<p>The sexual health and identity of older women remain underexplored, especially in conservative cultural contexts. This study qualitatively examined how midlife and older Iranian women perceive their body image and sexual satisfaction in later life with particular attention to how they exercise agency in redefining sexual selfhood under conditions of gender inequality and ageism. In-depth interviews with 20 women (aged mid-50s and above) were analyzed using thematic content analysis. Seven major themes emerged: redefinition of sexual relationships in old age; continuation or transformation of feminine identity; the central role of intimacy and communication; encounters with cultural norms and stigma; the role of fantasy and non-physical sexual expression; the body’s response to biological aging; and the duality of personal desire versus marital duty. These findings show that sexual identity in older age is a dynamic, multi-dimensional concept shaped by individual, relational, and societal factors. The women experienced sexuality not just as a physical act but as an expression of intimacy, love, and womanhood. Despite ageist stereotypes, gender inequalities, and traditional expectations that challenged their sexual identity, most participants exercised agency to redefine and sustain their sexual selves in later life. The study concludes that sexual identity does not disappear in later life but is continually renegotiated through women’s situated agency, and that with body acceptance, emotionally safe intimacy, and supportive sociocultural and clinical contexts midlife and older women can sustain sexual satisfaction and well-being.</p>