Internalized ageism and late-life sexual health: gendered sexual meanings and a self-esteem–anxiety pathway to sexual dysfunction/distress

OBJECTIVES: To examine whether internalized ageism undermines older adults' sexual health through gendered sexual meanings and a self-esteem-anxiety pathway. METHOD: structural equation modeling, a gender-moderated serial mediation model in which ageism predicted sexual dysfunction/sexual distress indirectly through lower self-esteem and higher anxiety. RESULTS: In Study 1, women's networks centered on affection/partnership and health, alongside stigma-laden nodes (e.g. prejudice, loneliness). Men's networks clustered around pleasure/sex with frustration as a salient negative anchor. In Study 2, ageism predicted lower self-esteem, which predicted higher anxiety, which predicted greater sexual dysfunction/distress. The serial indirect effect emerged for men but not women; women instead showed a significant direct effect of ageism on sexual dysfunction/distress. CONCLUSION: Together, these findings advance an integrative framework showing that gender-specific ways of interpreting sexuality channel ageist beliefs into distinct pathways toward sexual health outcomes. Public health and clinical practice should normalize diverse sexual expressions in aging, screen for internalized ageism and proximal psychological harms aiming to promote equitable sexual health.