Body image influences sexuality in a powerful way. It affects not only how sexually confident you felt as an adolescent or young adult, but even how you feel as a mature adult — even if the issues that made you feel self -conscious back then have been resolved.

The factors making you feel ashamed as an adolescent might have been things like having buck teeth, not being tall enough or being too tall, acne, breast size, lack of muscles, your hair . . . the list is endless.

A positive self-image turns out to be one of the primary building blocks of sexual self-esteem. In "SexSmart: How Your Childhood Shaped Your Sexuality and What to Do About It," there are detailed case studies that reveal how damage to your self-image can create social anxiety and can tank your ability to feel sexual. pleasure.

Abusive parents who made openly hostile remarks to children about their appearance are a common source of negative self-images.

A happily married, very attractive neighbor of mine has a birthmark on her face, and her father told her that because of it, no one would ever want to marry her. Another father called his tall, gangly adolescent daughter “eleven legs.”

The first comment is clearly vicious. In the second case, the father thought that he was teasing. But teasing is not harmless. That young woman also grew up to think that no one would ever want to date or marry her.

Adolescents are cruel. It’s amazing how damaging old comments from friends and frenemies are to one’s self confidence. I vividly remember a friend of mine, I’ll call her Janice, telling me that my nose was too when I was in middle school. I had never worried about the size or shape of my nose before Janice said that. But afterward, I became acutely aware of my nose size — to poor effect, needless to say.

The memory of Janice saying that in the cafeteria is extremely vivid in my mind even now. I remember how we were sitting, and I picture her zinging me with that comment with a little smirk on her face.

Luckily, I managed to make peace with my nose size over the years. But others may not be so lucky. Memories of damaging comments can linger in your mind, affecting how good you feel about yourself sexually.

If childhood or adolescence, feelings of shame are prominent. In my practice, I have used eye movement desensitization and reprocessing (EMDR), a powerful therapeutic technique, to help patients overcome past trauma.

If you want to investigate EMDR, my friend and colleague Dr. Deborah Korn has just come out with a book entitled “Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal,” which describes just how helpful the technique is.

I highly recommend it.