Presenting the model of sexual performance of postmenopausal women based on sexual self-expression with the mediating role of state-attribute anxiety and sexual self-esteem

Document Type : Original Article


1 Ph.D Student, Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran

2 Associate Professor, Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran

3 Assistant professor, Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran

4 Assistant Professor, Cognitive Science Research Center, Faculty of Medicine, Gilan University of Medical Sciences, Rasht, Iran


Aim: The purpose of this study was to provide a model of sexual performance of women under menopause based on sexual self-expression with the mediating role of state-attribute anxiety and sexual self-esteem. Method: The research method was descriptive and correlation type using structural equations. The statistical population in this research was made up of all post-menopausal women who referred to the health and treatment centers of Rodsar city between February 1400 and May 1401. To determine the sample, first three health centers were randomly selected and then 350 women who They went to these centers to receive services and met the entry requirements and were selected as samples. The measurement tools in this research were the questionnaires of women's sexual performance (1997), women's sexual self-esteem (1996), Spielberger's anxiety (1970) and Halbert's sexual entitlement (1992). Data analysis was done using Pearson's correlation coefficient and structural equation modeling with AMOS software. Findings: The results of the fit of the proposed model indicated a good fit of the model with the data, and the standard coefficients of the paths of the proposed model showed that the highest coefficient was for the path of sexual self-expression and sexual self-esteem (P < 0.001, β = 0.321) and The lowest coefficient is assigned to state anxiety for sexual performance (P=0.166, β=0.077). Also, the bootstrap results for the indirect path of the proposed model showed that sexual self-expression through trait anxiety has an indirect effect on women's sexual performance, and sexual self-expression through sexual self-esteem has an indirect effect on women's sexual performance. Conclusion: It is suggested to pay more attention to sexual self-expression and sexual self-esteem in couples therapy and sex therapy centers to help women with sexual dysfunction.


Ahmadi, F., Tahmasabi, R., Norozi, A., & Akbarizadeh, F. (2022). Prevalence of sexual dysfunction and its influencing factors in women of reproductive age. Bimonthly Journal of Southern Medicine, Bushehr University of Medical Sciences and Health Services, 25 (2), 114-129.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Translated by Rezaei, F., Fakhrai, A., Farmand, A., Nilufri, A., Hashemi Azar, J., and Shamlou, F. (2014). Tehran: Arjmand Publications.
Barchielli, B., Accinni, T., Ferracuti, S., Carlone, L., Petrini, F., Biondi, M., Pasquini, M. (2022). Sexual Habits and Sexual Dysfunctions in a Sample of Patients with Psychotic Disorders Compared to a Group of Healthy Adults. Journal of Clinical Medicine, 11 (505), 1-11.
Batmaz, H., Celik, E. (2022). Sexual dissatisfaction and sexual self-efficacy: an examination of the role of sexual self-confidence as a mediator. Journal of Men's Health, 18 (1), 1-7.
Bittoni, C., Kiesner, J. (2022). Sexual Desire in Women: Paradoxical and Nonlinear Associations with Anxiety and Depressed Mood. Archives of Sexual Behavior, 1-16.
Derogatis, L.R., Revicki, D.A., Rosen, R.C., Jordan, R., Lucas, J., Spana, C. (2021). Psychometric validation of the Female Sexual Distress Scale-Desire/Arousal/Orgasm. Derogatis et al. Journal Patient Rep Outcomes, 5 (1), 1-11.
Fayaz Saberi, M. H., Tuzande Jani, H., Samari, A. A., & Nejat, H. (2019). Prediction of marriage stability based on marital compatibility and sexual self-expression with the mediation of emotional intelligence. Research in Clinical and Counseling Psychology, 9(2), 56-70.
France, B.L. (2019). The impact of sexual self-disclosure, sexual compatibility, and sexual conflict on predicted outcome values in sexual relationships. The Canadian Journal of Human Sexuality, 28 (1), 57-67.
Gava, G., Visconti, M., Salvi, F., Bartolomei, I., Seracchioli, R., Meriggiola, MC. (2019). Prevalence and Psychopathological Determinants of Sexual Dysfunction and Related Distress in Women with and Without Multiple Sclerosis. Journal Sex Med, 16(6), 833–842.
Ghanadian, F., Nayinian, M. R., & Heydari Nasab, L. (2020) Investigating the relationship between sexual self-concept and sexual performance and self-esteem in women with vaginismus disorder. Quarterly Journal of Health in the Arena, 8(4), 59-68.
Ghasemi, N., Rezaei, F., & Sadeghi, M. (2022). Influential factors in psychopathology and treatment of female sexual desire disorder from the perspective of Iranian experts: a qualitative study. Midwifery and Paramedical Nursing Quarterly, 8(1), 82-95.
Ghasemzadeh, F., Isazadegan, A., & Mikaeli, F. (2019). Prediction of state/trait anxiety based on brain-behavioral system and morning/evening types in college students. Journal of Health Promotion Management, 8(4), 26-34.
Gianotten, W.A., Alley, J.C., Diamond, L.M. (2021). The Health Benefits of Sexual Expression. International Journal of Sexual Health, 33 (4), 478-493.
Heydarian Far, N., Amanolahi, A., & Aghaian, B. (2015). Investigating the relationship between sexual self-esteem, sexual self-awareness and sexual self-instrument with sexual satisfaction. National Healthy Family Congress.
Hullman, G.A., Weigel, D.J., Brown, R.D (2022). How Conversational Goals Predict Sexual Self Disclosure Decisions. The Journal of Sex Research, 1-14.
Karami, J., Shalani, B., & Hoveyzi, N. (2017). Correlation of sexual self-esteem and sexual dysfunction with marital satisfaction in nurses of Kermanshah hospitals. Journal of Qom University of Medical Sciences, 11 (9), 93-86.
Kazemzadeh, J., Rabieipour, S., & Rajabzadeh, H. (2022). Investigating the status of sexual self-esteem and its related factors in women who survived breast cancer. Journal of Nursing and Midwifery, 20(1), 93-85.
Khodayari, M., & Ahadi, H. (2021). Developing a structural model for predicting couples' reconciliation based on self-expression with the mediation of social exchange in women with early marriage. Monthly Journal of Psychological Science, 20(107), 2075-2062.
Kong, L. V., Goh, P. H., Ting, R. S. K. (2022). Bidimensional self-esteem and sexual functioning among Malaysian young adults: the moderating role of relationship status. Psychology & Sexuality, 21-34.
Mehraban Nia, M. (2021). Investigating the effect of emotional intelligence training on sexual self-expression in women aged 15-30 in Kashmer city. The second international conference on jurisprudence, law, psychology and educational sciences in Iran and the Islamic world.
Milani, S., Dawson, S.J., Velten, J. (2021). Visual Attention and Sexual Function in Women. Current Sexual Health Reports, 13, 89-96.
Robert, E.P. (2022). Sexual Performance Anxiety. Sexual Medicine Reviews, 8 (2), 183-190.
Rostami, M., Saadati, N., & Yousefi, Z. (2018). The investigation and comparison of the efficacy of emotionally focused couple therapy and solution focused couple therapy on reducing fear of intimacy and increasing couples' sexual satisfaction. Biannual Journal of Applied Counseling, 8(2), 1-22. doi: 10.22055/jac.2018.23429.1509
 Saberi, H., Salahian, A., & Amiri, M. (2022). Presenting a model for predicting women's sexual performance based on childhood trauma with the mediating role of sexual self-concept. Journal of Psychology of Women, 2(4), 52-43.
Saadati N, Heydari H. (2016). Child abuse dimensions with self body-image and sexual satisfaction. J Research Health; 6 (4): 413-422
Sayadi, F., & Golmakani, N. (2020). Investigating the relationship between sexual rights and the quality of sexual life in married women. Journal of Nursing and Midwifery, 18(9), 750-758.
Shameli, L., & Davodi, M. (2019). Disordered eating patterns and sexual self-esteem in married women: The mediating role of body image concerns. Tolo Health Monthly, 18 (6), 72-89.
Trento, S.R.S., Madeiro, A., Rufino, A.C. (2021). Sexual Function and Associated Factors in Postmenopausal Women. Revista Bras Ginecol Obstet, 43 (7), 522-529.
Wongsomboon, V., Webster, G.D., Burleson, M.H. (2022). It’s The “Why”: Links between (Non) autonomous Sexual Motives, Sexual Assertiveness, and Women’s Orgasm in Casual Sex. Arch Sex Behav, 51, 621–632.
Wu, T., Zheng, Y. (2021). Effect of Sexual Esteem and Sexual Communication on the Relationship Between Body Image and Sexual Function in Chinese Heterosexual Women. Journal of Sexual Medicine, 1-13.
Zamani, N., Rezaei Jamaloui, H., Bohodi Moghadam, Z., Meshki, M., & Peykari, H. (2019). Determining the effect of intervention based on sexual concerns on sexual performance (sexual fatigue, sexual desire, sexual satisfaction, failure in sexual relations) of women with type 1 diabetes. Family and Health Quarterly, 10 (3), 65-82.
Zhang, H., Xie, L., Tsing Lo, SS., Fan, S., Yip, P. (2022). Female Sexual Assertiveness and Sexual Satisfaction Among Chinese Couples in Hong Kong: A Dyadic Approach. The Journal of Sex Research, 59, 2, 203-211.