3. Results

The average age of the women included in the study was 42.18 ± 11.57 (range: 22–75). 63.0% of the women were university graduates, 59.4% had a spouse with a university degree, and 54.4% were employed. 70.5% of the women did not have any chronic disease, and 86.5% did not have a diagnosed gynecological disease (Table 1). It was found that 70.1% of the women had no experience with gynecological surgery, 59.1% did not have regular gynecological examinations, and 46.3% had their last gynecological examination within the last year. It was found that 67.6% had not experienced any negative or uncomfortable incident during a gynecological examination before, and 52.0% did not have a preferred physician for gynecological examinations (Table 2). University graduates had higher average FGSIS scores than high school graduates, and employed women had higher average FGSIS scores than unemployed women, and the differences were statistically significant (p < 0.05) (Table 1). Women in the study who regularly underwent gynecological examinations, those who had a gynecological examination in the last year, and those who preferred a male gynecological examiner had higher average FGSIS scores (p < 0.05) (Table 2). There were no differences in average FGSIS scores according to other sociodemographic and gynecological characteristics of women (p > 0.05).

Characteristics | n | Percentage | GEAS mean ± SD | FGSIS mean ± SD | DASS‐21 depression mean ± SD | DASS‐21 anxiety mean ± SD | DASS‐21 stress mean ± SD
Age
18–27a | 18 | 6.5 | 68.94 ± 10.97 | 19.77 ± 4.02 | 5.77 ± 4.08 | 5.11 ± 2.72 | 7.55 ± 3.88
28–37b | 97 | 34.5 | 66.10 ± 11.96 | 18.81 ± 3.53 | 5.93 ± 4.21 | 5.14 ± 3.36 | 7.58 ± 3.53
38–47c | 76 | 27.0 | 65.57 ± 10.59 | 18.94 ± 2.90 | 4.63 ± 3.23 | 4.31 ± 3.13 | 5.81 ± 3.55
48 years and olderd | 90 | 32.0 | 67.62 ± 13.22 | 18.43 ± 3.76 | 5.55 ± 3.35 | 4.70 ± 2.61 | 6.65 ± 2.67
Test and p | — | — | F = 0.687, p = 0.561 | F = 0.847, p = 0.469 | F = 1.880, p = 0.133 | F = 1.146, p = 0.331 | F = 4.443, p = 0.005between b and c
Educational status
Primary schoola | 44 | 15.6 | 68.40 ± 15.60 | 17.93 ± 3.55 | 5.79 ± 3.17 | 5.77 ± 2.72 | 7.00 ± 3.08
High schoolb | 60 | 21.4 | 66.53 ± 11.38 | 17.85 ± 3.63 | 6.65 ± 4.79 | 5.75 ± 3.54 | 7.48 ± 3.82
Universityc | 177 | 63.0 | 66.22 ± 11.12 | 19.32 ± 3.32 | 4.96 ± 3.31 | 4.19 ± 2.79 | 6.53 ± 3.26
Test and p | — | — | F = 0.591, p = 0.55 | F = 5.762, p = 0.004between b and c | F = 5.008, p = 0.007between b and c | F = 9.130, p < 0.001between a and cbetween b and c | F = 1.882, p = 0.154
Spouse’s educational status
Primary schoola | 44 | 15.7 | 65.18 ± 12.31 | 17.50 ± 4.28 | 6.11 ± 3.62 | 5.31 ± 2.58 | 6.97 ± 3.18
High schoolb | 70 | 24.9 | 67.24 ± 12.68 | 18.87 ± 3.24 | 6.20 ± 4.08 | 5.14 ± 3.71 | 7.15 ± 3.68
Universityc | 167 | 59.4 | 66.75 ± 11.59 | 19.02 ± 3.32 | 4.96 ± 3.50 | 4.47 ± 2.81 | 6.61 ± 3.29
Test and p | — | — | F = 0.422, p = 0.66 | F = 2.395, p = 0.093 | F = 3.632, p = 0.028between b and c | F = 2.017, p = 0.135 | F = 0.697, p = 0.449
Employment status
Employed | 153 | 54.4 | 66.47 ± 11.23 | 19.31 ± 3.45 | 5.02 ± 3.72 | 4.47 ± 3.07 | 6.50 ± 3.56
Unemployed | 128 | 45.6 | 66.81 ± 12.82 | 18.16 ± 3.43 | 5.96 ± 3.64 | 5.14 ± 2.97 | 7.16 ± 3.10
Test and p | — | — | t = ‐0.234, p = 0.815 | t = 2.785, p = 0.006 | t = 0.708, p = 0.035 | t = 0.863, p = 0.392 | t = −1.624, p = 0.101
Chronic illness
Yes | 83 | 29.5 | 68.37 ± 11.99 | 18.49 ± 3.80 | 6.34 ± 3.90 | 5.46 ± 3.28 | 7.25 ± 3.49
No | 198 | 70.5 | 65.89 ± 11.90 | 18.91 ± 3.34 | 5.07 ± 3.57 | 4.48 ± 2.89 | 6.62 ± 3.31
Test and p | — | — | t = 1.586, p = 0.11 | t = ‐0.921, p = 0.358 | t = 2.653, p = 0.012 | t = 2.499, p = 0.019 | t = 1.435, p = 0.163
Gynecological disease
Yes | 38 | 13.5 | 68.15 ± 9.78 | 17.89 ± 3.63 | 6.47 ± 4.26 | 5.63 ± 2.99 | 7.36 ± 3.98
No | 243 | 86.5 | 66.39 ± 12.26 | 18.93 ± 3.44 | 5.29 ± 3.59 | 4.64 ± 3.03 | 6.72 ± 3.26
Test and p | — | — | t = 0.846, p = 0.398 | t = −1.708, p = 0.089 | t = 1.833, p = 0.112 | t = 1.873, p = 0.06 | t = 1.102, p = 0.271

Characteristics | n | Percentage | GEAS mean ± SD | FGSIS mean ± SD | DASS‐21 depression mean ± SD | DASS‐21 anxiety mean ± SD | DASS‐21 stress mean ± SD
Experience with gynecological surgery
Yes | 84 | 29.9 | 68.71 ± 11.73 | 18.53 ± 3.07 | 6.28 ± 4.11 | 5.41 ± 3.24 | 7.25 ± 3.55
No | 197 | 70.1 | 65.74 ± 11.97 | 18.89 ± 3.65 | 5.09 ± 3.47 | 4.50 ± 2.91 | 6.61 ± 3.28
Test and p | — | — | t = 1.916, p = 0.056 | t = ‐0.798, p = 0.426 | t = 2.482, p = 0.022 | t = 2.323, p = 0.028 | t = 1.438, p = 0.152
Regular GYN examinations
Yes | 115 | 40.9 | 67.28 ± 11.11 | 19.82 ± 3.29 | 4.77 ± 3.28 | 4.32 ± 2.90 | 6.28 ± 3.32
No | 166 | 59.1 | 66.17 ± 12.52 | 18.07 ± 3.44 | 5.92 ± 3.92 | 5.09 ± 3.10 | 7.16 ± 3.36
Test and p | — | — | t = 0.766, p = 0.444 | t = 4.271, p < 0.001 | t = −2.575, p = 0.008 | t = −2.094, p = 0.035 | t = −2.169, p = 0.031
Last GYN examination
Within the last yeara | 130 | 46.3 | 66.45 ± 10.78 | 19.34 ± 3.54 | 4.89 ± 3.35 | 4.64 ± 3.07 | 6.40 ± 3.45
Within 1–3 yearsb | 68 | 24.2 | 66.75 ± 13.18 | 18.25 ± 3.29 | 5.91 ± 4.36 | 4.64 ± 2.96 | 7.14 ± 3.40
More than 3 yearsc | 56 | 19.9 | 66.98 ± 12.50 | 17.91 ± 3.35 | 6.10 ± 3.50 | 5.19 ± 3.02 | 7.21 ± 3.19
No examination has been performedd | 27 | 9.6 | 66.44 ± 13.55 | 19.29 ± 3.52 | 5.62 ± 3.77 | 4.85 ± 3.21 | 7.03 ± 3.21
Test and p | — | — | F = 0.030, p = 0.993 | F = 3.090, p = 0.028between a and c | F = 1.956, p = 0.121 | F = 0.479, p = 0.697 | F = 1.154, p = 0.328
Negative GYN experience
Yes | 64 | 22.8 | 69.65 ± 11.91 | 18.32 ± 3.73 | 6.12 ± 4.70 | 5.00 ± 3.28 | 7.12 ± 3.89
No | 190 | 67.6 | 65.98 ± 11.83 | 19.10 ± 3.45 | 5.12 ± 3.23 | 4.57 ± 2.91 | 6.66 ± 3.18
I do not remember | 27 | 9.6 | 64.00 ± 12.05 | 17.70 ± 2.78 | 6.14 ± 4.00 | 5.66 ± 3.29 | 7.03 ± 3.39
Test and p | — | — | F = 3.021, p = 0.05 | F = 2.653, p = 0.072 | F = 2.280, p = 0.104 | F = 1.759, p = 0.174 | F = 0.506, p = 0.604
GYN physician gender preference
I prefer a female doctora | 128 | 45.5 | 67.64 ± 12.86 | 18.39 ± 3.37 | 6.03 ± 3.68 | 5.12 ± 3.32 | 7.03 ± 3.30
I prefer a male doctorb | 7 | 2.5 | 65.71 ± 7.43 | 21.42 ± 2.37 | 3.57 ± 1.71 | 1.85 ± 1.67 | 3.14 ± 1.67
I have no preferencec | 146 | 52.0 | 65.78 ± 11.25 | 19.00 ± 3.57 | 5.03 ± 3.73 | 4.60 ± 2.74 | 6.78 ± 3.40
Test and p | — | — | F = 0.851, p = 0.428 | F = 3.141, p = 0.045between a and b | F = 3.443, p = 0.033between a and b | F = 4.384, p = 0.013between a and b, between b and c | F = 4.527, p = 0.012between a and b, between b and c

Statistically significant differences were found in DASS‐21 depression subscale scores among women based on their education status, spouse’s education level, employment status, and having a chronic illness (p < 0.05) (Table 1). Those with a high school education level had higher DASS‐21 depression subscale scores than those with a university education status, those who were unemployed had higher scores than those who were employed, and those with a chronic illness had higher scores than those without a chronic illness, all of which were statistically significant. Those with a primary school education had higher scores than those with a university education, those with a high school education had higher scores than those with a university education, and those with a chronic illness had higher DASS‐21 anxiety subscale scores than those without a chronic illness, all of which were statistically significant (p < 0.05) (Table 1).

Women with experience in gynecological surgery had higher mean scores on the DASS‐21 depression and anxiety subscales compared to those without, those who did not have regular gynecological examinations compared to those who did, and those who preferred female gynecological physicians compared to those who preferred male physicians; these differences were found to be statistically significant (p < 0.05) (Table 2). Women aged 28–37 had higher mean scores on the DASS‐21 stress subscale compared to women aged 38–47; this difference was also statistically significant (p < 0.05) (Table 1).

Furthermore, those who did not have regular gynecological examinations had higher mean DASS‐21 stress subscale scores than those who did, those who preferred female gynecological physicians had higher scores than those who preferred male physicians, and those who preferred male physicians had higher scores than those who had no preference (p < 0.05) (Table 2).

The total score on the gynecological examination anxiety scale was 66.62 ± 11.96 (min: 20–max: 100), indicating above‐moderate anxiety; the total score on the FGSIS was 18.79 ± 3.48 (min: 7–max: 28); and the mean scores on the DASS‐21 depression subscale were 5.45 ± 3.71 (mild depression), 4.77 ± 3.04 (mild anxiety), and 6.80 ± 3.37 (normal level) (Table 3). The prevalence rates for severe and very severe depression, anxiety, and stress were 7.5%, 15.7%, and 6.4%, respectively (Figure 1).

Figure 1: Women’s depression, anxiety, and stress levels (%).

Scales | Min–max scores on the scale | Min–max values obtained | Mean ± SD
Gynecological examination anxiety scale | 20–100 | 40–99 | 66.62 ± 11.96
GEAS subscales | Approach of health personnel | 4–20 | 4–20 | 12.51 ± 4.17
Experience of health personnel | 5–25 | 5–25 | 19.00 ± 5.89
Negative experiences | 5–25 | 6–25 | 15.62 ± 3.91
Hygienic reasons | 3–15 | 3–15 | 10.39 ± 3.23
Individual attitudes | 3–15 | 3–15 | 9.08 ± 2.54
Female genital self‐image scale | 7–28 | 10–28 | 18.79 ± 3.48
DASS‐21 subscales | Depression | 0–21 | 0–21 | 5.45 ± 3.71
Anxiety | 0–21 | 0–16 | 4.77 ± 3.04
Stress | 0–21 | 0–16 | 6.80 ± 3.37

In this study, a low‐level negative correlation was found between female genital self‐image and gynecological examination anxiety (r = −0.141, p < 0.05), and a low‐level negative correlation was found between the DASS‐21 depression subscale and the FGSIS (r = −0.320, p < 0.001). A low‐level negative correlation was found between the DASS‐21 anxiety subscale and the FGSIS (r = −0.295), and a low‐level negative correlation was found between the DASS‐21 stress subscale and the genital self‐image scale (r = −0.246, p < 0.001). A high‐level positive correlation was found between depression and anxiety (r = 0.712), a high‐level positive correlation between depression and stress (r = 0.730), and a moderate‐level positive correlation between stress and anxiety (r = 0.681, p < 0.001), (Table 4)

Scales | Gynecological examination anxiety scale | Female genital self‐image scale | DASS‐depression | DASS‐anxiety | DASS‐stress
Female genital self‐image scale | r | −0.141 | – | — | — | —
p | 0.018 | – | — | — | —
DASS‐depression | r | 0.081 | −0.320 | – | — | —
p | 0.175 | <0.001 | – | — | —
DASS‐anxiety | r | 0.083 | −0.295 | 0.712 | – | —
p | 0.165 | <0.001 | <0.001 | – | —
DASS‐stress | r | 0.079 | −0.246 | 0.730 | 0.681 | –
p | 0.185 | <0.001 | <0.001 | <0.001 | –

Multiple linear regression analysis revealed that previous negative experiences during gynecological examinations were significantly associated with higher levels of gynecological examination anxiety (β = 0.129, p = 0.033), whereas higher female genital self‐image was significantly associated with lower anxiety (β = −0.140, p = 0.027), (Table 5). None of the other variables, including age, educational level, having a chronic illness, diagnosed gynecological disease, experience with gynecological surgery, regular gynecological examination status, time since the last examination, and physician gender preference for gynecological examinations, showed any statistically significant association with anxiety (p > 0.05). In addition, hierarchical regression analysis was conducted to examine the contribution of variable blocks, and the results were largely consistent with the main analysis (see Table S1).

Coefficientsa
Model | Unstandardized coefficients | Standardized coefficients | t | Sig.
B | Std. error | β
1 | Constant | 73.363 | 5.572 | — | 13.166 | <0.001
Age | 0.014 | 0.068 | 0.014 | 0.208 | 0.836
Educational status (reference: primary school and high school) | −0.084 | 1.619 | −0.003 | −.052 | 0.959
Chronic illness (reference: yes) | 1.793 | 1.701 | 0.069 | 1.054 | 0.293
Gynecological disease(reference: yes) | −1.382 | 2.348 | −0.040 | −0.589 | 0.557
Experience with gynecological surgery(reference: yes) | 2.856 | 1.696 | 0.109 | 1.684 | 0.093
Regular GYN examinations (reference: no) | −2.576 | 1.694 | −0.106 | −1.520 | 0.130
Last GYN examination (reference: more than 3 years and no examination) | 1.611 | 1.779 | 0.062 | 0.905 | 0.366
Negative GYN experience (reference: yes) | 3.663 | 1.714 | 0.129 | 2.137 | 0.033
GYN physician gender preference (reference: I prefer a female doctor) | 1.684 | 1.454 | 0.070 | 1.158 | 0.248
Female genital self‐image | −0.482 | 0.217 | −0.140 | −2.224 | 0.027