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Exploring Sexual Schemas in Menopause: Considering the Role of Sexual Function and Depression
Andrea C. Ensign
Faculty Advisor: Cindy Meston, PhD; Graduate Student Advisor: Kate Metcalfe, MA
Menopause brings a range of sexual (e.g., reduced desire, lubrication) and psychological changes (e.g., depression) that can reshape women’s sexual well-being. Sexual schemas—cognitive frameworks that guide beliefs and expectations about sexuality—offer a useful lens for understanding these shifts, yet little is known about how schemas evolve during menopause. This mixed-methods study examined how sexual function and depression relate to postmenopausal women’s sexual self-concepts. A total of 101 women (4 perimenopausal, 97 postmenopausal; M age = 54.87) wrote essays describing their sexual self-view and how menopause influenced it. Essays were coded for overall valence and thematic content, and logistic regressions tested whether sexual function (FSFI) and depression (PHQ-8) predicted schema valence. Thirty-five essays reflected positive schemas, including improved function, redefined self-worth, and enhanced intimacy, while 45 reflected negative schemas marked by guilt, insecurity, dysfunction, or a sense of loss; 21 mixed-valence responses were excluded from quantitative analyses. The model predicting schema valence was significant, χ²(6, N = 81) = 40.60, p < .001. Higher sexual function scores were associated with greater odds of endorsing positive schemas (OR = 1.39, 95% CI [1.16, 1.73], p = .001). Depression predicted negative schemas (p = .004), though this effect weakened when sexual function was included. Overall, findings suggest that sexual schemas during menopause are intertwined with identity, self-worth, and emotional connection, and that sexual function is a central predictor of women’s sexual self-perceptions. Interventions addressing both physical and psychological aspects of sexual health may help prevent the development of more negative sexual self-concepts during menopause.