Negotiating Sexual Agency

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Qualitative Health Research
DOI: 10.1177/1049732306297415
2007; 17; 189 Qual Health Res
Jill M. Wood, Phyllis Kernoff Mansfield and Patricia Barthalow Koch
Negotiating Sexual Agency: Postmenopausal Women's Meaning and Experience of Sexual Desire
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Negotiating Sexual Agency: Postmenopausal
Womens Meaning and Experience of
Sexual Desire
Jill M. Wood
Phyllis Kernoff Mansfield
Patricia Barthalow Koch
Penn State University, University Park
The purpose of this feminist grounded theory study was to understand the meaning and experience of postmenopausal
womens sexual desire. Data collection from 22 postmenopausal women who were ongoing participants of the TREMIN
Research Program on Womens Health occurred via audiotaped, telephone-based, semistructured interviews. Womens
descriptions of their sexual needs and desires led to the discovery of the core category, negotiating sexual agency, which
refers to womens ability to act on behalf of their sexual needs, desires, and wishes. Women negotiated their sexual
agency within three main domains (or axial codes): their own sexual self, their partners, and the medical system. An
important finding was womens internalization of sociocultural assumptions that privilege their male partners sexual
needs over their own. The findings of this study, especially the contexts in which women negotiate their sexual agency,
are important for women, womens health care providers, and womens life partners to understand.
Keywords: menopause; sexuality; sexual desire; patriarchy; sexual agency
I
t is widely believed that menopause significantly
affects womens sexuality and sexual response (e.g.,
Basson, 2005; Dennerstein, Dudley, & Guthrie, 2003;
Leiblum, 1990; Mansfield, Voda, & Koch, 1995).
Sexual desire, in particular, has captured the attention
of menopause researchers and scholars lately, in large
part because sexual desire is the component of the
sexual response cycle that is believed to be most influ-
enced by hormonal factors and, thus, is seen as treat-
able with hormones, especially among menopausal
women (e.g., Koster & Garde, 1993; Riley & Riley,
2000). To date, most of the research on womens sex-
ual desire during menopause has been studied from
a biomedical perspective, that is, by research that
emphasizes biological factors, such as reproductive
physiology, endocrinology, and chemical changes
within the body that determine or predict sexual desire
(e.g., Apperloo, VanDerstege, Hoek, & Schultz, 2003;
Regan, 1999). The result of using a biomedical lens is
that researchers conceptualizations of womens sexu-
ality during the menopausal transition have been
understood predominantly in terms of womens sexual
dysfunction, disease, and disorder (e.g., Tiefer,
1995, 2000, 2002).
Feminist scholars have been critical of a biomedical
conceptualization of sexual desire for several reasons.
First, a biomedical approach focuses primarily on sex-
ual desire as a phenomenon located solely within the
individual, thereby overlooking important contextual
factors (McCormick, 1994; Tiefer, 1995, 2000, 2002).
Feminist scholars have pointed out that biomedical dis-
ciplines construct sexual desire as disease focused and,
in essence, label women who do not fit the norm as
pathological and dysfunctional (Working Group on a
New View of Womens Sexual Problems, 2002).
Although feminist scholars have constructed a sci-
entifically sound and theoretically rigorous critique of
existing biomedical research on womens sexual desire
(see Wood, Koch, & Mansfield, 2006), they have been
slow in conducting their own research on menopausal
womens experience of sexual desire. The purpose of
this study was to address this need by studying
womens experiences of sexual desire associated with
menopause from a feminist perspective. The meaning
189
Qualitative Health Research
Volume 17 Number 2
February 2007 189-200
2007 Sage Publications
10.1177/1049732306297415
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Authors Note: Our deepest gratitude to all the women who shared
their life experiences during the interviews conducted for this
research.
190 Qualitative Health Research
that women attach to their sexual desire was explored
within the context of their lived experience. Three
overarching research questions guided the study:
(a) How do menopausal women experience sexual
desire? (b) How do menopausal women perceive and
make sense of their sexual desire? and (c) What influ-
ences womens experience of sexual desire during
menopause?
Womens Sexual Desire
Despite the fact that sexual desire has been the topic
of considerable recent biomedical research, there
remains a great deal of ambiguity regarding its defini-
tion, operationalization, and conceptualization as it
applies to women (Basson, 2002; Levine, 1998).
Variations in how sexual desire is conceptualized, and
therefore defined, relate to the particular discipline or
approach used to study it. Without an adequate defini-
tion of sexual desire, it is difficult to determine what
constitutes low sexual desire and how to address
womens concerns with their level of sexual desire.
Nevertheless, various estimates indicate that womens
low sexual desire is a significant problem reported
to physicians and sex therapists. Low sexual desire
is estimated to affect anywhere from 33% (Laumann,
Paik, & Rosen, 1999; Warnock, 2002) to 67%
(Nusbaum, Gamble, Skinner, & Heiman, 2000) of
women, depending on the population and how low sex-
ual desire is defined and reported. For instance, when
self-reported, womens low sexual desire is the most
common reason why women seek sex therapy
(Everaerd, Laan, Both, & van der Velde, 2000). In fact,
most community and large-scale studies of American
women demonstrate that women are concerned with
their levels of sexual desire (Ellison, 2000). One such
study of nearly 3,000 White, college-educated
American women born between 1905 and 1977
reported that the most commonly indicated concern
(34%, n = 555) was low sexual desire (Mansfield,
Koch, & Voda, 1998). Such findings point to the
importance of low sexual desire concerns in many
womens lives.
Womens Sexual Desire at
Midlife and Menopause
Many women appear to experience changes in their
level of sexual desire during the menopausal transition,
and most research indicates that this change is that of
decreased sexual desire (Basson, 2005; The Boston
Womens Health Book Collective, 1998; Leiblum,
1990; Mansfield, Koch, et al., 1998; Mansfield, Voda,
et al., 1995). Most biomedical researchers attribute
these declines to the direct or indirect result of deficient
levels of estrogen (Bottiglioni & DeAloysio, 1982;
McCoy, 1992) or testosterone (Dow, Hart, & Forrest,
1983; Leiblum, Bachmann, Kemmann, Colburn, &
Swartzman, 1983; Sanders & Bancroft, 1982), although
the evidence regarding testosterone is inconclusive
(Davis, 1999, 2000).
Biomedical researchers also consider the effects of
physiological aging on midlife womens sexual desire
and have attempted to sort out the separate but over-
lapping effects of aging and menopause on sexuality
changes. Cross-sectional studies have found that
menopausal status affects sexuality measures, such as
sexual desire, independent of age (e.g., Dennerstein,
Smith, Morse, & Burger, 1994; Hallstrom, 1977).
Other researchers have found that, independent of age,
menopausal status has no effect on sexuality changes
(e.g., Cain et al., 2003; Hawton, Gathy, & Day, 1994;
Mansfield et al., 1995). At this time, the relationship
among menopausal status, age, and sexual desire
remains inconclusive.
In contrast to biomedical research, sociocultural
researchers have focused on the influence of contextual
factors and life circumstances on menopausal womens
sexual desire (e.g., Bachmann et al., 1985; Conway-
Turner, 1992; Mansfield et al., 1995, 1998). Findings
emphasize the role of the cultural context in which
women age and the stigma surrounding menopause.
Bell (1990), for instance, has shown that the notion of
menopause as a hormone deficiency disease results in
womens negative expectations even before they enter
the menopausal transition. Similarly, other researchers
have found that a womans negative attitudes toward
menopause are related to her having more menopausal
symptoms (Gannon & Stevens, 1998; Olofsson &
Collins, 2000).
Cross-cultural studies have provided further evi-
dence of the role of sociocultural factors on womens
experience of menopause. Japanese women, for
example, report fewer menopause-related symptoms
than do American women; researchers speculate that
such differences might be due to cultural factors, such
as lifestyle, that differ between the countries (Avis,
Kaufert, Lock, McKinlay, & Vass, 1993).
Method
We chose grounded theory as our research method
because it is well suited to our feminist paradigm for
understanding participants everyday life situations
where the focus of the study is on understanding
meanings, adaptations, processes, and relationships
between phenomena (Grbich, 1999). Feminist quali-
tative research methods seek to understand the
assumptions underlying knowledge that is legit-
imized and maintained by such ideologies. This
understanding then illustrates the gendered nature of
broader power structures and systems, and serves to
emancipate women from such ideologies (Grbich,
1999; Rothe, 2000).
Sample and Data Collection
We employed purposeful, or criterion-based, sam-
pling to collect in-depth, detailed information about
participants lived experiences of sexual desire in
the years following menopause. Women enrolled in a
longitudinal research project housed in the United
States, the TREMIN Research Program on Womens
Health, were recruited for participation in this study
if they responded to the 2002 TREMIN Health Report
Form, were postmenopausal (no menses for at least
12 months), and did not use exogenous hormones.
The TREMIN Program, named after its founder,
Alan Treloar (TRE) from the University of Minnesota
(MIN), is considered to be the oldest ongoing study of
menstruation and womens health in the world; women
complete annual health surveys and record their men-
strual cycles prospectively on calendar cards.
Approximately 60 women fit the eligibility criteria
for this study and were invited to participate. Thirty-
four of those 60 women agreed to participate. There
are several reasons why women might have chosen
not to participate in the study, including: the highly
personal nature of the subject matter, the time com-
mitment, and the fact that data collection occurred
around the holidays (October through January). IRB
approval was received before the researchers had any
communication with the participants, and the primary
interviewer was blinded to any identifying character-
istics of the women and all previous data collection
(e.g., surveys, menstrual calendar cards).
The final sample of 22 women came from across
the United States; all were White, highly educated
and middle class, and heterosexual. Data collection
occurred until the point of saturation was reached. An
overwhelming majority of the women had been mar-
ried, although a few had been divorced or widowed and
were single at the time of the interview. Women ranged
in age from 58 to 65 years (mean age: 62 years).
Data collection occurred via audiotaped, semistruc-
tured telephone interviews, which were immediately
transcribed by the first author. Most participants were
interviewed once (interviews lasted approximately an
hour), although several participants were contacted a
second time for a follow-up interview. The goals of
the study were to understand womens lived experience
of sexual desire and the meanings attached to their
desire, so the interviewer asked the women to describe
and define what sexual desire was like for them. Because
the main focus of the interview was to encourage women
to tell stories and reconstruct their experiences of sexual
desire, there were no predetermined categories or topics.
The interviewer did not prompt women to address spe-
cific influences on their sexual desire, for instance. In
this way, the interviews were very loosely structured and
were truly guided by the participants. Sample questions
included Tell me what sexual desire is like for you and
Tell me about your experience of menopause and how
it has affected your sexuality.
Data Analysis
The constant comparative method of data analysis
was used (Glaser & Strauss, 1967). Three types of cod-
ing occurred during analysis: open coding, axial cod-
ing, and selective coding (Grbich, 1999), and a
nonnumerical data analysis program, NVivo 2.0, was
used to assist in managing the enormous amount of data
collected.
Starting with axial coding, we developed codes from
the ground up, using womens own voices and words
to establish three broad contexts (the self, partners,
and the medical system) in which women considered
their sexuality and sexual desire issues. Using the report
feature in NVivo, the first author then proceeded to a
more abstract level by grouping axial codes into themes
to search for the presence or absence of conditions
within each context that altered womens sexual feelings
within that context. The consistency in womens discus-
sions of their ability to act on behalf of their needs,
desires, and wishes in terms of sexual behavior and sex-
ual decision-making led to the discovery of the basic
process, or core category: negotiating sexual agency.
Finally, selective coding resulted in the overall schema,
which linked all codes to the core category, thereby
explaining the relationship between and among codes
(see Figure 1).
Findings
Negotiating Sexual Agency
The goal in grounded theory is to identify the basic
social process or core category that accounts for a
Wood et al. / Negotiating Sexual Agency 191
pattern of behavior that is salient for those involved
(Strauss & Corbin, 1990). In this study, womens
descriptions of their sexual needs and desires led to the
discovery of the core category, negotiating sexual
agency. The question of sexual agency was established
during open coding to refer to times either when
women reported little to no control over their sexual
satisfaction or when women reported control in seek-
ing sexual satisfaction. Sexual agency was a code that
appeared in every transcript, and more than 30 frag-
ments of text (ranging from a few words to several
paragraphs) were coded as such during open coding.
The core category of negotiating sexual agency
refers to womens interactions within the three main
axial codes, the sexual self, partners, and the med-
ical system and on behalf of their own sexual needs,
desires, and wishes. These negotiations occurred in the
context of their sexual behavior, their sexual decision
making, and even in terms of how womens sexuality is
viewed within society (e.g., Brumberg, 1997; Fine,
1988; Vance, 1992; Wolf, 1998). Feminists make a dis-
tinction between women as sexual subjects and as sex-
ual objects. Theoretically, as sexual subjects (much like
as sexual agents), women are in control not only of their
own bodies but also of their sexual desire: they are
agents of their own sexuality. In contrast, women as
sexual objects are not actors in charge of their sexuality
at all but are used by others, primarily men. In this
sense, sexual agency (like sexual subjectivity) is a com-
plex and abstract concept. It can refer to womens abil-
ity to make their own choices about sex, or to their
inability to make such choices, when they have inter-
nalized patriarchal constructions about their roles as
sexual beings, including how sexual desire is appropri-
ated and conceptualized. In this study, women continu-
ally negotiated sexual agency within three main
categories or contexts: the sexual self, partners, and the
medical system.
Figure 1
Visual Representation of Codes and Relationships to the Core Variables
The Sexual Self
Womens internal sexual self refers to their percep-
tions of themselves as sexual agents and sexual beings
with sexual rights and needs. Notions of themselves as
sexual beings had multiple origins: the sexual mes-
sages they had received earlier in life, their personal
beliefs about sexuality and sexual expression, their
health status, and various life circumstances. Taken
together, these categories illustrate the complex inter-
nal negotiation that women experienced in acting on
behalf of their sexual rights, needs, and pleasure.
Internalized messages regarding the appropriate place
for sexuality in their lives proved to be a powerful force
in determining womens ability to negotiate their sexual
agency. A plethora of factors influenced their conceptu-
alization of sexual desire, including parents, schooling,
the conservative era of the 1950s in which they were
raised, religion, partners, marriage and children, and the
media. The messages that they received about sexuality
and sexual desire from these influences were over-
whelmingly negative. One woman said,
Yeah, well initially, in the 50s there was the whole
thing of the propriety of being very modest and vir-
ginal. You know Ill tell you how far back this goes, a
real seminal experience, uh, I was already something
of a tomboy because I had three brothers and you know
in a patriarchal society boys had more freedom and
seemed to be more valued. In second grade, I remem-
ber thinking, that there was something going on about
women that I was picking up from adults in the com-
munity. That there was something about women who
moved their hips freely who were free and easy in their
bodies that was very judged about. And I remember
thinking, I am never going to let them . . . , because
there was that mocking and denigration, that you
know, icky icky feelings. So I remember locking up
my hips right then and there. And in third grade, where
every year you have a program in the grade school for
the community at the end of the year, every grade had
a different country, and we had Cuba, which was inter-
esting, so we were going to be doing the rumba and I
was good at dancing, you know I had it down pat. But
they tried to get me, they wanted me to be in the cen-
ter, and I hated the costumes, they emphasized your
hips and they wanted me to move my hips! And there
was this silly headdress, it was just mortifying, and I
wouldnt move my hips. But they still wanted me
because I really had it down, but that discomfort was
the teachers and the school people who had really put
out the message about how unacceptable it was, you
know them telling me to do it, and especially it seemed
so inappropriate for a girl. And I remember really
being puzzled about that.
Other women also characterized how growing up
in the 1950s influenced their sexual agency:
Well, I grew up in a very repressive time, a genera-
tion, and also in a very repressive family. Sex was
never talked about in my family, and when it was it
was always in a negative way. Especially us girls, my
brother was never really talked to in the same way
about sex, as girls we were somehow more blamed
about sex, that there were bad things that could hap-
pen and it was our job to stay away from it, sex.
These messages were almost always rooted in insti-
tutional sexism and gave rise to, among other things, a
sexual double standard: the notion that the acceptabil-
ity or appropriateness of certain aspects of sexuality is
different for women than for men and, more specifi-
cally, that men have more flexibility and permission to
act as sexual agents. The double standard included a
social stigma toward women who embodied or who
were in tune with their sexual needs and sexual desire.
These women were viewed as sluts and labeled with
derogatory terms. However, women were aware that
no such terms existed for men who acted on their sex-
ual desires. In fact, women mentioned that men in our
culture are often lauded for acting on their sexual
urges. One woman said,
Yeah, I mean, men were always supposed to be sow-
ing their wild oats while women had to save them-
selves, that idea. You were supposed to be a virgin in
those days. You know, well, I mean people still
sometimes think of that nowadays, and still men
have that freedom where women are, well you
wouldnt want to say the word slut, but that kind of
thing, its still a different standard.
In their discussions of the sexual double standard,
women stated that the contradictory messages that
they received actually served to distance them from
their experience of sexual desire. One woman said,
The only way I can explain it, this feeling that my sex-
ual desire is out there somewhere, away from myself,
is that there are all of these other forces dictating when
a woman, at least in my generation, should and could
have sex. And the rules or standards about women
feeling turned on or interested in sex were even more
confusing. You know: Have sex for your husband, get
excited for him, but not too excited because you want
him to feel like he can please you and satisfy you.
Dont be turned on by other men who arent your
husband, thats wrong. Its like, someone else has
dictated with who, where, and when I should have sex
and how excited I should be about it, I just {pause},
its like I just stopped trying to have it be mine. I gave
up trying to understand and sort out all of those rules
and mixed messages. . . . I rarely feel sexual desire
anymore at all.
These women learned to place their sexual desire
outside of their own experiences, thereby surrendering
their sexual agency. The sexual double standard stifled
womens ability to truly experience sexual desire as
part of their sexual response and sexual agency.
Stress from various parts of their lives was another
important factor in determining womens interest in
sex. Nearly all of the women mentioned feeling
rushed and busy in their lives, and feeling that there
just was not enough time in the day to accomplish
what they needed to do. Women explained that feel-
ing distracted by unfinished tasks, worries, and vari-
ous stressful life events (e.g., family visits, holiday
food preparation, grandchildren) made them feel
tense and therefore less interested in sex.
By contrast, women described how a romantic set-
ting could turn them on sexually, whereas an unpleas-
ant setting could turn them off:
Well, I have to tell you something. We went up to this
lodge, up in Wisconsin; it was some friends of ours.
It was just a beautiful place, and our bedroom had a
skylight, and [laughing], I really got turned on then,
you know. I really had a lot of desire then. It was a
completely different setting and I loved it there. And I
was excited, and we had this big bedroom by our-
selves. I think the setting really has a lot to do with
it, because years ago, we were in this motel and it
wasnt very nice, and it smelled like smoke and all
that, and I just couldnt get in the mood, it just didnt
work, so I chalked it up to the place or a bad night, or
whatever. You know, yeah, it just didnt matter what
we did, nothing doing.
It is noteworthy that women located influences
(e.g., a romantic setting or movie) outside of them-
selves. They responded to these settings by feeling
sexually interested or uninterested, but there was little
evidence that they were active negotiators of their
sexual agency in terms of what facilitated or inhibited
their sexual desire.
Partners
Women negotiated sexual agency with their partners
and in the context of their relationships with their part-
ners. For most women, negotiations depended on hav-
ing a suitable partner. Some women reported having
difficulties meeting men, whereas others had partners
but still felt emotionally lonely. This latter group
explained feeling disappointed and frustrated because
they had to turn to sex with their partner to feel con-
nected or emotionally close, whereas they would have
preferred to establish intimacy in a nonsexual way,
such as through hugging, holding hands, or talking.
One woman says,
Sometimes I just feel like I want a hug or a kiss on
the cheek. Or just for him to tell me how much he
loves me. Having sex definitely gives me that feel-
ing, that sense of being connected with him, but
sometimes I want to get that in other ways, not
through sex. Hes, my husband, is just not good
at being emotionally expressive though. Sometimes
it ends up being easier for me to just have sex to get
that feeling I need.
Some women were disappointed with their partners
sexual technique; they discussed feeling like sex was
too much work, especially in terms of needing more
foreplay to feel sexual desire or become aroused.
However, these women also felt some obligation to
attend to their partners sexual needs, which often
meant engaging in intercourse that was not necessarily
wanted, satisfying, or pleasurable for them. To this
end, women negotiated their sexual agency in terms of
balancing their feelings of apathy or lack of interest in
sex with their realization that sex was an obligatory
task in their partnership or marriage. One woman said,
Oh boy! I can remember getting a message from an
adult when I was first married, Never say no or hell
go somewhere else.
Although some women attempted to discuss their
concerns with their partners, most women did not.
Their failure to negotiate sexual agency is a reflection
of the larger sociocultural messages they had received
that women should serve mens sexual needs and
privilege mens sexual needs over their own pleasure.
An overwhelming majority of the women inter-
viewed expressed concern about their partners erectile
difficulties in the context of their concerns about their
own sexual satisfaction and sexual desire. Women
negotiated how to handle instances in which their part-
ners lost their erection during sex or were unable to
obtain an erection during sex play. The women were
most concerned with their partners egos, however, as
opposed to being frustrated or disappointed that the
sexual encounter was not pleasurable or satisfying for
them, although this was certainly a secondary concern
for women. Women often negotiated this awkward
position, of wanting to protect their partner from expe-
riencing an erectile difficulty while also avoiding a
sexual experience that was unpleasant for them as well,
by avoiding sex altogether. One woman explained,
Well, part of it is my husband. If he cant perform,
then the situation ends up being uncomfortable and
unsatisfying for both of us. So by spacing it out Im
almost preventing that from happening.
The quality of womens relationships with their
partners was the most commonly discussed influence on
womens experience of sexual desire. Women explained
that sex was just one aspect of a good relationship, and
they associated qualities such as sensitivity, respect-
fulness, kindness, tenderness, light-heartedness,
mutuality, feeling safe, and being connected with
healthy, positive relationships. In contrast, women used
terms such as selfishness, clueless, sexist,
removed, and distant to describe relationships that
they considered unhealthy and negative.
Women who felt that they were in good relation-
ships were better able to negotiate their sexual agency,
because they felt safe and respected as people by their
partners, not just as sexual objects. Those who were
able to talk to their partners about sex also discussed
being more interested in sex (i.e., sexual desire) and
being more satisfied with their sexual experiences
overall. Communication was a very important aspect
of womens sexual agency. Women who talked to their
partners about how to facilitate their sexual desire dis-
cussed feeling more sexual desire.
The Medical System
A third site where women negotiated their sexual
agency was within the medical system, particularly
with their health practitioner. Nearly all of the women
interviewed said that their doctors (or other health prac-
titioners) had talked to them about sexuality issues, but
only as they pertained to the menopausal conditions of
vaginal dryness and vaginal pain or discomfort. They
received predominantly negative messages from their
physicians that depicted menopausal changes as
unavoidable symptoms associated with menopause, as
illnesses that could be treated but not cured.
When women presented sexual concerns to their
physicians, they received little in the way of useful
information that could help them deal with their con-
cerns. More commonly, their physicians recommended
products that would allow them to continue to be avail-
able as sex partners. For example, one woman
explained that she was having problems becoming
lubricated during foreplay, even though she felt sexual
desire and was interested in having sex with her
husband. Her physician suggested KY Jelly but in the
interest of pleasing her husband. The woman said,
He [the doctor] . . . saw sex from a male point of
view though. You know, Gee, you cant deprive
your husband of sex. So, I think that was why he
suggested it [the KY Jelly].
Womens perceptions of themselves as sexual
beings were also altered by health problems such as
polio, breast cancer, degenerative back problems, and
severe clinical depression. The debilitating effects of
pain, for example, detracted from some womens
interest in sex. Other women reported that various
surgeries had left them without bodily sensation in
parts of their body, resulting in diminished sexual
response. Women who experienced chronic health
problems often explained that they felt out of control
of their bodies functioning and also their sexuality.
Women were asked directly how they thought
menopause had affected them sexually. Some
thought menopause played a minor role, but others
thought that conditions such as severe hot flashes
made them irritable and, hence, uninterested in sex:
[Laughing]. Well again, I thought that you got most of
those symptoms after your period stopped, not before.
I went through, well heres the thing, for a while they
were called hot flashes, then power surges, and my
favorite one is personal summer. Its wonderful, espe-
cially said with a Southern accent and a fan in your
hand. I told my friends, pretend youre looking for
something in the freezer, stick your whole head in the
freezer, or I used to go out back at work and come in
the front, which cooled me down just enough. Uh, hot
flashes were hell, for a while they were happening
every two and a half hours, day and night. Night
sweats. Um, it got to the point where at one point I
decided that Id write down when I had them, and it
was like, Oh theres one, oohp, there it is. And I
wasnt waiting for it, but it was just amazing how reg-
ular they were. It happened for months. . . . Its ter-
rible to live with anyone when youre going through
that, I was not a pleasant person, and I most certainly
didnt want to have sex. I was too damn hot!
Social support proved to be a context that influ-
enced womens ability to negotiate their sexual agency.
These included informal groups of friends who would
laugh about hot flashes over lunch, as well as a more
formal group of women who met regularly to discuss
what was going on in their lives. Social support
seemed to be a very powerful factor in terms of
whether women felt isolated and whether they felt val-
idated. Most of the women, however, even those who
met regularly with other women, did not discuss sex-
ual desire or other sexuality issues outright. When
asked why they did not discuss sex, women explained
that sex was a taboo topic and that it was not appropri-
ate to discuss. Although women did not use social sup-
port as a way of sharing their perceptions or concerns
about sexuality, they felt comfort in the fact that the
social support was available if need be.
Many of the women did not have some form of
social support, and they discussed feeling isolated and
wondered if their experiences with menopause and
sexual desire were normal. Women who felt isolated
explained that they knew that their friends were prob-
ably also going through menopause but that they never
talked about their experiences. One woman said,
And thats something I havent talked to my friends
about, to see if they have the same frustrations or if
thats just the way my body is reacting. I dont know
why we havent talked about it. Sex just doesnt
seem like something you talk about in that way.
Women who felt isolated and wondered if their
experiences with sexual desire and with menopause
were normal were less able to negotiate their sexual
agency within the medical system, especially with
their doctors. These women were also very interested
in asking the interviewer what other women in the
study said about their experience of sexual desire and
menopause. One woman said,
Id be interested in the results of your study, in
how other women are feeling. I mean, what do other
women say? Do they feel like menopause has affected
their sexual desire? I mean, is it different for every
woman?
Discussion
Strauss and Corbin (1990) describe the central phe-
nomenon of a grounded theory study as the core cate-
gory. In this study, the core category is negotiating
sexual agency: the way women interact or negotiate
with their partners, their health care providers, and
their internal sexual selves to fulfill their sexual needs,
desires, and wishes. Feminist researchers and scholars
have used the term sexual agency to describe womens
ability to realize and to act on behalf of their own
wishes, needs, and interests in terms of sexual deci-
sion making and sexual behavior (e.g., Fine, 1988;
Vance 1992; Winterich, 2003). Our findings provided
little evidence that the women in this study were
active negotiators of their sexual agency. In particular,
they had difficulty negotiating their sexual agency
when they perceived that their partners sexual needs
were more important or more pressing than their own.
Womens internalization of sociocultural assump-
tions (that privilege mens sexual needs) is often
unconscious, because such beliefs are viewed as nor-
mative. Young women learn to suppress their sexual
agency as they become more interested in being
attractive to men (e.g., the object of mens sexual
desire) and relinquish control over their bodies and
sense of selves to others (i.e., men, the patriarchal
culture) (Hollway, 1989). Brumberg (1997) and Wolf
(1998) have suggested that when women internalize a
male (phallocentric) view of sexuality, they are less
able to negotiate their own sexual agency.
In the context of social script theory, we have seen
that two intricately related social phenomenasocial
scripts and institutional sexismare key influences
on womens experiences and meaning of sexual
desire. Gagnon (1990) has defined a social script as
an individuals personal sense of her or his sexuality,
as influenced by various sociocultural factors, such as
gender role expectations, religion, the media, and
generational factors.
In the current study, womens sexual social scripts
were interconnected, in that they all privileged mens
sexual needs and sexual desire. Institutional sexism
was an important underpinning of the womens social
scripts, especially in light of the overwhelmingly neg-
ative messages that these particular women had
received about sexuality while growing up in the con-
servative era of the 1950s.
Women in the current study discussed their first
experiences of sexual desire, which occurred when
they were relatively young (ages 5 to 18). At that age,
women generally had not yet distanced themselves
from their experience of desire. By the time the girls
reached adolescence, however, the sexual double stan-
dard (Hollway, 1989; Milhausen & Herold, 2001;
Muehlenhard & McCoy, 1991) was firmly in place, and
they had learned to surrender their sexual agency to
become sexual objects seeking boys and mens atten-
tion (Fine, 1988; Tolman, 2002). The notion that sex for
women must be rooted in love, whereas men are per-
mitted to have sex to fulfill their sexual wants and
needs, was one aspect of the sexual double standard
they learned (Hollway, 1989; Milhausen & Herold,
2001; Muehlenhard & McCoy, 1991). As part of this
process, they also learned to stifle their sexual feelings
when the costs were too high (e.g., feeling unsafe,
fear of pregnancy, fear of getting a bad reputation).
Another important contributor to the loss of sexual
agency in women as they age is their vulnerability to
pressures to conform to cultural ideals of beauty,
which are, essentially, unattainable. Koch, Mansfield,
Thureau, and Carey (2005) found that middle-aged
women lost their sense of sexual agency when they
perceived themselves as having become less attrac-
tive as they aged, and the current findings are consis-
tent. Bordo (e.g., 1993) argued that women cannot
have agency or subjectivity in a culture that objecti-
fies them.
A final factor in determining whether a woman
was able to negotiate her sexual agency was the
degree to which she could discuss her sexual desire
with others in her life. Women in this current study
experienced both voice and silence, depending on the
other person with whom they were communicating.
Allen (2003) found that dominant heterosexuality
discourse influenced an individuals sexual subjectiv-
ity and that an individuals voice reflected her per-
ception of herself as a sexual being. Specifically,
Allen found that participants ability to talk about
themselves as sexual beings was a gendered phenom-
enon, and that voice was associated with sexual sub-
jectivity (i.e., agency), whereas silence was often an
indication of sexual objectivity.
We underscore the fact that the womens experi-
ences and meanings of sexual desire tended to be
devoid of any mention of sex for fun, pleasure, stress
relief, or relaxation. Fines (1988) work demonstrated
that girls learn that they have sex done to them,
whereas boys learn to desire and obtain sex. As such,
girls learn to be passive in sex, and learn that one func-
tion of sex is to serve boys needs and interests. Fine
termed the systematic dismissal of girls sexual agency
the missing discourse of desire (p. 54). The findings
of this current research project, nearly two decades
after Fine coined the phrase the missing discourse of
desire, suggest that older womens sexuality discourse
is still missing any mention of womens entitlement to
sexual equality, including the right to make sexual
choices and the right to experience sexual desire and
pleasure without guilt. The current state of womens
sexuality can be characterized as the still missing dis-
course of desire. We agree with Daniluk (1993), that
the absence of such a discourse further disempowers
women and perpetuates womens sexual silence, sub-
mission, and isolation.
Implications
Womens experiences and meanings of sexual
desire are of the utmost importance in developing
new and refuting old sexual responding models, espe-
cially when such models are the basis for defining
sexual disorders and dysfunctions. Our current under-
standing of womens sexual response has been lim-
ited by the exclusion of womens narratives in
research. This research project is a beginning attempt
to remedy this research gap; indeed, recent literature
has called for feminist and qualitative research on
womens sexual response (e.g., Graham, Sanders,
Milhausen, & McBride, 2004; Working Group on a
New View of Womens Sexual Problems, 2002).
This research demonstrates that the contexts of
womens lives (not just their sexual lives) are critical
and crucial influences on the experience of sexual
desire as well as the meaning that women attach to
their sexual desire. It is clear that factors outside of
womens selves are often responsible for womens
degree of sexual interest, and this information, if
made available to women, might help then feel less
shame and blame for having low sexual desire,
vaginal dryness, and so on.
Health care providers have a unique opportunity to
support women in their negotiation of sexual agency.
Because women negotiated their sexual agency in the
context of their sexual behavior and in terms of how
womens sexuality is viewed within society, womens
health care providers should be aware of how they
frame discussions of sexuality. Although it is inadvis-
able to force women to talk about their sexual lives,
the very act of enabling women to discuss topics that
are considered taboo is likely to be experienced as
freeing and empowering (Hyde, 2001; Tolman &
Szalacha, 1999). For instance, women discussed that
they had often received messages that women should
serve mens sexual needs and that womens sexual
pleasure was less important than that of their male
partners. Similarly, many women were disappointed
that their providers broached the subject of sexuality
only from a disease-focused perspective, especially in
terms of how menopausal symptoms might detract
from womens enjoyment of sex. When discussing
such sexuality issues, health care providers can
enable women to feel more comfortable with their sex-
ual desire by discussing sexuality in a positive, holistic
way (Working Group on a New View of Womens
Sexual Problems, 2002).
Finally, it is important for health care professionals
to understand how womens male partners influence
womens negotiation of sexual agency and womens
sexual desire. Women in this study expressed concern
about their partners erectile difficulties. Providers
who work with men with erectile challenges must
understand how such issues affect womens experi-
ence of sex as well as mens, and can encourage men
to communicate with their partners about how erec-
tile problems might temporarily interrupt sex but that
sex does not need to be focused solely on vaginal-
penile intercourse.
This study further suggests that the diagnosis and
treatment of sexual desire disorders is inappropriate
when women do not consider their level of desire to be
problematic. Currently, the conceptualization of
womens low and high sexual desire is based on
epistemologically and methodologically flawed
research that has resulted in the establishment of
unsound definitions as to what constitute normal and
abnormal levels of sexual desire. Notably, diagnostic
standards (e.g., Diagnostic and Statistical Manual of
Mental Disorders, 4th ed.; American Psychiatric
Association, 1994) are rooted in biomedical research
that locates the source of womens sexual desire within
the physical body, including factors such as hormones
and tissue elasticity. However, these diagnostic factors
completely exclude the context of womens lives, such
as womens partners, other life priorities, and the polit-
ically charged nature of womens sexuality. As demon-
strated by this current research project, women might
choose to avoid sex for various legitimate reasons,
including dissatisfaction with the nature of the rela-
tionship, pain or discomfort during intercourse, or
simply a lack of interest in sex. Womens choice to not
engage in sex when it is not pleasurable or satisfactory
for them needs to be recognized as a legitimate option.
Limitations
We acknowledge certain methodological limitations
of this study. First, the participants in this study were
an extremely homogenous and privileged group of
women, who were all White, middle class, and highly
educated. The privilege afforded to these women by
virtue of their race or ethnicity, class, and educational
status is noteworthy, and we are aware of the implica-
tions of this limitation. In addition, the women were all
heterosexual, and we do not know whether our results
would apply to a sample of lesbian women; for
example, would the internalized objectification of
women relate to sexual desire under those circum-
stances? We hope to replicate our study with a more
diverse sample. Moreover, by virtue of the fact that
TREMIN participants have completed annual health
report forms and kept menstrual calendar cards, it is
likely that these women were particularly well attuned
to changes in their bodies. Similarly, these women
might have been more aware than many women of
influences on their health or sexuality, especially as
specific health and sexuality information has been fun-
neled to the participants from the TREMIN
researchers. Although these participants were consid-
ered to be key informants (and excellent candidates for
this research project), the homogenous sample is cer-
tainly a limitation of this research.
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Jill M. Wood, PhD, is the undergraduate director and a lecturer
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Phyllis Kernoff Mansfield, PhD, is a professor of womens stud-
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Womens Health at Penn State University, University Park.
Patricia Barthalow Koch, PhD, is an associate professor of
biobehavioral health and womens studies and assistant director
of the TREMIN Research Program on Womens Health at Penn
State University, University Park.

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