(002) Exploring Sexual Schemas in Menopause: The Role of Sexual Function and Depression

Abstract Introduction The transition through menopause brings a range of changes-sexual (eg, reduced desire and lubrication) and psychological (eg, depression)-that can profoundly influence women’s sexual health and overall well-being. One way to capture the full impact of menopause on women’s sexual well-being is through the lens of sexual schemas: cognitive frameworks that shape beliefs, expectations, and attitudes about sex. The significant biological and psychosocial shifts that accompany menopause likely play a central role in shaping these schemas. In turn, sexual schemas, particularly when negative, have important implications for sexual function and overall well-being (Meston et al., 2013). Objective Although sexual schemas are known to influence sexual behavior and satisfaction among premenopausal women, less is known about how they evolve in response to menopause (Huberman et al., 2021). This mixed-methods study examined how sexual function and depression contribute to postmenopausal women’s sexual self-concept, or their sexual schemas. Methods A total of 101 women (4 perimenopausal and 97 postmenopausal; Mean age 54.87) wrote essays describing how they view themselves as sexual beings and how menopause has affected that self-view. Responses were coded for overall valence and thematic content using thematic content analysis. Logistic regressions were conducted to examine whether sexual function (FSFI; Rosen et al., 2000) and depression (PHQ-8; Kroenke et al., 2009) predicted schema valence. Results Thirty-five responses were coded as positive, characterized by themes of improved sexual function, redefined self-worth, and enhanced intimacy or self-understanding (eg, “I gained more sense of my own wants, needs and desires”). In contrast, forty-five responses were coded as negative, reflecting guilt about sexual changes, insecurity, sexual dysfunction, and a sense of loss for one’s former self (eg, “I long for the days when I knew my body, when things felt ‘normal’”). The remaining 21 responses contained both positive and negative elements and were excluded from regression analyses. A logistic regression examined whether sexual function and depression predicted schema valence. The overall model was statistically significant, χ2(6, N = 81) = 40.60, p .001, indicating that the predictors reliably distinguished between positive and negative schemas. Higher sexual function scores were associated with greater odds of endorsing a positive schema (OR = 1.39, 95% CI 1.16, 1.73, p = .001). Depressive symptoms alone predicted negative schema endorsement (p = .004), although this effect was attenuated when sexual function was included in the model. Conclusions Qualitative themes revealed that sexual schemas during menopause are not purely physical constructs but are deeply entwined with identity, self-worth, and emotional connection. Quantitative findings underscore the central role of sexual function in shaping women’s sexual self-perceptions during menopause, suggesting that diminished sexual functioning may erode positive self-schemas-or, conversely, that positive schemas may help sustain sexual function. Although depression was linked to more negative schemas, this association appeared largely driven by sexual dysfunction. Together, the findings highlight the need for clinical interventions that address both physical and psychological dimensions of sexual well-being during menopause, as sexual dysfunction is closely tied to the development of more negative sexual self-concepts. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Stripes Beauty.