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AbstractOlder adults face age-related changes as well as stigma in relation to their bodies and sexuality, challenging their understanding of themselves as sexual, thought to impact both sexual desire, activity and satisfaction. A qualitative study with a semi-structured interview was completed with 32 people, aged 65–85, to investigate how older people construct understanding of their self as sexual in an ageing body. The analysis generated two main themes; "Positions of the ageing body as sexual", with three subthemes, and "Negotiating change, transitions in identities", with two sub themes. Results showed variations in participants' thoughts about their body and how either appearance, agency or body function influenced different aspects of current sexuality and sexual satisfaction, and understandings of self. Statements showed examples of both internalized ageist understandings of the ageing body as sexual, but also rejections or low relevance of ageist attitudes in the understandings of present body image and sexual satisfaction. Results showed differences in how changes were understood and negotiated either through enhancement strategies or through cognitive-emotional, and social regulation. The findings demonstrated paradoxes and contradictions in the understanding and management of the ageing body and sexual satisfaction, where variations were found along but also across the divides of gender, relationship status and quality, sexual orientation, self-esteem and age cohorts. Implications indicate that health care strategies and policies should understand sexual ageing from a developmental perspective to support individual projects of developing affirmative and adjusted identities as sexual in an ageing body.