Objectification theory (Fredrickson B. L., & Roberts, T. A. (1997). Psychology of Women Quarterly, 21, 173-206) proposes that body image concerns impair sexual function and satisfaction. The present study was designed to test whether body shame was related to sexual problems and pleasure among heterosexual men and women (N = 320). Using structural equation modeling, we tested whether adult men and women's body shame was linked to greater sexual problems (lower sexual arousability and ability to reach orgasm) and less pleasure from physical intimacy. Although women were significantly more likely to report appearance concerns than men across sexual and non-sexual contexts, appearance concerns were positively related to both men and women's sexual problems. The relationship between body shame and sexual pleasure and problems was mediated by sexual self-consciousness during physical intimacy. Men and women's body shame was related to greater sexual self-consciousness, which in turn predicted lower sexual pleasure and sexual arousability. Results persisted controlling for relationship status and age. Being in a relationship was associated with less sexual self-consciousness and less orgasm difficulty for men and women. Although some paths were significantly stronger for women than for men, results largely supported the proposition that body concerns negatively affect sexual pleasure and promote sexual problems for both men and women. Findings were discussed in terms of objectification theory and the increased cultural emphasis on physical appearance.