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This thesis explores the processes through which sexual and gendered experiences of Iranian Muslim menopausal women are shaped by hegemonic gender norms, and how these women do, in turn, express their agency. It addresses a significant gap in the literature, due in part to the dominant biomedical discourse that have failed to acknowledge the role of sociocultural factors in understanding the sexuality of menopausal women. Moreover, it is the first study that analyses the sexual, embodied and gendered experiences of Iranian Muslim menopausal women from their point of view, contributing to biographical sociology and sexualities research. Specifically, this is achieved by undertaking empirical research linking sexuality, ageing, and the body to the matter of menopause - conceived here as a gendered, embodied and lived phenomenon characterised both by cultural constraint and by individual reflexive body techniques. 30 biographical, life course interviews, were conducted and I scrutinise the ways in which women articulate critical agency and bodily practices in milieux structured by masculine power over three different stages of their lives: childhood, womanhood and menopause. Highlighting the events and experiences that have been significant in shaping the sexual and gendered biographies of my interviewees, I discuss how cultural meanings and symbols have emerged and been negotiated by these women at these different stages of their lives. Importantly, it is argued that this ultimately demonstrates the significance of female agency in respect of the socio-cultural contexts in which women are typically conceived as being afforded little autonomy, as well as their reflexive embodiment, their cultural consent as well as the contesting of power. Indeed, the women’s stories reveal that ‘the gendered body’ and experiences of sexuality are created in the interaction between, at the macro-level, socio-cultural structures and, at the micro-level, personal, embodied, responses to these normative structures.

Endometrial polyps are bothersome lesions, commonly seen in clinical practice causing abnormal uterine bleeding and concern about the risk of malignant transformation. The mechanisms leading to the growth of polyps is unclear. The role of altered steroid receptor expression was studied using immunohistochemistry to examine the expression of ER-α ER-β PR-A and PR-B in polyps and endometrium in women treated with and without tamoxifen. A reduction in stromal ER-β expression in polyps from both groups compared to endometrium, and a reduction in stromal PR-B expression in tamoxifen polyps compared to tamoxifen endometrium suggests that an altered sensitivity to these estrogen and progesterone is key to polyp formation. In order to examine the genetic pathways that lead to polyp formation, a cross-platform microarray was carried out that similarly examined polyps and endometrium from women treated with and without tamoxifen. A subset of 3272 polyp genes was identified. Of these, 1659 genes were upregulated in polyps relative to the endometrium, and 1613 genes down regulated in polyps relative to the endometrium. The mechanisms by which endometrial polyps are prevented in tamoxifen treated women using the LNG-IUS is thought to be via the mechanism of decidualisation. Firstly, decidualisation was confirmed in endometrial biopsy samples from tamoxifen treated women with the LNG-IUS in situ using immunohistochemistry to demonstrate an increase in IGFBP-1 expression in decidualised stromal cells. Finally, the effect of decidualisation on the expression levels 2 polyp genes, beta-catenin and Notch 2 in endometrial and polyp stromal cells, was examined by quantitative RTPCR using an in-vitro model to test the effects of medroxyprogesterone acetate, levonorgestrel and desogestrel treatment in combination with either estrogen or tamoxifen. This study demonstrated that progestin treatment did in-part reverse the polyp effect on these genes.

This thesis is presented in three parts. Part One is a literature review of the key issues faced by women with gynaecological cancer, the need for psychosocial interventions, and the effectiveness of psychosocial interventions in meeting this need. Part Two presents the empirical paper. This paper explores how a new peer support service for women with gynaecological cancer was experienced by both the peer helpers and the women they were supporting. In Part Three, the issues and challenges raised during the completion of the empirical study are discussed.

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