Female genital self-image: a systematic review of predictive and associated factors.

INTRODUCTION: Female genital self-image (FGSI) is a critical component of body image and sexual well-being. A comprehensive synthesis of the factors influencing FGSI is essential for both clinical practice and future research. OBJECTIVES: This study examines the factors that predict or are associated with FGSI. METHODS: A methodical search was conducted across several academic databases-PubMed, Web of Science, Scopus, PsycINFO, Embase and Cochrane Library-to identify relevant studies published between January 2000 and June 2025. RESULTS: A total of 47 studies were considered suitable for inclusion in this review, encompassing data from 33 734 individuals. The studies exhibited heterogeneity in design (predominantly cross-sectional) and measurement instruments for FGSI. We found that factors associated with FGSI can be classified into four distinct categories, including demographic factors (eg, age, education, ethnicity, and relationship status), physical and anatomical factors (eg, vulvovaginal morphology, menstrual cycle characteristics, and genital conditions like pelvic floor discomfort symptoms), sexual factors (eg, sexual function, satisfaction, assertiveness, and experiences), and psychological factors (eg, overall body image, self-esteem, and depression). CONCLUSION: FGSI is a multifaceted construct that is influenced by a complex interplay of demographic, physical, sexual, and psychological factors. A clear understanding of these associated and predictive factors is vital for developing effective interventions aimed at promoting positive FGSI and overall sexual health in women. Given the cross-sectional nature of most included studies, causal inferences cannot be made. This review provides a foundational framework for both clinical assessment and future research in this field.