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Try out PMC Labs and tell us what you think. Learn More. Background: Women often undergo physical changes during the menopause transition, but the relationship between body image and sexual function in midlife is unclear. We used a qualitative approach to explore how body image relates to sexual function and satisfaction in midlife women. Sessions were audiorecorded and transcribed. Two investigators developed a codebook using an iterative process; the primary investigator then coded all data.
Codes relating to body image were examined to identify key themes. All but two women identified as heterosexual. Feeling attractive was an important reason for sexual activity. Changes in appearance, especially weight gain and breast changes, were common among these women.
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Women's body image impacted their sexual satisfaction; women who felt self-conscious about their bodies reported that these concerns had a negative impact on their sexual satisfaction, whereas women who felt confident discussed better sexual satisfaction, even in the face of bodily changes. Black women were more likely to discuss feeling confident than White women.
Conclusions: Feeling attractive is important to sexual satisfaction in midlife women. Bodily changes, especially weight gain, are common during midlife. While many women are self-conscious about their appearance, some women develop increased self-acceptance.
Supporting positive body image may help midlife women maintain sexual satisfaction with aging. S exuality is an important component of the quality of life to many women as they age. In addition, many women experience changes in their bodies, 47 including weight gain or redistribution of weight 8 ; changes in sexual organs such as sagging of breasts 89 and vaginal changes 10 ; and changes in their face and hair, such as the development of wrinkles or gray hair.
Models of female sexual response can help healthcare providers and researchers more deeply understand and contextualize changes in sexual function. While prior models focused on physical aspects, a newer model, proposed by Rosemary Basson, highlights both physical and emotional aspects of female sexual response.
A woman's feelings about her own body and attractiveness may be an important aspect of whether or not desire occurs for her. This model also highlights that participating in sexual activity in not only physical outcomes, but also emotional outcomes, both of which are important to women. Feelings of attractiveness may be part of these emotional outcomes. While body dissatisfaction and negative body image are extremely common among women, 13—16 including midlife and older women, 17—20 body image does not necessarily worsen as women age.
There are differences between Black women and White women with regard to body image.
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Black women consistently report more positive body image than White women, even at higher weights. The relationship between body image and sexual function has been examined in prior quantitative studies, but most were conducted among college-aged women, not midlife women, and these studies are often limited by the use of nonvalidated measures of body image, sexual function, and sexual satisfaction. In the literature among younger women, negative body image was correlated with sexual problems, sexual dysfunction, and sexual dissatisfaction. In two studies, no associations were found between body image and sexual satisfaction, particularly after controlling for other factors such as menopausal and mood symptoms.
Body image, attractiveness, and sexual satisfaction among midlife women: a qualitative study
Because they use standardized questions and answer choices, quantitative studies may overlook nuances and individual variations in women's experiences. Qualitative research allows women to speak at length, using their own words, to describe aspects of phenomena that are most relevant to them. To our knowledge, no qualitative studies have specifically addressed the role of body image in sexual function and satisfaction in midlife women.
In this study, our aim was to use individual interviews and focus groups to explore the role of body image in sexual function and satisfaction in a racially diverse group of women 45—60 years of age. We recruited women from the general population of Pittsburgh, PA in and Women were recruited using flyers placed in community spaces and doctors' offices; social media advertisements; online newsletters; and the University of Pittsburgh Clinical and Translational Science Institute CTSI research registry.
Interested women contacted the study team and were screened for eligibility over the telephone. We included women who were 45—60 years old and had any partnered sexual activity in the prior 12 months. Sexual activity was broadly defined and included penetrative sex, oral sex, and intimate touching. Eligible women could choose to participate in either an individual interview or a focus group. Individual interviews allowed women who do not feel comfortable speaking in a Women looking for sex Hamm to participate, while focus groups allowed researchers to potentially uncover unique themes due to group synergy.
We used both to obtain a variety of perspectives. At the beginning of each interview or focus group, an informed consent script was read to the potential participant. This script highlighted that participation was voluntary and could be discontinued at any time; that all information would be kept confidential; and outlined potential risks and benefits of the study.
Women could then choose to remain and participate in the study or leave. All interviews and focus groups were conducted by a facilitator M. The facilitator took minimal notes during interviews, while the principal investigator H. Consistent with the emergent nature of qualitative research, not all questions on the interview guide were asked of every participant, and some participants may have been asked follow-up questions not included in the interview guide. The overall study was focused broadly on sexual function and satisfaction in midlife women, with some specific probing questions regarding body image.
Interviews and focus groups were audiorecorded and transcribed verbatim, omitting any names or other individual identifiers. The facilitator and principal investigator used an iterative approach to develop a codebook a list of short phrases with clear definitions and examples from the transcripts until a final codebook was agreed upon.
The principal investigator then used this codebook to as codes to all data.
A fine-grained, editing style was used to as codes. The text can then be reorganized, if necessary, so that its meaning can be more clearly seen.
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Overall kappa was 0. Women also completed brief demographic questionnaires, which were linked to transcripts using an anonymous identifier. Using a thematic analysis approach, all codes regarding body image were examined, and key themes and representative quotes were identified. All but two women self-identified as heterosexual, with one reporting homosexual and one marking both homosexual and not sure.
Three major themes emerged: 1 feeling attractive was an important reason for sexual activity; 2 changes in appearance, especially weight gain and breast changes, were common; and 3 response to changes in appearance affected sexual satisfaction. Many women expressed that feeling attractive was an important reason for sexual activity. Everybody wants to feel desired. Everybody wants to know their partner is all about them.
You need to feel that. If you can't feel pretty, if you can't feel happy, I mean, there's something missing, you know? They wanted confirmation that their partner was still physically attracted to them, even if they had been together for years.
Some women also emphasized that feeling attractive was not only an important outcome of sex, but also a prerequisite for sex. Very hard to feel any of that when I feel like huge and fat … just bleh, out of shape, really big, I feel very unattractive. And it doesn't matter how many times he tells me otherwise. If I don't feel it, I'm just not as much fun in bed.
In contrast, there were several women who mentioned how feeling attractive had become a less important reason for sex as they got older. Interviewer: You mentioned when you were younger the orgasm being more of a driving force. A year-old White woman: That, and feeling sexy and attractive and all that other stuff, it was almost like part of your identity.
Like having someone say that you Women looking for sex Hamm sexy was kind of what you were going after. I don't go after looking sexy anymore … I'm satisfied with what I do, who I am, and having sex or being sexy isn't a part of that. Other women agreed that, as they got older, they felt more self-confident and did not need as much external validation. Women also discussed how, particularly in the context of a long-term relationship, feeling attractive became less important to their sexual satisfaction as time went by. Interviewer: And do concerns about your looks or your body affect your sexual satisfaction at all?
A year-old White woman: You know what? Yes, but I've managed to kind of put those things on the back burner and not let them bother me … [I]n the early times of our relationship, I was a bit self-conscious about my weight … I don't think that physical attractiveness is necessarily the most important thing in a relationship. Physical looks fade over the time of your life … And there's got to be much more important things that hold that relationship together other than physical attractiveness.
Many women discussed changes in their appearance as they aged.
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Dissatisfaction with body weight was particularly common. Some women reported they had been overweight for some time, whereas others reported gaining weight during the menopause transition. Most expressed a strong desire to lose weight.
Many women emphasized that the weight bothered them more than their partners, particularly for the women who were in long-term relationships. Women stated that their partners would reassure them that they still found them attractive. A year-old White woman: You know, that's one thing: he's never made me feel like—there's times where my weight has been up.
And when he married me, I was like pounds.