[Peri- and postmenopausal changes--body awareness, sexuality, and self- image of the middle-aged and older woman]

INTRODUCTION, METHODS: For the first time a study has been made, in a German urban population, of sexuality, body awareness and self-image of women between 50 and 82 years. A special anonymous questionnaire was designed by female gynaecologists and psychologists for this cross-sectional study in Munich. It focuses on body awareness, self imagery, sexual activity and psychological and physiological sexual feeling in their biographic context. 102 women took part.

53.9% are sexually active and 74.5% think of themselves as "a knowing woman", "middle aged" or "in the best years". Self perception of the body as being attractive correlates highly significantly with the psychological well-being. There is no correlation between women's psychological well-being and the perception of their general beauty. Women who find their body attractive think of themselves as more sensual than those, who do not find their body attractive. General and bodily perception of beauty are negatively correlated to the body mass index. Here, 61.8% of the women think they are overweight, but only 41.2 % have a body mass index over 25. 12.9% were sexually abused, and another 8.8% do not want to answer this question. There is a strong correlation between fear and sexual abuse. Only about 50% of the women speak about their sexuality and, of them, only 9.8% speak with their gynaeclologist.

Sexuality is very important for the middle-aged and older woman, their body perception is as sensitive as in younger women and is of enormous importance for their psychological well-being. A Sexual history should be obligatory for older women. Fear of the examination can be a hint towards sexual abuse and should be taken seriously. All therapeutic interventions such as medication or operations should be discussed, and the patient's sexual wishes and expectations have to be taken into consideration.