Background: Sexual satisfaction is a key component of individual well-being and harmony in a couple. However, sexual dissatisfaction remains underexplored in sub-Saharan Africa, particularly in the Democratic Republic of Congo. This study aimed to identify factors associated with sexual dissatisfaction among couples in Kinshasa.

Methods: A community-based cross-sectional study was conducted over a 15-day period in six randomly selected neighborhoods of Kinshasa. Adults aged 18–64 years living in marital or cohabiting relationships were included using a two-stage probabilistic sampling method. Sexual satisfaction was assessed using the Index of Sexual Satisfaction (ISS). Independent variables included sociodemographic, medical, psychological, relational, sociocultural, and aesthetic factors. Data were collected through face-to-face interviews using a structured questionnaire. Multivariable logistic regression analysis was performed to identify independent factors associated with sexual dissatisfaction. Adjusted odds ratios (aORs) with 95% confidence intervals were reported.

Results: A total of 454 participants were included, of whom 56.6% were women. The median age was 34 years (IQR: 28–43). The prevalence of sexual dissatisfaction was 20% for the couple, 15 % in men and 24 % in women. In multivariable analysis, factors significantly associated with sexual dissatisfaction included poor sexual communication (aOR = 14.31; p < 0.001), moderate communication (aOR = 15.78; p < 0.001), high stress levels (aOR = 2.78; p = 0.002), infidelity (aOR = 2.01; p = 0.032), and sexual conflicts (aOR = 5.28; p < 0.001). Among women, key determinants included sociocultural stigma, shame associated with sexuality (aOR= 4.41; p=0.035), negative beliefs about contraception (aOR=3.99: p=0.041) and vulvar aesthetic concerns (aOR = 14.85), while the fact that women could speak out about sexual desire was protective (aOR = 0.13). Concerning male related factors, premature ejaculation (aOR = 3.48; p = 0.028) and interest in genital cosmetic surgery (aOR = 4.56; p = 0.005) were significantly associated with dissatisfaction in couples

Conclusion: Sexual satisfaction among couples in Kinshasa is strongly influenced not only by relational and psychosocial factors but also by genital aesthetic concerns, particularly among women. These findings highlight the need to integrate vulvar body image, sociocultural norm deconstruction, and sexual education into comprehensive care.

TBA