"Feeling Frumpy": The Relationships Between Body Image and Sexual Response Changes in Midlife Women‪.‬

Many women notice changes in their sexual response as they move through the menopausal transition. These changes may involve sexual desire/interest, arousal, orgasm, enjoyment, or frequency of sexual activity. More often than not, the changes reflect decreased rather than increased sexual responsivity and activity, although some women do experience heightened sexual response during this time (Avis, Stellato, Crawford, Johannes, & Longcope, 2000; Bottiglioni & DeAloysio, 1982; Cole, 1988; Dennerstein, Alexander, & Katz, 2003; Dennerstein, Lehert, Burger, Garamszegi, & Dudley, 1999; Dennerstein, Smith, Morse, & Burger, 1994; Hallstrom, 1977; Hallstrom & Samuelsson, 1990; Mansfield, Koch, & Voda, 1998; Mansfield, Voda, & Koch, 1995; McCoy & Davidson, 1985; Pfeiffer, Verwoerdt, & Davis, 1972). Menopause and sexuality researchers have used various theoretical paradigms to study these sexual changes, resulting in differing explanations (Rostosky & Travis, 2000; Voda & George, 1986). The biomedical/positivist perspective gives primary importance to hormonal changes that women experience during menopausal transition. This perspective purports that shifting hormone levels account directly, or indirectly through menopausal symptoms, for sexual response declines and that hormone therapy can improve sexual responsivity in midlife women (see Sherwin, 1991 for a review). However, the biomedical approach has been criticized as viewing menopause as a "deficiency disease" and sexual changes as problematic rather than adaptive (Bancroft, Loftus, & Long, 2003; Voda & George, 1986). A related perspective, evolutionary/sexual strategies theory, would argue that female sexual desire naturally diminishes with age and approaching loss of fertility since optimal reproduction (fueling natural selection and survival) is the basis for human sexuality (Buss, 1998). Yet many researchers purport that a purely biomedical or evolutionary model of women's midlife sexuality that poses a direct link between declining hormone levels and declining sexual response is insufficient or inconclusive (Bancroft et al., 2003; Burger, Dudley, & Hopper, 1995; Davis, 2000; Dennerstein, Dudley, Hopper, & Burger, 1997; Gannon, 1994; Mansfield, Koch, & Voda, 2000; Myers, 1995; Schreiner-Engel, Schiavi, White, & Ghizzani, 1989).