Relationship Satisfaction and Body Image-Related Quality of Life as Correlates of Sexual Function During Pregnancy: A Systematic Review.

Abstract

<i>Background and Objectives:</i> Sexual function often fluctuates during pregnancy, yet the contributions of body image-related quality of life (BI-QoL)-operationalized via body image instruments such as the Body Exposure during Sexual Activities Questionnaire (BESAQ) and pregnancy-specific body image scales-and relationship satisfaction remain inconsistently quantified. This systematic review aimed to synthesize evidence on the associations between BI-QoL, relationship satisfaction, and female sexual function in pregnant women. <i>Methods:</i> Following PRISMA 2020, PubMed/MEDLINE, Scopus, and Web of Science were searched up to 23 August 2025. Eligible studies enrolled pregnant women and reported quantitative data on BI-QoL and/or relationship satisfaction alongside sexual outcomes. Risk-of-bias used design-appropriate tools; findings were narratively synthesized due to heterogeneity. <i>Results:</i> Thirteen studies met criteria (predominantly cross-sectional; sample sizes 107-472; one RCT; several couples/longitudinal cohorts). Female Sexual Function Index (FSFI) means clustered in the mid-20s; in a randomized trial, the intervention arm improved FSFI by +1.76 points (22.95 → 24.71; <i>p</i> = 0.002). Overall female sexual dysfunction reached 54.7% in the largest cross-sectional sample. Higher body exposure anxiety was associated with ~4.24-fold greater odds of dysfunction across trimesters. Marital satisfaction explained ≈36% of FSFI variance in multivariable models. Pregnancy context factors related to BI-QoL included planned pregnancy (β = -0.273) and third trimester (β = -0.280) indicating better BI-QoL, while more children predicted worse BI-QoL (β = +0.317). In one cohort, BI during sexual activity worsened postpartum versus pregnancy (<i>p</i> = 0.01). <i>Conclusions:</i> Across diverse settings, poorer BI-QoL and lower relationship satisfaction were consistently linked to reduced sexual function during pregnancy, with desire/arousal most affected. Routine screening and couple-sensitive counseling should be considered as promising, yet still under-tested, strategies that warrant further evaluation in intervention studies.