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Objective To evaluate the perception of women living in Puerto Rico regarding their genitalia and explore the associations of those perceptions with female sexual distress. Methods Women from Puerto Rico willing to complete a self‐administered online survey from June 2018 through July 2020 were included in this cross‐sectional study. Inclusion criteria included being between 21 and 65 years of age, living in Puerto Rico, having identified as heterosexual, bisexual, or lesbian, and having been sexually active. Descriptive statistics were calculated. The Mann–Whitney test, Pearson's correlation, and robust linear regression were used to associate female genital self‐image and sexual distress. Results The most common negative thought and perception within women was dissatisfaction with the size of their genitalia (21.9%), and 21.3% of women contemplated undergoing cosmetic surgery, mainly to increase and improve sensation. For each 1‐unit increase in the Female Genital Self‐Image Scale score, the Female Sexual Distress Scale‐Revised score decreased by 1.24 units (95% confidence interval –1.67 to –0.82). Conclusion A better genital self‐image perception might lower levels of sexual distress. Screening instruments could help to identify poor genital perception and sexual distress.

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