When Sex Hurts: Understanding Sexual Pain in Midlife
What’s happening, why it’s common, and what can help
You’re Not Alone — and You’re Not Broken
Pain during sex can feel isolating, confusing, and distressing. Many women quietly wonder if something is wrong with them — or feel pressure to “push through” discomfort they don’t understand.
The reality is that sexual pain is common in midlife, especially during periods of hormonal, physical, and emotional change. And while pain should never be ignored, it is also something that can be understood and supported.
At Intimate Wellbeing, we believe clarity reduces fear — and understanding your body is the first step toward feeling safer, more confident, and more supported.
What Is Sexual Pain?
Sexual pain — sometimes referred to medically as dyspareunia — describes discomfort or pain that occurs before, during, or after sexual activity.
Pain can look and feel different for different women. Some experience sharp or burning sensations, while others feel tightness, aching, or a sense of resistance. Pain may occur only with penetration, during certain positions, or linger afterward.
Sexual pain is not “all in your head,” and it’s not something you need to tolerate.
How Sexual Pain Can Show Up
Sexual pain may include:
- Burning, stinging, or sharp pain with penetration
- A feeling of tightness or inability to relax
- Deep aching during or after sex
- Pain linked to dryness or irritation
- Discomfort that varies with position, timing, or stress levels
Pain may be consistent or intermittent, and it may change over time.
Why Does Sex Hurt?
Sexual pain often has more than one contributing factor. Understanding these layers can help reduce fear and guide supportive care.
Common contributors include:
Tissue Changes & Dryness
Hormonal shifts — particularly during perimenopause and menopause — can affect tissue thickness, elasticity, and natural lubrication, making friction more uncomfortable.
Hormonal Transitions
Lower estrogen levels can influence vaginal tissue, arousal patterns, and sensitivity, increasing vulnerability to discomfort.
Pelvic Floor Tension
The pelvic floor muscles may tighten protectively in response to pain, stress, or past discomfort. Over time, this tension can make penetration feel painful or difficult.
Nervous System & Emotional Factors
Stress, anxiety, pressure, or previous painful experiences can heighten the body’s protective responses during intimacy.
Underlying Medical Conditions
In some cases, pain may be linked to specific conditions such as inflammatory skin changes, nerve sensitivity, or other gynecological concerns. A healthcare provider can help determine whether further assessment is needed.
Often, more than one factor is involved — which is why simple advice like “just relax” or “use more lube” is rarely sufficient on its own.
What Can Help
Many women find relief through supportive, layered approaches that address both comfort and safety.
Options women often explore include:
- Improving tissue hydration and comfort with consistent care
- Reducing friction during intimacy
- Supporting pelvic floor relaxation and responsiveness
- Slowing down arousal and reducing pressure
- Addressing emotional and nervous system safety
The most effective approach is personal — and it’s okay for what works to evolve over time.
Is It Time to See a Doctor?
If sexual pain is persistent, worsening, or accompanied by symptoms such as bleeding, significant irritation, or changes in tissue appearance, it’s important to speak with a healthcare provider.
A knowledgeable provider can help rule out infections or medical conditions and discuss appropriate treatment or support options.
Learning More
Many women find it helpful to pair written information with expert-led conversations that explore sexual pain, dryness, pelvic floor health, and arousal in more depth.
You may wish to explore related education in the SPARK Library, where expert conversations address the physical and emotional layers of sexual pain in midlife.
A Gentle Reminder
Sex should never be something you endure.
Understanding what’s happening in your body — and knowing support exists — can be the beginning of a very different experience.
You deserve care, clarity, and compassion at every stage of midlife.
Pain, Shame & Self-Blame
Watch this free webinar as Dr. Veronica Li delves into the realms of sexual pain and understanding the associated feelings of guilt, shame, and the internal self-critical narrative.
Our trifecta for midlife comfort
Moisturize for Daily Comfort
Just like facial moisturizer supports your skin, vaginal moisturizers are designed to hydrate delicate tissues inside and out. They provide longer-lasting relief and are ideal for ongoing support, not just in the moment.
Use Lubricant for Intimacy
When intimacy becomes uncomfortable, adding a lubricant can make all the difference. Water-based lubricants are a great option—they’re safe with toys and condoms, and they mimic your body’s natural moisture.
Add Gentle Vibration for Better Circulation
You may not realize that vibrators can do more than enhance intimacy—they can actually help improve moisture levels over time. Regular use of gentle, external or internal vibration increases blood flow to the pelvic area, which in turn supports tissue health, elasticity, and natural lubrication.