Private places -- private shame: Women's genital body image and sexual health

Body image dissatisfaction is prevalent among women, affecting many components of their sexual health. The increase in female genital cosmetic surgery indicates that women may be experiencing dissatisfaction with even those parts of their body considered to be private -- their genitals.;Research has been constrained by lack of a reliable and valid instrument to measure genital body image. The purpose of this study was to explore the relationship between genital body image, global body image, and sexual health while psychometrically testing a previously developed instrument -- The Genital Self Image Scale (GSIS). Lower scores on the GSIS indicate more genital body image dissatisfaction. Four diverse groups were utilized: young, nulliparous women (N = 192), women post childbirth (N = 56), women with pelvic organ prolapse (N = 47) and older women without prolapse (N = 45).;Content validity was determined using a panel of five experts (three gynecologic surgeons and two sex therapists) resulting in a Content Validity Index of .79. Through item reduction and content validity testing the GSIS was reduced to 20 items and renamed the GSIS-20. Factor analysis was performed using principal component analysis with oblique rotation revealing four factors, identified as Genital Confidence, Appeal, Function and Comfort. Internal consistency for the GSIS-20 was satisfactory across samples (.79 - .89) as was test-retest reliability (r = .883). There was a positive correlation between the GSIS-20 and sexual function (r = .330 - .416) for all groups except women post childbirth (r = .050). In all groups there was a positive correlation between GSIS-20 scores and global body image (.412 - .503). Women with prolapse had significantly lower GSIS-20 scores (t = 2.34, p< .05) than women in the control group. Women who indicated an interest in genital cosmetic surgery had significantly lower GSIS-20 scores than women who did not (t = 5.53, p < .01).;Reliability and validity of the GSIS-20 was supported across diverse samples of women. In this study pelvic organ prolapse negatively affected genital body image and genital body image dissatisfaction negatively affected women's sexual health. Implications for clinicians and researchers are discussed.