Introduction: This study aimed to determine pelvic pain and sexual dysfunction in primiparous pregnant women with varying levels of fear of childbirth (FOC). Methods: This is a descriptive correlational study. This study was conducted with 400 pregnant women at 24–40 weeks of gestation who applied to the obstetrics polyclinic of a hospital between January 2022 and March 2022. Data were collected through a personal information form, the Wijma Delivery Expectancy Questionnaire (W-DEQ-A), the Pelvic Pain Impact Questionnaire (PPIQ), and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) Female Form. Results: Of the 400 pregnant women, 232 (58%) had high/severe FOC. High/severe FOC was a risk factor that negatively affected pelvic pain and sexual function (frequency of sexual intercourse, communication, sexual satisfaction, avoidance, touching, vaginismus, and anorgasmia) in pregnant women (p < 0.000). In addition, pregnant women with high/severe FOC avoided vaginal examination (p = 0.016), had higher fear of vaginal examination (p = 0.004), experienced more pain or burning during sexual intercourse (p = 0.017), and had more fear of pain during sexual intercourse (p = 0.003). Conclusions: High/severe FOC during pregnancy is an important risk factor that negatively affects pelvic pain and sexual function. Policy Implications: Identifying pregnant women with high/severe FOC and support programs such as antenatal education programs or cognitive coping strategies to cope with FOC may be useful in preventing pelvic pain and sexual functions that may be negatively affected.