Relationships between body image, sexual dysfunction, and health-related quality of life among middle-aged women: A cross-sectional study


      • Validated measures have not previously been used to evaluate the relationship between sexual function, body image, relationship with partner, and health-related quality of life (HRQoL) among middle-aged women.
      • Negative appearance evaluation and menopausal symptoms predicted poor HRQoL among middle-aged women. Sexual dysfunction tended to be a negative predictor of the mental component summary (MCS) of HRQoL.
      • A higher frequency of orgasm predicted a better physical component summary (PCS) of HRQoL; sexual satisfaction and relationship satisfaction with partner predicted better MCS.
      • These findings will be useful in health education and health promotion for middle-aged women, and help health providers to focus on these predictors when caring for middle-aged women.



      To examine whether body image, sexual function, and relationship with a partner influence health-related quality of life (HRQoL) among middle-aged women, as well as to identify the association with menopausal symptoms.

      Main outcome measures

      Physical component summary and mental component summary of HRQoL.


      This was an analysis of 1026 women (2013–2014); data regarding demographic characteristics, sexual function, body image, relationship with partner, menopausal symptoms and HRQoL during middle age were collected. HRQoL, sexual function, body image, relationship with partner, and menopausal symptoms were measured using the Medical Outcomes Study SF-12, Female Sexual Function Index (FSFI), Multidimensional Body-Self Relations Questionnaire-Appearance Scale, the Relationship Assessment Scale, and the Greene Climacteric Scale, respectively. A multivariate regression was used to examine factors influencing HRQoL.


      After adjusting for covariates, significant factors predicting the physical component summary (PCS) of HRQoL among middle-aged women included the orgasm domain of the FSFI (β = 0.69; p =  0.023), appearance evaluation (β = 0.93; p =  0.037), and menopausal symptoms (β = −0.25; p <  0.001). The factors predicting the mental component summary (MCS) of HRQoL included the satisfaction domain of the FSFI (β = 0.70; p =  0.014), appearance evaluation (β = 2.09; p < 0.001), self-classified weight (β = 1.21; p <  0.001), relationship with partner (β = 0.16; p =  0.034), and menopausal symptoms (β = −0.36; p <  0.001).


      The results indicated that negative appearance evaluation and menopausal symptoms predicted poor HRQoL among middle-aged women. Higher frequency of orgasm predicted better PCS; sexual satisfaction and satisfaction with relationship with a partner predicted better MCS of HRQoL.


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