Genital self-image as a correlate of sexual function in pregnancy: multivariable cross-sectional findings

Although women’s genital self-image was thought to be related to sexual function, evidence for this association during pregnancy was limited. Therefore, this study examined the relationship between genital self-image and sexual function among pregnant women. This study was conducted in northern Turkey between March and July 2025 at an Obstetrics and Pediatrics Training and Research Hospital with 1,000 pregnant women. The design was cross-sectional; participants were enrolled via consecutive sampling during routine antenatal visits. Sexual function was measured with the Female Sexual Function Index, 19-item version (FSFI-19), and genital self-image with the Female Genital Self-Image Scale (FGSIS). Statistical analyses reported Pearson correlations and multivariable linear regression models adjusted for age, parity, trimester, education, planned pregnancy, and years married, using HC3 robust standard errors. Most participants were aged 25–34 years (65.4%). Mean (SD) scores were FGSIS 17.42 (3.03) and FSFI-19 total 19.92 (4.77). Using the FSFI-19 cut-off of 26.55, 94.2% met screening criteria for likely sexual dysfunction (this threshold is not diagnostic in pregnancy). Genital self-image correlated positively with sexual function (FGSIS–FSFI: r = 0.489; domain r ≈ 0.32–0.47; all p < 0.001). In multivariable models, higher FGSIS remained associated with higher FSFI total (β = 0.408; p < 0.001; Adjusted R²=0.070; F(8, 991) = 9.98). Multiparity was also associated with higher FSFI (p < 0.001), whereas age, trimester, education, planned pregnancy, and years married showed no consistent adjusted associations. A more positive genital self-image is associated with better sexual function during pregnancy, independent of core demographic and obstetric factors. However, causality cannot be inferred from cross-sectional data. Although the effect size is modest, these findings highlight genital self-image as a potential target for psychosocial assessment and support in antenatal care. Longitudinal, multi-site studies using probabilistic/stratified sampling and testing mediating/moderating pathways are warranted to clarify temporality and inform interventions.