Why Sex Hurts After 40 (And What Actually Helps)
If sex has become uncomfortable — or downright painful — after 40, you might be wondering:
Is this normal?
Is something wrong with me?
Why does no one talk about this?
You’re not imagining it.
And you’re not alone.
Painful sex is very common in perimenopause and menopause, but it is not something you have to accept as part of aging.
First: Painful Sex Is a Medical Issue — Not a Personal Failure
Many women blame themselves when sex starts to hurt. They assume it’s:
stress
low libido
anxiety
relationship issues
But in most cases, pain has physical causes — especially after 40.
When sex hurts, the body learns to avoid it. Desire drops because pain is present, not because you’re “losing interest.”
The Most Common Reasons Sex Hurts After 40
1. Estrogen Decline Changes Vaginal Tissue
As estrogen levels fluctuate and decline:
Vaginal tissue becomes thinner and less elastic
Natural lubrication decreases
Blood flow to the vaginal tissue drops
This can cause:
dryness
burning
tearing
pain with penetration
These changes are part of Genitourinary Syndrome of Menopause (GSM) — a medical condition affecting up to half of postmenopausal women, yet often overlooked.
2. Pain at the Vaginal Opening (Not Deep Inside)
Many women describe:
stinging
burning
pain right at the entrance
discomfort with tampons or exams
This is often due to local estrogen deficiency at the vaginal opening and vulva — even if you’re already on systemic hormone therapy.
3. Pelvic Floor Muscle Tightening
When pain is present, the pelvic floor muscles may reflexively tighten to “protect” the body.
This can lead to:
sharp or burning pain
pain with penetration
pain that persists even after dryness is treated
Pain → muscle guarding → more pain → avoidance.
4. Recurrent UTIs or Bladder Symptoms
Low estrogen affects the bladder and urethra, increasing:
urinary urgency
frequency
recurrent UTIs
These symptoms can overlap with or worsen sexual pain.
What Actually Helps (And What Usually Doesn’t)
1. Treating the Tissue (This Is Foundational)
Vaginal estradiol restores thickness, elasticity, and blood flow to vaginal tissue.
It helps:
reduce dryness and irritation
improve comfort with sex
lower UTI risk
support long-term tissue health
Importantly, systemic estrogen alone often isn’t enough to treat vaginal pain.
2. Addressing the Pelvic Floor
If pain persists, pelvic floor physical therapy can be incredibly effective. Treating muscle tension helps break the pain-guarding cycle.
3. Lubricants & Moisturizers (Helpful, But Not Enough)
Lubricants can reduce friction, but they don’t reverse tissue changes. They’re supportive — not curative — when estrogen deficiency is the root cause.
4. Treating Desire Comes After Treating Pain
Many women seek help for “low libido,” when the real issue is discomfort.
When sex feels better:
anxiety decreases
avoidance fades
desire often returns naturally
What This Means for You
If you’re experiencing:
Painful sex
Burning or irritation
Dryness that doesn’t improve
Recurrent UTIs
Loss of desire tied to discomfort
…you deserve a real evaluation — not reassurance alone.
Pain with sex is common, but it is not normal to ignore.
Key Takeaways
Sex should not hurt — at any age
Estrogen decline plays a major role in midlife sexual pain
Vaginal estradiol treats the tissue where pain begins
Pelvic floor support may be essential
Treating pain often improves libido and intimacy
Ready to Feel Like Yourself Again?
At Kultivate Women’s Health, we specialize in sexual health and menopause care that addresses comfort, confidence, and quality of life — not just hormone levels.
Book a visit at Kultivate Women’s Health today to explore whether hormone support, targeted therapies, or a comprehensive sexual health plan is right for you.