Introduction Pregnancy is characterized by physical, hormonal, and psychological changes that can affect women’s sexuality, and, for those who are in a dyadic relationship, it also affects the couple’s sexual relationship. On the other hand, the pregnancy state can function as a protective factor for body dissatisfaction as women embrace a new phase of the life cycle when body changes, namely more body volume, are expected. Aim To examine whether the effect of body dissatisfaction on sexual distress is mediated by cognitive distraction with the appearance of the body and to test a moderated mediation model of the impact of body dissatisfaction on sexual distress, with pregnancy used as the moderating factor. Methods In this cross-sectional study, 87 cisgender heterosexual women (50.6% pregnant; n = 44), aged between 25 and 40 years old (mean = 31.93; SD = 3.46) involved in an exclusive and committed dyadic relationship completed a web-based questionnaire. Main Outcome Measures Validated measures consisted of a validated general measure of body dissatisfaction (global body dissatisfaction scale), sexual distress (adapted from the National Survey of Sexual Attitudes and Lifestyles), and cognitive distraction based on body appearance during sexual activity (body appearance cognitive distraction scale). Results Results indicated that body dissatisfaction and sexual distress are related, but they are fully mediated by cognitive distraction. The mediation effect of cognitive distraction did not differ significantly by pregnancy status, after controlling for the trimester of pregnancy. Clinical Implications This study advances our understanding of sexuality during pregnancy by evaluating sexual distress and establishing that it is a clinically relevant variable related to body dissatisfaction that deserves attention from healthcare providers. Strength & Limitations This preliminary study uses a robust method of data analysis to test a theory-based cognitive model of sexual distress in pregnant women; however, no causality can be established. Conclusion The data highlights that pregnancy may not be a protective factor for the impact of body dissatisfaction on sexual distress.

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