Sleep Matters for Intimacy: Impact of Sleep Quality and Psychosocial Context on Female Sexual Function During Pregnancy

<i>Background and Objectives</i>: Sleep disruption and reduced physical activity are common in pregnancy and may impair sexual function through mood, body-image, and relational pathways. We prospectively examined whether sleep quality and physical activity predicted third-trimester sexual function in a Romanian antenatal cohort, and explored psychosocial correlates. <i>Materials and Methods:</i> In a single-center cohort, 102 pregnant adults were enrolled ≤ 20 weeks and followed to the third trimester. Sleep (Pittsburgh Sleep Quality Index, PSQI), sexual function (Female Sexual Function Index-Romanian version, FSFI-RO), physical activity (IPAQ-SF), depressive symptoms (PHQ-9), body-image avoidance (Body Exposure during Sexual Activities Questionnaire, BESAQ), and perceived social support (MSPSS) were assessed. Groups were defined by mid-/late-pregnancy sleep (good, PSQI ≤ 5; poor, PSQI > 5). Analyses used <i>t</i>-tests, Pearson correlations, multivariable linear regression for FSFI-Total, and logistic regression for FSFI-Total < 26.55. <i>Results</i>: Compared with good sleepers (n = 56), women with poor sleep (n = 46) had lower third-trimester FSFI-Total (24.4 ± 3.9 vs. 27.9 ± 4.3; <i>p</i> < 0.001) and higher odds of FSFI-defined dysfunction (adjusted OR 121.1; 95% CI 19.2-763.0; <i>p</i> < 0.001). FSFI-Total correlated with worse sleep (PSQI r = -0.42), depressive symptoms (PHQ-9 r = -0.36), social support (MSPSS r = 0.40), body-image avoidance (BESAQ r = -0.34) and physical activity (IPAQ-SF r = 0.24; all <i>p</i> ≤ 0.015). In adjusted models (R² = 0.42), higher MSPSS (β = 0.26; <i>p</i> = 0.004) was protective, whereas PSQI (β = -0.24; <i>p</i> = 0.008), ΔPHQ-9 (β = -0.19; <i>p</i> = 0.023), BESAQ (β = -0.17; <i>p</i> = 0.031), and higher BMI (β = -0.14; <i>p</i> = 0.049) predicted lower FSFI-Total. <i>Conclusions</i>: In this antenatal cohort, poor sleep was strongly and independently associated with lower sexual function, with meaningful contributions from social support, mood, body-image cognition, and physical activity, highlighting sleep as a clinically actionable target for preserving sexual well-being in pregnancy.