Change in the shape of the abdomen after pregnancy, weight change or ageing is common, and many women wonder how it affects intimacy. Research has not measured abdominal sagging directly. What it does measure is overall body image, and that is linked with sexual function and sexual satisfaction. A systematic review of 15 qualitative studies on women’s perceptions of sexual function after childbirth found body image concerns among the themes women report, and a systematic review of 47 studies on genital self-image placed overall body image among the factors associated with how women see themselves sexually.
What do women say after childbirth?
Women commonly describe changes in desire, arousal and comfort during the postpartum period, together with concern about how their bodies look and feel. These accounts appear across different settings, and they often surface under conditions of limited support and little open discussion.
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Mejia-Mercado et al., 2026, in the Journal of Midwifery & Women’s Health, reviewed 15 qualitative studies from diverse cultural settings on women’s perceptions of sexual function after childbirth. Recurring themes covered psychosexual adjustment, sexual functioning, and contextual and relational factors. Women often reported pain, fear, diminished desire, body image concerns and cultural constraints, frequently amid insufficient support and a broader silence around these matters.
This was a qualitative synthesis, so it documents experiences rather than frequencies. It offers no prevalence figure, which means the proportion of women reporting any single concern cannot be estimated from it. Abdominal appearance was not a measured variable in the reviewed studies.
How are body image and sexual function related?
Across studies, women who report a poorer view of their own bodies also tend to report lower sexual function, including lower desire and less satisfaction. This pattern reflects an association between measures, not one thing producing the other. It says nothing about direction or about the abdomen.
Marvi et al., 2026, in the Journal of Education and Health Promotion, reviewed observational studies of body image and sexual function in peri- and postmenopausal women. Of 487 studies identified, 6 met the inclusion criteria. Poorer body image was associated with lower sexual function, and the association depended on demographic factors.
The evidence base was observational and small, so poorer body image is associated with lower sexual function and cannot be said to cause it. The included studies did not measure abdominal sagging or loose skin, so no claim about the abdomen follows from them.
How common is sexual distress in pregnancy?
Sexual distress is reported by a substantial minority of pregnant women. A meta-analysis estimated that 34.9% of pregnant women experience sexual distress, with a wide confidence interval and very high heterogeneity between the studies pooled, meaning the single figure should be read as an average rather than as a fixed rate.
Senoglu et al., 2026, in the Journal of Sexual Medicine, pooled 6 studies with a combined sample of 4295 and estimated a pooled prevalence of sexual distress in pregnancy of 34.9%, with a 95% CI of 27.9 to 42.7. Satisfaction with body image before and during pregnancy was among the factors associated with that distress.
Heterogeneity was very high, with an I2 of 95.1%, so the pooled figure averages studies that differ considerably from one another. The review also included only studies published in English and Turkish, which limits how far the estimate extends to other populations. Neither the abdomen nor pannus was measured.
Does overall body image connect to sexual self-image?
Yes, the two are linked in the available literature. A systematic review of female genital self-image found that how women feel about their genitals is associated with their broader body image and self-esteem, among other factors. The review did not examine the abdomen.
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Ghorbani et al., 2026, in the Journal of Sexual Medicine, reviewed 47 studies covering 33,734 people on female genital self-image. Associated factors fell into demographic, physical, sexual and psychological categories, and overall body image and self-esteem appeared among them.
Most of the included studies were cross-sectional, so no causal inference can be drawn; a link between body image and sexual self-perception does not show which drives the other. This review addresses genital self-image, and abdominal sagging or pannus was not measured in any study cited in this article.
How can couples cope with this concern?
Couples can start by naming the worry plainly and without blame, so that a concern about appearance is not mistaken for a loss of interest in the partner. Attention can then shift toward sensation, closeness and what feels comfortable, rather than toward an external judgement of how the body looks.
Practical adjustments help some couples: choosing lighting that feels comfortable, trying positions that reduce self-consciousness, and pacing contact so that neither partner feels assessed. Body acceptance tends to build gradually, and partners can say what they find attractive rather than avoiding the subject. Anyone with a physical concern about the abdomen should see a doctor.
Our editorial position is that these studies are about body image in general; what they establish is an association, not that abdominal changes cause sexual problems. [More research needed: whether Iranian and Iranian-diaspora samples show the same pattern is not examined in this article’s sources.]
Mejía-Mercado V, Gallego-Gómez C, Torres-Costoso A, Martínez-Vizcaíno V, Quezada-Bascuñán CA, Martínez-Bustelo S, Rodríguez-Gutiérrez E, de Arenas-Arroyo SN, Ferri-Morales A. Women’s Perceptions of Sexual Function During the Postpartum Period: Systematic Review of Qualitative Evidence. J Midwifery Womens Health. 2026. PMID: 42610361. DOI: 10.1111/jmwh.70178
Marvi N, Khadivzadeh T, Erfanian Arghavanian F. Relationship between body image and sexual function in peri and postmenopausal women: A systematic review. J Educ Health Promot. 2026;15:215. PMID: 42328381. DOI: 10.4103/jehp.jehp_1934_24
Şenoğlu A, Akça Eİ, Karaçam Z, Kurnaz D. Prevalence rates of sexual distress during pregnancy and influencing factors: a systematic review and meta-analysis. J Sex Med. 2026;23(7). PMID: 42296273. DOI: 10.1093/jsxmed/qdag179
Ghorbani Z, Rastegar F, Sattari M, Abdnezhad R, Khorsandi B, Taheri M, Alavi-Arjas F. Female genital self-image: a systematic review of predictive and associated factors. J Sex Med. 2026;23(9). PMID: 42614116. DOI: 10.1093/jsxmed/qdag237
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