceptible to body image issues. A 2006 study found upward of 80 percent of young women reported experiencing dissatisfaction with their bodies, and a 2012 study on girls in the eighth, 10th, and 12th grades found girls experience a decrease in satisfaction with their bodies as they move through adolescence (with Latina girls particularly experiencing this hit to their self-esteem as they got older).

“New curricula should begin prior to puberty, as girls experience intense negative shifts in their body image during puberty and should be delivered in all settings (e.g., churches, schools, community centers),” the researchers recommend. “We can truly make s**uality education comprehensive and reflective of theoretical constructs relevant to girls. New curricula [would] incorporate topics beyond the traditional birth control and STI prevention messages, such as body image, race, gender, relationships, and more.”

If body confidence can begin in the classroom—with young people being actively encouraged to love their bodies—it might help set a precedent for healthier intimate relationships as adults.