Sex After 40: Why It Feels Different—And How to Make It Better
Pain, dryness, tension, and disconnection aren’t just in your head (and they’re not your fault)
Let’s talk about something most women aren’t warned about—how sex can change during and after your 40s.
Maybe you’ve noticed intimacy feels different. Maybe it’s less enjoyable, even painful. Or maybe your desire is lower than it used to be, and you’re wondering what happened to your spark.
Here’s the truth: you’re not broken, you’re not alone, and there are things you can do.
What’s Actually Going On?
During perimenopause and menopause, shifting hormone levels—especially fluctuating progesterone, estrogen and testosterone and cortisol dysregulation—affect everything from vaginal tissue to mood, libido, and pelvic floor function.
The Most Common Changes We Hear About:
Pain or burning during intercourse
Vaginal dryness or irritation
Decreased sensation or pleasure
Trouble relaxing or becoming aroused
Loss of desire or emotional disconnect
Post-intercourse bladder irritation or UTIs
Studies show that nearly 50–60% of women over 40 experience sexual pain or discomfort, and many avoid intimacy altogether rather than bring it up with their provider. (North American Menopause Society, 2022)
Hormones Are Only Part of the Story
While estrogen plays a big role in keeping tissues supple, lubricated, and sensitive—your pelvic floor, nervous system, adrenals and stress response matter too.
In midlife, your ovaries start passing the hormone-production baton to your adrenal glands. If your adrenals are already tapped out from years of stress, high-intensity exercise, or poor sleep, you’re more likely to feel exhausted, emotionally disconnected, and sexually “offline.”
Tight or Tense Pelvic Floor?
When the pelvic floor muscles stay “on” all the time (from stress, posture, trauma, or clenching), they can become short, tender, and less responsive to arousal. This can make penetration painful and limit sensation.
One study in Obstetrics & Gynecology (2021) found that hypertonic (tight) pelvic floors were a leading cause of painful sex in midlife women—and often went undiagnosed.
It’s worth noting that if you're dealing with heavy or erratic bleeding, it’s important to rule out things like fibroids, thyroid issues, or estrogen dominance and not just blame your hormones. Supporting your liver with cruciferous veggies and nutrients like DIM or calcium D-glucarate to improve hormone clearance.
Okay, But What Can I ACTUALLY Do About It?
You absolutely do not need to power through, just “relax more” or worse, “have a glass of wine or two.”
At South Texas Pelvic Health, we specialize in helping women navigate the physical and emotional shifts that come with sex, hormones, and midlife transitions – both in the treatment room and out.
Pelvic Floor Therapy Can Help By:
Releasing tight, tender, or guarded muscles internally and externally
Restoring blood flow and tissue health with various visceral and myofasical techniques and movement
Teaching you to reconnect with your breath, core, and sensations
Addressing scar tissue from childbirth, tearing, or surgeries
Guiding you through graded exposure to intimacy without pain or pressure
Supporting your nervous system through safe and manageable techniques
What About Topical Estrogen and Other Products?
For many women, especially those experiencing vaginal dryness, irritation, or loss of tissue elasticity, topical estrogen therapy can be an incredibly helpful tool.
Unlike systemic hormone replacement, vaginal estrogen creams or suppositories deliver small, localized doses that directly improve the tissue quality of the vaginal and vulvar area.
That said—it’s not the right choice for everyone.
Some women prefer not to use hormones or have medical histories where estrogen is not recommended.
That’s why we also offer (and carry in-clinic) a curated range of non-hormonal products to support your comfort, intimacy, and healing:
Kindra® V Relief Lotion and Serum – Formulated for sensitive, menopausal skin to soothe irritation and improve elasticity
Good Clean Love® Hyaluronic Acid Moisturizers – Support hydration and tissue healing naturally without hormones
Überlube® Silicone-Based Lubricant – Long-lasting and non-irritating for increased comfort during intimacy, especially when tissues feel fragile
MedRoots™ – Previously known as Pacific Roots, these high-quality, THC-free products include CBD-based vaginal suppositories, lubricants, and creams designed to ease pelvic tension, reduce inflammation, and support relaxation before or after intimacy
We help you figure out what your body needs!
What About Low Desire?
According to sex researcher Emily Nagoski, many women experience responsive desire—where intimacy becomes enjoyable after it begins. That’s completely normal, especially during this transition.
Combine that with nervous system overload, adrenal fatigue, and pelvic discomfort—and of course you’re not “in the mood.”
We have created a list of the top supplements we recommend to help support your adrenals. Enter your email below and we will send it right to your inbox then keep reading for a glimpse into what Marisa’s journey with us looked like!
Real Patient Story:
“Marisa” came to us feeling embarrassed and frustrated. At 46, she was avoiding sex with her husband because it felt “like sandpaper.” Lubricants didn’t help, and she assumed something was wrong with her relationship—or worse, herself.
During her evaluation, we discovered guarded pelvic floor muscles and significant tension through her inner thighs and abdominals—plus a history of birth trauma she’d never processed.
Through manual therapy, visceral work, myofascial release, breathwork, mobility drills, and nervous system regulation, and finding the right supplements to support her system, she was able to feel safe in her body again. Within 2 months, intimacy no longer came with pain—and she felt more connected than ever.
“This therapy didn’t just change my sex life. It changed how I show up in my own body! I didn’t even realize how much tension I was holding until I learned how to release it. South Texas Pelvic Health is truly holistic care!”
Let’s Redefine What Sex After 40 Looks Like
Pain, disconnection, or lack of desire don’t mean the end of pleasure. With the right support, this season can become one of renewed connection, confidence, and joy.
Ready to Feel Good in Your Body Again?
You don’t have to figure this out alone—and you’re not expected to just “deal with it.”
Let’s find out what’s going on and create a plan to bring ease and enjoyment back into intimacy and into life in general.
If you are local to Corpus Christi, Texas or the surrounding areas we would love to connect with you in person. If not, we offer virtual appointments as well! Click HERE to get started today!