1. Introduction

Gynecological examination is a physical examination of a woman’s external and internal genital organs by a healthcare professional [1, 2], and unlike other examination methods, it affects women both physically and psychologically [3]. Although the examination duration is shorter than that of other medical assessments, it can elicit negative emotions in many individuals and is often perceived as an inappropriate procedure [4, 5]. Women generally express a loss of control during this process and, especially in emergency examinations, experience feelings such as anxiety, shame, fear, pain, embarrassment, and concerns about cleanliness and personal hygiene regarding the detection of diseases or pathological conditions [6, 7]. The use of instruments such as speculums, lack of information about the examination method, and discomfort experienced during the examination of genital organs—which individuals believe should be covered, hidden, and protected—can further complicate the process [8–10]. Therefore, gynecological examinations may be perceived as harmful, leading to reactions such as avoidance of examinations and reluctance to seek routine and diagnostic healthcare services [8, 10].

Many factors influence women’s decisions to undergo regular gynecological examinations. Studies have reported that women’s reasons for avoiding gynecological examinations include feelings of loss of control over their bodies, the examiner being of the opposite sex, the presence of multiple individuals in the examination room, negative perceptions of their genitalia, concerns about genital hygiene and odor, and the fear of experiencing pain during diagnosis and examination [11–15]. Increased concerns about violations of personal privacy and a greater focus on privacy issues can lead to increased anxiety levels and stress and negatively impact mental well‐being in women [16].

Anxiety is a significant factor that can prevent women from making the best use of healthcare services [17]. Gynecological examinations, while a routine part of a woman’s life, are often described as a medical procedure that frequently causes anxiety [18]. Studies in the literature report that women generally experience moderate anxiety before gynecological examinations [5, 9, 16, 17, 19–21]. Furthermore, a systematic review of 15 studies indicated that between 10% and 80% of women experienced fear, embarrassment, and anxiety related to gynecological examinations [22]. Research, particularly concerning genital self‐image, shows that some women avoid or postpone regular gynecological examinations due to anxiety about healthcare professionals visually evaluating their genital area [23].

A significant number of women report feelings of shame, anxiety about their health, fear of pain, and discomfort related to the exposure of their bodies. These emotional responses can negatively affect women’s willingness to participate in gynecological examinations and seek care. One study indicated that women’s genital self‐perception is a factor affecting participation in examinations [24]. In the study conducted by Timur Taşhan et al. [10], 24% of women stated that they had their first gynecological examination, 73.6% stated that they felt embarrassed during the examination, 61.6% stated that they experienced stress, and 74.8% stated that they felt uncomfortable due to the exposure of their private parts. In another study, it was determined that more than half of the women expressed anxiety about their health during pelvic examinations, ~42% experienced feelings of shame, and 18% were afraid of coming to the examination in their clothes and experiencing pain during the procedure [25]. Fathnezhad‐Kazemi et al. [19] revealed that 74.1% of women reported feelings of shame and embarrassment during gynecological examinations, and ~60% experienced stress. This process appears to be not only a physical but also a significantly psychological experience, suggesting that feelings of shame and stress can negatively impact women’s body image and genital self‐image.

Genital self‐image, considered a subdimension of body image, is a subjective concept encompassing an individual’s feelings, attitudes, and experiences regarding their genital organs [26, 27]. Genital self‐perception, on the other hand, includes a person’s thoughts and feelings about the appearance and function of their genital area and constitutes a fundamental component of the genital self‐image [28]. At the societal level, the pressure to conform to idealized and flawlessly presented vulvar and vaginal appearances may lead women to perceive their completely normal and biologically diverse genital anatomy as inadequate [29, 30]. Conversely, it has been reported that a positive genital self‐image increases the willingness of health professionals to evaluate the genital area [26]. Women who are dissatisfied with their genital appearance tend to postpone or not schedule clinical appointments at all, which can reduce their access to preventive health services [28].

Accordingly, women may experience anxiety about participating in gynecological examinations, and the identification of potential problems may be delayed, leading to negative outcomes. Women’s anxiety about gynecological examinations and their genital self‐image may interact with their mood levels; these psychological states can increase the severity of anxiety, intensifying avoidance behaviors and feelings of discomfort related to the examination.

In the current literature, gynecological examination anxiety has generally been addressed as a unidimensional phenomenon, and its relationship with sociodemographic data has mostly been examined [25, 31]. However, studies examining the relationship between gynecological examination anxiety and genital self‐image, a significant component of women’s body perception, are also limited [24]. Furthermore, the role of psychological variables such as depression, anxiety, and stress in this process has been evaluated separately in most studies, and holistic approaches that consider these variables together have not been sufficiently investigated [32, 33]. In this context, it can be said that there is a need for more research into studies that address gynecological examination anxiety, together with its psychological and body image dimensions. This study aims to examine the relationship between women’s gynecological examination anxiety levels, genital self‐image, depression, anxiety, and stress.

1.1. Research Questions

•What is women’s genital self‐image like?•What is the level of anxiety that women experience during gynecological examinations?•What are the levels of depression, anxiety, and stress among women?•Is there a relationship between women’s anxiety levels during gynecological examinations and their levels of depression, anxiety, and stress?•Which factors are associated with women’s anxiety during gynecological examinations?