Phenotype-based profiling of female sexual function in pregnancy: a cross-sectional study

Introduction: Sexual function during pregnancy is commonly described in terms of overall decline or sexual dysfunction prevalence, potentially overlooking heterogeneity across individual domains. We aimed to identify distinct sexual function phenotypes during pregnancy and to examine whether gestational diabetes mellitus (GDM) is associated with poorer sexual function or specific sexual profiles. Methods: In this cross-sectional observational study, 83 pregnant women undergoing routine GDM screening between weeks 24 and 28 of gestation completed the Female Sexual Function Index (FSFI). Clinical and obstetric data were collected. K-means cluster analysis on standardized FSFI domain scores identified multidomain phenotypes. Group comparisons and multivariable regression models were performed. Results: Sexual dysfunction was present in 51 of 83 women (61.4%). Three sexual phenotypes were identified: preserved sexual function (n=49), global sexual impairment (n=25), and desire-satisfaction dissociation (n=9). Pre-pregnancy weight differed across phenotypes (p=0.026). Hypertensive disorders of pregnancy, twin pregnancy, and conception by assisted reproductive technology (ART) were more frequent in the desire-satisfaction dissociation phenotype (p=0.024, p=0.042, and p=0.048, respectively). Older age (OR 1.15, 95% CI 1.01-1.32; p=0.041) and lower pre-pregnancy weight (OR 0.95, 95% CI 0.92-0.99; p=0.019) were independently associated with global sexual impairment. GDM was not associated with total FSFI score, sexual dysfunction prevalence, or phenotype distribution. Discussion: Female sexual function during pregnancy is heterogeneous and distributed across distinct multidomain phenotypes. Gestational diabetes mellitus did not explain this heterogeneity, whereas phenotype-based profiling identified distinctive sexual patterns. These findings support a more nuanced framework for studying sexuality in pregnancy beyond dichotomous definitions of dysfunction.