The marriage of older men to younger women is common across cultures. On one hand, husband-older marriage may serve the interests of both sexes, a conclusion broadly consistent with reported gender differences in mate preferences. On the other hand, men alone may benefit from such marriages at a cost to women if seniority enables men to exert dominance in conflicts of interest. Indeed, in public health large spousal age gaps are generally deemed “pathological”, both as a cause and consequence of gender inequalities harmful to women. We investigate these alternative models of spousal age gap using data from a cross-sectional survey of women in Mwanza, northwestern Tanzania (n = 993). Consistent with the notion that spousal age gaps are a product of sexual conflict, women typically married with a larger age gap than stated ideals. However, adjusting for potential confounds, spousal age gap was not associated with fertility or the risk of divorce. Furthermore, women's mental health and autonomy in household decision-making was higher in husband-older marriages compared to rare cases of same-age or wife-older marriage. Beyond this comparison, the magnitude of spousal age gaps was unrelated to either measure of women's wellbeing among the overwhelming majority of marriages where the husband was older. Together these findings suggest husband-older marriage does not influence marital stability, relatively large spousal age gaps are neither especially costly nor beneficial to women, and that alternative sociodemographic factors are more important in driving variation in women's wellbeing and reproductive success in this context. Our results support neither a model of mutual benefits, nor a pathological conceptualization of spousal age gaps. We conclude by both encouraging evolutionary human scientists to engage more fully with models of sexual conflict in future studies of marriage and mating, and suggesting that public health scholars consider more neutral interpretations of spousal age differences.