To understand how genital self-image affects sexual well-being, it is important to consider its influence on sexual function and distress. It is also important to learn what type of genital appearance is considered visually appealing to men and women, and whether genitalia modified by cosmetic surgery are judged as more attractive compared to unmodified genitalia. The present study assessed women’s genital self-image, sexual functioning and sexual distress in order to elucidate the relationship between these three elements of sexual well-being. Additionally, genital photographs were presented to men and women in order to assess conceptions of female genital attractiveness relative to surgical status (i.e. before and after). Four hundred and seventy-six women (M age=24.38) completed online questionnaires to assess genital self-image, sexual satisfaction, functioning and distress. The female sample along with 429 men (M age = 27.47) also reviewed pictures of pre- and post-surgery genitalia and rated them on levels of attractiveness. The Female Genital Self-Image Scale, the Relational Concern and Personal Concern subscales of the Sexual Satisfaction Scale – Women, and the Female Sexual Functioning Index were administered. Genital self-image was positively correlated with functioning variables including arousal, lubrication, orgasm, satisfaction and pain, and negatively correlated with sexual distress. Men rated unaltered and altered genitalia as more attractive than women; older participants rated unaltered and altered genitalia as more attractive than younger participants, and men and women of all ages found altered genitalia more attractive than unaltered genitalia.Women with positive genital self-image experience higher levels of sexual functioning and lower levels of sexual distress. Female genitalia modified by genital cosmetic surgery are considered more attractive regardless of age and gender. / text