Pelvic floor disorders and body image concerns as determinants of sexual desire during pregnancy

Abstract

Pregnancy is a multidimensional process that leads to significant changes in a woman’s body image and sexual life. This study aimed to examine the relationships among pelvic floor dysfunction, body image perception, and sexual desire in pregnant women in the third trimester, and to evaluate the predictive role of these variables on sexual desire. This cross-sectional study included 209 pregnant women in their third trimester (Mean age = 28.63, SD = 5.88) in the study. Participants completed the Pelvic Floor Distress Inventory-20 (PFDI-20), the Body Understanding Measure for Pregnancy Scale (BUMPS), the Sexual Interest and Desire Inventory-Female (SIDI-F), and the Attitude Scale Toward Sexuality During Pregnancy (ASTSP). In the third trimester, no significant differences were found between BMI subgroups in terms of pelvic floor dysfunction, sexual desire, or sexual attitudes, similar to the findings in the primigravidae and multigravidae subgroup. Correlation analyses revealed significant relationships between increased pelvic floor dysfunction and decreased sexual desire, as well as more negative sexual attitudes. On the other hand, although limited, an increase in sexual desire was observed with poorer body image perception. Regression analyses showed that pelvic floor dysfunction and body image were significant predictors of sexual desire, independent of demographic and obstetric variables. The results indicate that sexual desire during pregnancy is influenced not only by physiological factors but also by psychosocial factors such as body image and pelvic health, and it is recommended that these aspects be integrated into prenatal care processes.

Introduction

Pregnancy is not only a physiological transformation process in a woman’s life, but also a multifaceted period that has profound effects on sexual, psychological, and social dimensions. It has been shown that various factors during the early, active, and post-pregnancy periods are closely related to women’s sexual and psychological well-being¹. During pregnancy, heightened emotional sensitivity and hormonal changes increase the incidence of mood disorders such as depression, anxiety, and stress, while factors including prenatal stress, low social support, and negative body image may further exacerbate this process². There are correlations between body image dissatisfaction during pregnancy and perinatal depression, postpartum depression, antenatal anxiety, and long-term anxiety. Although the available evidence is limited, existing findings suggest a possible association between mental health and body image dissatisfaction³. Sexual life is also significantly influenced by body image changes and cultural norms during pregnancy⁴. Body image directly affects a woman’s sexual pleasure and behaviors; low body satisfaction can result in sexual aversion and avoidance behaviors⁵.

Common pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, and anorectal dysfunctions, not only cause several physical health problems but also directly affect the quality of sexual life⁶. Approximately 25% of women report urinary incontinence, while 19% report anal incontinence. Furthermore, anatomical pelvic organ prolapse is observed in up to 50% of women who have given birth, with 20% of them experiencing symptoms. When sexual health is considered a fundamental component of individuals’ overall health and well-being, the impact of these physical issues on women’s quality of life becomes even more apparent⁷.

Pregnancy and childbirth induce profound transformations in the female body. Weight gain, stretch marks, appearance changes due to abdominal muscle dysfunction, and changes in vaginal tissue elasticity during this process can lead to negative body image perceptions for many women. Body image perception refers to how individuals perceive physical changes in their bodies and the cognitive, emotional, and attitudinal evaluations associated with these changes. It encompasses personal feelings and attitudes toward body size, shape, and appearance and is further shaped by the physiological, social, and psychological changes occurring during pregnancy^8,9. The accompanying dissatisfaction can damage a woman’s confidence in her body, resulting in decreased sexual desire, lack of self-confidence, and emotional distance in relationships¹⁰. Body image dissatisfaction not only reduces sexual pleasure and satisfaction but also creates a negative attitude toward sexuality in general¹. In pregnant women experiencing clinically significant psychosocial distress (e.g., low social support, anxiety, or negative body image), failure to manage this process with adequate psychosocial support and professional counseling can lead to long-term sexual dysfunction and serious sexual health problems, including relationship breakdown⁵.

The World Health Organization defines sexual health as a fundamental component of individuals’ overall health and well-being¹¹. In this context, in order to achieve holistic well-being, it is crucial to consider sexual health alongside the physical and psychological changes experienced by women during pregnancy and the postpartum period. This ensures that individuals attain complete physical, emotional, mental, and social well-being². During active pregnancy and the postpartum period, psychosocial and cultural factors directly influence women’s sexual health. Sexuality, which has a significant impact on individual well-being and interpersonal relationships, greatly affects overall quality of life¹². This situation may also lead to negative cognitive, emotional, and behavioral outcomes for the child and decrease the quality of mother-infant interaction. Furthermore, it may weaken the mother’s ability to bond with the baby and reduce both the intention and duration of breastfeeding³. At this point, a well-structured sexual health education program can serve as an effective intervention to improve the quality of sexual life during pregnancy, prevent pregnancy-related sexual problems, and support the sexual health of both the pregnant woman and her partner⁵. Considering these factors, the first aim of this study is to evaluate attitudes toward sexuality during pregnancy among women in their third trimester and to examine the relationship between sexual desire, body image, and pelvic floor dysfunction, as well as to identify factors influencing sexual desire. The second aim of the study is to investigate sexual desire and pelvic floor dysfunction across subgroups based on sexual attitude, parity (primigravidae and multigravidae), and body mass index (BMI).

Materials and methods

Participants

A cross-sectional study design was employed, whereby a quantitative method was used to collect data via validated outcome measures. The study was conducted between March 1, 2025 and May 1, 2025 at Mardin Training and Research Hospital. Participants were recruited consecutively from the Non-Stress Test (NST) unit of the obstetrics and gynecology department during routine antenatal follow-up visits. Pregnant women who attended the NST unit during the study period were screened for eligibility by the research team. Convenience sampling was used in the study. A total of 209 pregnant women were included in the study. The inclusion criteria were: (a) to be able to communicate in Turkish, and (b) being in the third trimester of pregnancy. The exclusion criteria were: (a) a diagnosis of mental or psychiatric disorders, (b) pregestational urinary and/or fecal incontinence, (c) illiteracy, (d) a history of surgery within the past month, (e) acute infection, and (f) skeletal disorders affecting the pelvis.

Measures

Demographics

Sociodemographic and obstetric information of the participants, such as age, gestational week, parity, and mode of delivery in previous births, were evaluated. Anthropometric measurements including height, body weight, and body mass index were recorded. Participants were also asked about the languages they spoke.

Pelvic floor dysfunction assessment

Participants’ complaints related to pelvic floor dysfunction and the severity of these complaints were assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20). This inventory was developed by Matthew Barber et al., has a Cronbach’s alpha of 0.88¹³, and consists of 20 items across three subscales: (a) Pelvic Organ Prolapse Distress, (b) Urinary Distress, and (c) Colorectal Distress. The scale is scored on a scale of 0–100 points. Higher total scores indicate greater pelvic floor dysfunction. The Turkish version of the scale was used in this study¹⁴.

Body image assessment

Body image perceptions of the participants were assessed using the Body Understanding Measure for Pregnancy Scale (BUMPS). This scale was developed by Kirk et al.¹⁵, and includes three subdimensions with a Cronbach’s alpha of 0.91: pregnancy appearance, weight gain concerns, and physical burden of pregnancy. The scale is scored between 18 and 90 points. Higher scores indicate a more negative perception of body image. The Turkish version of the scale consists of 18 items and was utilized¹⁶.

Sexual desire and attitude assessment

Participants’ sexual functions and attitudes were evaluated using the Sexual Interest and Desire Inventory-Female (SIDI-F) and the Attitude Scale Toward Sexuality During Pregnancy (ASTSP). The SIDI-F was developed by Clayton et al.¹⁷, demonstrates good internal consistency (Cronbach’s α = 0.90), and consists of 13 items. Some items are used for clinical evaluation and filtering purposes and contribute only a limited amount to the total score. In this context, the scale is scored between 0 and 51 points. Higher scores on this scale indicate higher sexual desire. The Turkish validated version was used¹⁸. The ASTSP, frequently used to assess pregnant women’s attitudes toward sexuality, was developed by Sezer and Erenel¹⁹ and demonstrates high internal consistency (Cronbach’s α = 0.92). It consists of 34 items. Higher scores reflect a more positive attitude toward sexuality during pregnancy. The maximum possible score on this scale is 170, with a cut-off score of 119 indicating a positive attitude. The Turkish version of the scale was applied in this study¹⁹.

Statistical analysis

Considering a similar study that evaluated pelvic floor dysfunction and sexual function in women²⁰, and using the G*Power 3.1.7 (Heinrich-Heine-Universität Düsseldorf, Germany) analysis program with a power of 95%, an alpha error of 5%, and an effect size of 0.37, the required sample size was calculated to be at least 89 pregnant women. All statistical analyses were performed using the SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Subgroup analyses were conducted separately according to primigravidae–multigravidae status, body mass index (BMI), mode of delivery, and positive–negative attitudes toward sexuality during pregnancy. BMI was categorized as Normal BMI, Overweight, and Obesity, while mode of delivery was categorized as Vaginal delivery or Cesarean delivery. Normality of the distribution was checked using skewness–kurtosis tests, histograms and Kolmogorov-Simirnov or Shapiro–Wilk Test. Continuous data were expressed as mean with standard deviation (SD) or median with 25th–75th percentiles, and categorical data as n (%). To assess differences between the subgroups, the independent-sample t-test was used for parametric data, the Mann–Whitney U test for non-parametric data for two subgroups. For comparisons among three subgroups, one-way ANOVA or Kruskal–Wallis tests have been applied according to normality of the distribution. Correlations between the variables were investigated using the Pearson correlation or Spearman’s correlation according to the normality of distribution. It was accepted that a correlation coefficient (r) between the variables between 0.20 and 0.39 is a weak correlation, between 0.40 and 0.59 is moderate, between 0.60 and 0.79 is strong, and between 0.80 and 1.0 is a very strong correlation²¹. Multiple linear regression analysis with the enter model was performed to find the independent variables that had the greatest effect on sexual desire. p < 0.05 was considered statistically significant in all analyses.

Ethical approval

Ethical approval for the study was obtained from the Non-Interventional Research Ethics Committee of Mardin Artuklu University (Date: 28/02/2025, Protocol number: 2025/2-51). All participants provided written informed consent prior to participation in the study. All methods were carried out in accordance with relevant guidelines and regulations and in compliance with the Declaration of Helsinki.

Results

The mean age of the 209 participants was 28.6 ± 5.9 years. Overall, the study population was predominantly overweight or obese according to BMI classification. The mean gestational age was 35.4 ± 3.4 weeks, indicating that most participants were in late pregnancy. Detailed sociodemographic and anthropometric characteristics are presented in Table 1.

Table 1.

Sociodemographic and obstetric characteristics of the participants.

Variables	n = 209
Age	28.63 ± 5.88
Level of Education	Illiterate: 17 (%8.1) Literate: 5 (%2.4) Primary education: 116 (%55.5) High School: 59 (%28.2) Bachelor’s Degree: 12 (%5.7)
Height (cm)	163.73 ± 11.26
Weight (kg)	75.05 ± 11.38
Body Mass Index (kg/m2)	28.2 ± 4.54
Subgroup of Body Mass Index	Normal: 43 (%20.6) Overweight: 105 (%50.2) Class I Obesity: 48 (%23) Class II Obesity: 10 (%4.8) Class III Obesity: 3 (%1.4)
Primi-Multi Gravidae Status	Primigravidae: 67 (%32) Multigravidae:142 (%68)
Gestational Week	35.41 ± 3.41
Parity	2.31 ± 1.35
Previous Mode of Delivery (n = 142)	Vaginal Delivery: 95 (%66.9) Cesarean Delivery: 47 (%33.1)

Participants were classified into normal weight, overweight, and obese groups based on BMI classification²². When pelvic floor dysfunction, sexual desire, attitudes toward sexuality, and body image were compared among these groups, no statistically significant differences were found in terms of pelvic floor dysfunction (F = 0.304, p = 0.738), sexual desire (F = 2.560, p = 0.08), or attitudes toward sexuality (F = 0.594, p = 0.553). However, a statistically significant difference was observed in body image scores (F = 8.115, p < 0.001). Participants with a normal BMI had significantly more positive body image perceptions compared to those in the overweight and obese categories. The comparison of scale scores by BMI classification is presented in Table 2.

Table 2.

Comparison of pelvic floor dysfunction, sexual desire, sexual attitudes, and body image across BMI subgroups.

	Normal BMI (n = 43)	Overweight (n = 105)	Obesity (n = 61)	F	p
Pelvic Floor Dysfunction	25.86 ± 10.64	24.33 ± 11.15	24.72 ± 10.34	0.304	0.738
Sexual Desire	17.30 ± 11.17	21.03 ± 10.31	18.21 ± 10.06	2.560	0.08
Sexual Attitude	95.25 ± 14.83	92.33 ± 14.92	94.31 ± 16.26	0.594	0.553
Body Image	54.06 ± 8.62*	58.17 ± 9.12	61.45 ± 9.78	8.115	< 0.001

BMI: body mass index, F: one-way Anova, * p < 0.05.

Among individuals scoring below the 119 cutoff point on the attitude toward sexuality scale, 183 exhibited a negative attitude, while 26 showed a positive attitude. When comparing those with negative and positive attitudes in terms of Pelvic Floor Dysfunction, Sexual Desire, and Body Image, it was found that individuals with a positive attitude had significantly lower mean PFD-20 scores (t = −3.644, p < 0.001) and higher BUMPs scores (t = −2.690, p = 0.008) than those with a negative attitude. Comparisons based on negative and positive sexual attitudes during pregnancy are presented in Table 3.

Table 3.

Comparison of pelvic floor dysfunction, sexual desire, and body image between sexual attitude groups defined by cutoff scores.

	Negative attitude (n = 183)	Positive attitude (n = 26)	t	p
Pelvic Floor Dysfunction	31.76 ± 12.76	23.76 ± 10.12	−3.644	< 0.001*
Sexual Desire	19.92 ± 10.45	16.03 ± 10.38	1.776	0.077
Body Image	57.62 ± 9.38	62.92 ± 9.43	−2.690	0.008*

t: independent sample T test, *p < 0.05.

Participants were grouped according to their previous mode of delivery as either vaginal birth or cesarean section. When compared in terms of outcome measures, those with a history of vaginal delivery had significantly higher levels of pelvic floor dysfunction (t = 2.118, p = 0.036), whereas no significant differences were found between the groups regarding sexual desire, attitude toward sexuality, and body image (p > 0.05). The primary outcome measures based on previous mode of delivery are presented in Table 4.

Table 4.

Comparison of pelvic floor dysfunction, sexual desire, sexual attitudes, and body image across delivery mode groups.

	Vaginal delivery (n = 95)	Cesarean delivery (n = 47)	t	p
Pelvic Floor Dysfunction	26.78 ± 11.7	22.48 ± 9.41	2.118	0.036*
Sexual Desire	18.38 ± 10.09	18.69 ± 10.62	−0.163	0.870
Sexual Attitude	94.55 ± 18.87	93.39 ± 15.64	0.357	0.722
Body Image	58.47 ± 9.5	57.23 ± 9.67	0.707	0.481

t: independent sample T test, * p < 0.05.

The comparison of pelvic floor dysfunction, sexual desire, sexual attitude, and body image between primigravidae and multigravidae women is presented in Table 5. Pelvic floor dysfunction was similar between the groups (t = −0.913, p = 0.362), as were sexual desire (t = 1.963, p = 0.051), sexual attitude (t = −0.787, p = 0.432), and body image (t = 0.425, p = 0.671).

Table 5.

Comparison of pelvic floor dysfunction, sexual desire, sexual attitudes, and body image between primigravid and multigravid women.

	Primigravidae (n = 67)	Multigravidae (n = 142)	t	p
Pelvic Floor Dysfunction	23.77 ± 10.78	25.23 ± 10.92	−0.913	0.362
Sexual Desire	21.48 ± 10.91	18.46 ± 10.19	1.963	0.051
Sexual Attitude	92.23 ± 13.43	94.12 ± 17.48	−0.787	0.432
Body Image	58.69 ± 9.78	58.09 ± 9.43	0.425	0.671

t: independent sample T test, * p < 0.05.

The results of correlation analyses examining the relationships between sociodemographic data, obstetric variables, and primary outcome measures are presented in Table 6. According to the correlation analysis, a statistically significant weak negative correlation was found between pelvic floor dysfunction and sexual desire (rho = −0.207, p = 0.003), while a weak negative correlation was observed between sexual attitude and pelvic floor dysfunction (rho = −0.247, p < 0.001). A weak positive correlation was found between body image and sexual desire (rho = 0.163, p = 0.018).

Table 6.

Correlations between age, pelvic floor dysfunction, and psychosexual characteristics.s

		Body image	Sexual attitude	Sexual desire	Pelvic floor dysfunction	Urinary distress	Colorectal distress	Prolapsus distress	Parity	Gestational week	BMI
Sexual Attitude	rho	0.116
	p	0.094
Sexual Desire	rho	0.163*	−0.045
	p	0.018	0.521
Pelvic Floor Dysfunction	rho	−0.113	−0.247*	−0.207*
	p	0.102	< 0.001	0.003
Urinary Distress	rho	−0.013	0.118	−0.207*	0.793*
	p	0.847	0.088	0.003	< 0.001
Colorectal Distress	rho	−0.091	−0.266*	−0.106	0.792*	0.430*
	p	0.192	< 0.001	0.128	< 0.001	< 0.001
Prolapsus Distress	rho	−0.120	−0.181*	−0.128	0.744*	0.422*	0.434*
	p	0.083	0.009	0.066	p < 0.001	p < 0.001	< 0.001
Parity	rho	−0.068	0.097	−0.129	0.110	0.083	0.019	0.086
	p	0.330	0.161	0.062	0.112	0.230	0.780	0.213
Gestational Week	rho	−0.118	−0.371*	0.006	−0.02	0.04	−0.058	−0.09	−0.027
	p	0.089	< 0.001	0.923	0.736	0.489	0.401	0.195	0.698
BMI	rho	0.216*	−0.010	−0.051	−0.018	0.043	−0.115	0.021	0.125	−0.079
	p	0.002	0.883	0.462	0.793	0.541	0.099	0.764	0.071	0.257
Age	rho	−0.029	0.03	−0.117	0.122	0.108	0.042	0.063	0.604*	−0.095	0.085
	p	0.672	0.666	0.091	0.077	0.121	0.546	0.361	< 0.001	0.173	0.221

BMI: body mass ındex, rho: spearman correlation coefficient, * p < 0.05. Bold values indicate statistically significant results (p 0.05).

A multiple linear regression analysis using the enter method was conducted to identify the factors influencing sexual desire, with pelvic floor dysfunction and body image included as independent variables (Table 7). While pelvic floor dysfunction negatively affected sexual desire (t = −2.394, p = 0.018), body image dissatisfaction had a positive effect on sexual desire (t = 2.064, p = 0.04). The model explained 5% of the variance (F = 5.465, Tolerance = 0.992, VIF = 1.008, p = 0.005).

Table 7.

The effect of pelvic floor dysfunction and body image on sexual desire.

	Unstandardized coefficients		Confidence interval		T	p
	Beta	SS	Lower	Upper
Constant	14.343	4.861	4.761	23.926	2.951	0.004*
Pelvic Floor Dysfunction	−0.159	0.066	−0.290	−0.028	−2.394	0.018*
Body Image	0.155	0.075	0.007	0.303	2.064	0.04*

Enter Model, linear regression analysis.

Discussion

This study was conducted to assess pregnant women’s sexual attitudes during pregnancy, and to determine the effects of pelvic floor muscle dysfunctions and body image on sexual desire. The sexual attitudes, sexual desire, body image, and pelvic floor muscle dysfunctions of pregnant women were assessed. Most of the participants were overweight according to BMI and were in the third trimester. It was found that the pregnant women who had a high level pelvic floor muscle dysfunction also had a negative attitude toward sexual activity during pregnancy. Body image and pelvic floor muscle dysfunction were identified as significant predictors of sexual desire. While impaired body image perception increased sexual desire, increased pelvic floor dysfunction had a negative effect on sexual desire.

Pelvic floor dysfunction is a condition that is commonly observed in pregnant women. Vertical pressure exerted by the upper pelvic organs on the pelvic floor, together with increased laxity of pelvic ligaments, may be considered among the principal causes²³. Particularly during the second and third trimesters, the increasing uterus size and the compression of pelvic organs contribute to urinary incontinence²⁴.

Pregnant women with pelvic floor dysfunction may also experience self-confidence issues and limitations in social and sexual participation. It is hypothesized that, in the later stages of pregnancy, pelvic floor dysfunction may exacerbate social and sexual participation restrictions and undermine self-confidence. Angelico et al. conducted a study which demonstrated that pelvic floor muscle training was associated with increased self-efficacy and higher social and sexual participation among pregnant women²⁵.

However, in this study, no significant correlation was found between pelvic floor dysfunction and age, gestational week, or parity. These findings may be explained by the fact that all of the participants were in the last trimester, with a mean gestational age of approximately 35 weeks. Nevertheless, pelvic floor dysfunction was found to be more common among women with a history of vaginal delivery, supporting the role of obstetric factors in pelvic floor impairment.

Sexual desire fluctuates during pregnancy. Sexual desire during pregnancy tends to decrease in the first trimester, largely due to fears of harming the fetus, but reaches its peak in the second trimester²⁶. During the last trimester, factors such as weight gain, increased abdominal volume, reduced mobility, decreased comfort, fatigue, and pelvic organ pressure may contribute to a reduction in sexual desire²⁶. Therefore, it is particularly important to examine the effects of pelvic floor dysfunction and body image on sexual desire. During pregnancy, not only sexual desire but also sexual attitude is important and is directly proportional to the desires of both partners. A lack of desire in one partner can negatively impact both the sexual desire and sexual attitude of the other partner²⁷. It has been reported that male partners generally experience lower levels of sexual desire in the last trimester²⁶. This may partly explain the decrease in sexual desire observed among pregnant women during this period. Strong spousal support during pregnancy contributes positively to sexual activity, both in terms of quality and attitudes²⁸. Although primigravida or multigravida status is considered a factor that may affect sexuality during pregnancy, Gandhi et al. reported that²⁹ it does not influence sexual desire or function, which is consistent with the findings of this study. The results of this study also show that even if attitudes towards sexuality are positive during pregnancy, sexual desire may be low.

One of the parameters that changes throughout pregnancy and is related to many factors is body image perception. During pregnancy, body image perception can be negatively affected, particularly by changing body measurements⁸. Negative attitudes about body image can diminish self-esteem and contribute to difficulties in sexual functioning³⁰. Dikmen et al. observed that reduced self-esteem is associated with lower sexual desire and poorer sexual quality³¹. This study revealed a negative correlation between body image perception and sexual desire. In other words, as body image perception declined, sexual desire tended to increase. This finding may reflect underlying psychological mechanisms, whereby women with poorer body image perception engage more intensely with their partners as a compensatory strategy to maintain the relationship³². Further studies on the mediating and moderating factors in the effects of body image perception on sexual desire may shed light on this issue. Additionally, according to the results of this study, pelvic floor function, sexual desire, and attitudes did not differ between pregnant women with high BMI and those with normal BMI. This suggests that body changes did not affect sexual desire in this study sample. In pregnant women in the third trimester, it is possible that BMI changes may not affect attitudes toward sexuality due to the acceptance of the natural processes of pregnancy and bodily changes. The woman’s adaptation to her condition and her anticipation of BMI changes throughout the course of pregnancy may prevent potential distortions in her perspective on sexuality.

The literature highlights various parameters related to sexual desire and attitudes toward sexuality. In this study, a bivariate correlation was observed between sexual desire with pelvic floor dysfunction, and body image; whereas no significant association was found with age, BMI, parity, or gestational age. Furthermore, linear regression analysis demonstrated that pelvic floor dysfunction and body image were independently associated with sexual desire. Several studies have demonstrated a significant association between age and sexual desire^33,34, whereas Eryilmaz et al.³⁵ found no such relationship. A systematic review emphasized the need to examine age together with additional variables, highlighting the contradictory evidence in the existing literature²⁶. Age differences can produce diverse results, reflecting variations in social maturity, hormonal status, psychological characteristics, and the number of children. While parity alone has not been identified as a factor influencing sexual desire, higher gestational age has been associated with lower levels of sexual desire³³. Since most participants in this study had a gestational age exceeding 30 weeks, no such association was found. Previous studies provide conflicting evidence regarding the relationship between BMI and sexual desire in pregnancy. Some indicate a negative correlation with higher BMI^1,26, whereas others report no significant link³⁶. Similarly, the present study found no significant association between BMI and sexual desire, nor any differences in sexual desire or attitudes across BMI subgroups. As noted earlier, this may reflect compensatory strategies employed by women to sustain their partnerships.

Bodily changes and body image perception play a significant role in the assessment of sexual function in pregnant women. Some studies have shown a significant relationship between sexual desire and sexual function during pregnancy and body image perception^37–39. However, other studies have failed to report a similar relationship^36,40. This raises questions about the impact of physical appearance on sexual desire. Sexual desire and sexual readiness should be specifically evaluated together in pregnant women. As demonstrated in the results of this study, there was no correlation—either positive or negative—between attitudes toward sexual activity and sexual desire. This suggests that a negative view of sexuality in a pregnant woman does not necessarily mean she lacks sexual desire. Considering the traditional social structure in which women are expected to suppress their sexual desire⁴¹, it may also be suggested that pregnant women, despite experiencing sexual desire, may be reluctant to engage in sexual activity.

According to the results of this study, pelvic floor dysfunction—especially with greater intensity in relation to urinary incontinence—was found to be associated with sexual desire. While some studies in the literature demonstrate a significant relationship between pelvic floor dysfunction and sexual desire^42–44, others have reported no such association^45,46. Pelvic floor dysfunction, in particular, may cause prolapse, changes in vaginal appearance, and urinary or fecal incontinence during intercourse, which can lead pregnant women to feel ashamed, reluctant, or withdrawn from sexual activity. Over time, this process may contribute to a decrease in sexual desire.

Given the significant role of sexuality in human life, its close relationship with anxiety and depression, partner bonding, and the profound physiological changes that occur during pregnancy, it is important to identify the determinants of sexual desire in pregnant women. The findings of this study indicate that pelvic floor dysfunction and body image are significant predictors of sexual desire. While impaired body image perception increased sexual desire, increased pelvic floor dysfunction had a negative effect on sexual desire. Although Abouzari-Gazafroodi et al. showed that sociodemographic features are the predictors of sexual desire in pregnants³³, there are no studies analyzing the effect of pelvic floor dysfunction on sexual desire in pregnant women. It was seen that the literature primarily reports associative findings rather than examining predictive or causal relationships. In a study conducted by Malary et al.⁴⁷, when they investigated the determinants of low sexual desire during pregnancy, they concluded that depression/anxiety, chronic stress, fatigue, trauma history, body image and relational factors were predictors of sexual desire. Additionally, Rados and colleagues stated in their study that body image is a predictor of sexual desire⁴⁸. While Rados and colleagues reported that low body image perception has a negative effect on sexual desire, the present study found the opposite, demonstrating positive effects. This discrepancy may be related to the participants’ psychosocial attitudes. As discussed earlier, the compensatory mechanism through which pregnant women may increase their sexual desire in order to maintain their partnered relationship could have influenced the participants in the current study.

While the World Health Organization (WHO) states that sexual activity is safe in healthy pregnancies, certain precautions should be observed⁴⁹. Pregnant women are advised to choose positions that do not put pressure on the abdomen or cause physical strain, particularly during the second and third trimesters. In cases of vaginal bleeding, amniotic fluid leakage, severe groin pain, or signs of premature labor, sexual intercourse should be discontinued and medical consultation sought. Moreover, sexually transmitted infections (STIs) pose a risk to both mother and fetus during pregnancy; therefore, if a partner is suspected of having an infection, condom use and prompt medical evaluation are essential.

The strengths of this study include the exploration of multiple predictors that may influence sexual desire, the simultaneous assessment of different parameters, and the evaluation of both sexual desire and attitudes toward sexuality during pregnancy. However, the study has certain limitations, such as the fact that participants generally had a high BMI and were all in the third trimester of pregnancy. Moreover, the inclusion of pregnant women from only a single region may have led to the influence of traditional and cultural factors on the study results. Future research could contribute by forming samples from different ethnic groups and regions, and by also evaluating psychosocial factors such as stress, anxiety, and depression.

Conclusion

This study revealed important findings by examining the effects of pelvic floor dysfunction and body image perception on sexual desire during pregnancy. The results demonstrate that body image perception and pelvic floor dysfunction are significant determinants of sexual desire in pregnancy. In particular, pelvic floor problems such as urinary incontinence were found to lead to a decrease in sexual desire, while negative body image perception was also shown to have a positive effect on sexual desire. However, no direct relationship was identified between sexual desire and attitudes toward sexuality. Although attitudes towards sexuality may seem positive during the third trimester of pregnancy, low sexual desire is a common occurrence. Attitudes toward sexuality during pregnancy are related to gestational week and pelvic floor dysfunction. In future research, psychosocial variables of women in different trimesters should be examined in greater detail, and the impact of factors such as partner support, cultural norms, and gender roles on sexual health could be evaluated through multidimensional approaches. Furthermore, it is recommended to elucidate the mediating mechanisms between body image, pelvic health, and sexual desire, and to develop individualized and holistic intervention programs.

Author contributions

Data collection: YY-NF. Data analysis and interpretation: BCÖ– YY. The author(s) read and approved the final manuscript. The first author (B.C.Ö) and the corresponding author (Y.Y) have the highest contribution in doing research and writing the manuscript.

Funding

Not applicable.

Data availability

The data are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare that there are no potential conflicts of interest, including any financial, personal or other relationships.

Ethics and consent to participate

Ethical approval for the study was obtained from the Non-Interventional Research Ethics Committee of XXXXX University (Date: 28/02/2025, Protocol number: 2025/2-51). All participants provided written informed consent indicating their voluntary participation in the study according to Helsinki Declaration.