Postmenopozal Kadınlarda Menopoz Semptomları ile Cinsel Yaşam Kalitesi Arasındaki İlişkide Genital Benlik İmajı ve Çift Uyumunun Aracı Rolü

Abstract

This descriptive-predictive study was conducted to examine, within the biopsychosocial approach, the mediating roles of genital self-image and dyadic adjustment in the relationship between menopausal symptoms and sexual quality of life in postmenopausal women. The hypotheses that menopause symptoms are negatively associated with sexual quality of life (H1-1), that genital self-image (H1-2) and dyadic adjustment (H1-3) have significant mediating roles in this relationship, and that these two mediators sequentially exert a significant serial mediating effect between menopause symptoms and sexual quality of life (H1-4) were tested. The study was conducted between September 2025 and February 2026 at the Obstetrics and Gynecology Outpatient Clinic of Hacettepe University Adult Hospital with 212 postmenopausal women. Data were collected through face-to-face interviews using the Descriptive Characteristics Data Collection Form, the Menopause Rating Scale, the Female Genital Self-Image Scale, the Revised Dyadic Adjustment Scale, and the Sexual Quality of Life-Female Questionnaire. The mean age of the participants was 55.82±4.36 years. The mean scores of the Menopause Rating Scale, Female Genital Self-Image Scale, Revised Dyadic Adjustment Scale, and Sexual Quality of Life-Female Questionnaire were 23.21±7.06, 19.89±4.68, 48.56±10.92, and 55.24±21.09, respectively. Correlation analyses revealed no significant relationship between sexual quality of life and menopause symptoms (r=-0.076, p=0.268), whereas significant positive correlations were found with genital self-image (r=0.239, p<0.001) and dyadic adjustment (r=0.586, p<0.001). According to the serial mediation analysis, both the total and direct effects of menopause symptoms on sexual quality of life were not statistically significant, and menopause symptoms did not significantly predict either genital self-image or dyadic adjustment. In contrast, genital self-image positively predicted both dyadic adjustment (β=0.142, p<0.05) and sexual quality of life (β=0.160, p<0.01), while dyadic adjustment emerged as the strongest direct predictor of sexual quality of life (β=0.562, p<0.001). Neither the indirect effects through genital self-image and dyadic adjustment nor the serial indirect effect were statistically significant; therefore, hypotheses H1-1, H1-2, H1-3, and H1-4 were not supported in this sample. The findings suggest that sexual quality of life in the postmenopausal period cannot be explained solely by menopause symptoms and that genital self-image, particularly dyadic adjustment, represents important psychosocial factors that should be taken into consideration in this process. Accordingly, it is recommended that nursing interventions aimed at promoting postmenopausal sexual health should include holistic approaches focusing not only on symptom management but also on strengthening genital self-image and supporting dyadic adjustment.