Purpose <p>Concern about female genital self-image (FGSI) is increasing due to its implications for women's well-being. Previous research has linked negative FGSI to psychological distress. However, the underlying mechanisms of this association remain unclear, with shame and emotional dysregulation being potential mediators. This study aimed to test a serial mediation model in which FGSI is associated with psychological distress through shame and emotional dysregulation.</p> Methods <p>A cross-sectional design was employed, with a total of 445 women (Age: M = 40.22, SD = 10.69, range = 17–70) completing an online survey.</p> Results <p>Linear regression analysis revealed a significant association between psychological distress and both existential shame and limited access to emotion regulation strategies. FGSI and the remaining dimensions of shame and emotional dysregulation did not show a direct significant association with psychological distress. Mediation analysis confirmed that the relationship between FGSI and psychological distress was fully mediated by existential shame, limited access to emotion regulation strategies, and the serial mediation of these two variables.</p> Conclusion <p>These findings have important practical implications for the development of preventive and intervention strategies aimed at women with low FGSI, focusing on addressing feelings of maladaptive shame and enhancing effective emotion regulation strategies.</p>