Impact of Female Genital Self-Image on sexual function and associated risk factors

Female sexual function results of complex interactions between biological and non-biological factors. Assess the influence of genital self-image on sexual function in women. A cross-sectional online survey was conducted among Portuguese women aged >= 18 years between 4(th) of April and 22(nd )of June 2023. Demographic information, medical history, sexual behavior, Female Genital Self-Image Scale (FGSIS) and Female Sexual Function Index-6 (FSFI-6) were featured in the questionnaire. We included 482 participants; 40.6% (n = 191) were uncomfortable with their genital image (FGSIS < 22 points). In general, 20.3% were not satisfied with sexual life (n = 96) and 19.5% (n = 80) met the criteria for female sexual dysfunction (FSFI-6 score <= 19). Women with negative genital self-image had lower FSFI-6 scores than women comfortable with genital appearance (24.0 versus 26.0; p < 0.01), presenting higher rates of female sexual dysfunction (24.5% versus 16.0%; p = 0.039). Subscales of desire, arousal, satisfaction and pain were all worse in the negative genital self-image group. Genital appearance dissatisfaction increases the risk of female sexual dysfunction by 1.5 times. Post-menopausal women had higher rates of negative genital self-image (37.9% versus 65.9%; p < 0.001) and female sexual dysfunction (38.2% versus 17.4%; p = 0.006). Depression and endometriosis were associated with higher rates of genital dissatisfaction and sexual dysfunction. A history of unwanted sexual experiences was associated with negative genital self-image (51.9% versus 38.9%; p = 0.077). Genital self-image has an important impact in female sexual function, and it is a risk factor for female sexual dysfunction. Menopause, depression, endometriosis and unwanted sexual contacts may be risk factors for a negative perception of the genital image.