Promoting women's genital self-image with vulva photographs and information about genital appearance and function: an online experiment.

Background: Women with more negative genital self-image are more likely to experience sexual dysfunction, less likely to protect themselves from sexually transmitted infections and unwanted pregnancy, and more likely to consider labiaplasty.

Aim: This study investigates whether women's genital self-image can be promoted via exposure to natural vulva diversity and information about genital appearance and function.

Methods: An online experiment was conducted as a two-arm randomized controlled trial including a vulva photographs only, photographs and information, and a control condition. Participants were 563 women aged 18-68 years (M = 27.6, SD = 8.3).

Outcomes: The primary outcome was the Genital Self-Image Scale; secondary outcomes included the Female Sexual Function Index, sexual health behavior, and interest in genital plastic surgery.

Results: Results indicated a significant main effect of time. Genital self-image increased significantly in all conditions immediately after the intervention (all p < .01, all partial η2 ≥ .03). In the group with vulva photographs, this increase remained stable at 2-week follow-up (p < .05, partial η2 = .02). Only women in the vulva photographs and information group showed a significantly more positive genital self-image at 8-week follow-up (p < .01, partial η2 = .05). Confirming the experimental effect, we found a significant group x time interaction (p < .001, partial η2 = .015). Planned contrasts indicated a significant group difference in genital self-image in the intervention groups vs. controls immediately after the intervention (p < .01, d = .53) and at the 2-week follow-up (p = .042, d = .41). No group differences were found at the 8-week follow-up (p < .60). The combined condition of photographs with information was not superior to photographs only at any time point. There were no effects on secondary outcomes (all p > .20).

Clinical translation: The results underscore that women's genital self-image can be improved rapidly and cost-effectively with education.

Strengths & limitations: This study is the first to examine the changeability of genital self-image in a large convenience sample using an experimental design. The intervention effect could only be shown in the short term. However, the effect was particularly impressive given that women's genital self-image was relatively positive prior to the intervention. The results may not generalize to women with a less positive genital self-image or those considering labiaplasty.

Conclusion: Exposure to photographs of natural vulvas with or without information about genital diversity and function is a useful tool for improving genital self-image in adult women, potentially benefiting sexual health and well-being.