Close relationships are important throughout life, but their dynamics may change as chronic health conditions permeate the lives of older women. To understand how older women (N = 36) manage their close relationships, this study was guided by two research questions: How do older women with chronic health conditions define meaningful relationships? How do older women negotiate intimacy loss and challenges that accompany changes in their health and abilities? The women completed the social convoy diagram and responded to open-ended questions where they discussed the importance of close relationships. How women defined their most meaningful relationships and negotiated intimacy loss and challenges involved the intersection of four interacting processes: biological, structural, cultural, and symbolic. These intersections, or relational systems, sometimes facilitated, and other times hindered, the women's ability to cope with limitations they associated with their chronic health problems. The authors discuss implications for future research on intimacy in late life. (Contains 1 table.)