For many women, sex during midlife can start to feel different, either physically, emotionally, or both. Hormonal changes, vaginal dryness, and shifts in libido can make penetrative sex uncomfortable or less appealing, which can lead to frustration or doubt.

However, here’s the truth: sex can be more than just penetration. Tapping into other forms of sex and intimacy can help you continue to lead a fulfilling sex life during menopause and beyond. Read on as we discuss the ways menopause can influence sex, and how broadening your definition of sex can help.

How menopause impacts intercourse

Aligning both physical and emotional desire can be complicated, and menopause doesn’t make the process simpler. Hormonal changes, common menopausal symptoms, and life stressors can affect how you feel both physically and mentally, which can disrupt pleasure and make penetrative sex difficult.

Here are a few ways that menopause and midlife can impact your sex life:

Physical changes: An international survey of 3,500 postmenopausal women found that 83% experienced vaginal dryness, and 42% experienced pain during intercourse (Simon, 2018) (Simon, 2018). Low estrogen levels play a major role in these issues, and hormonal changes also contribute to low desire, poor arousal, and difficulty reaching orgasm (Simon, 2018) (Simon, 2018).
Mood symptoms: For many people, sex is as much a mental game as a physical one. Anxiety and depression are common during and after the menopause transition (Simon, 2018) (Simon, 2018), and these mood disorders can affect your ability to have and enjoy sex (Stute, 2022) (Stute, 2022).
Emotional challenges: Midlife can bring a whole host of challenges that can impact your sex life. These include relationship conflicts, changes in body image and self-esteem, stress, your partner’s health and sexual performance, and negative perceptions of aging (Alotaibi, 2025) (Alotaibi, 2025).

Speak with your healthcare provider if you’re experiencing painful sex, and remember: experiencing these changes doesn’t mean your sex life is over. With the right tools, communication, and mindset, you can learn to understand your sexuality in new ways and explore what intimacy means to you now.

Expanding the definition of sex

Everyone’s experience with sex is different: what you’re comfortable with, what you enjoy, how important it is to you, and how it affects your relationships. However, our definition of sex is often the same: vaginal penetration.

Penetrative sex is an important part of many people’s sex lives. However, focusing on penetration over other forms of intimacy can lead to discomfort, frustration, and overall dissatisfaction, especially during peri- and postmenopause. It’s important to remember that sex is more than one thing; it exists on a spectrum, and intimacy looks different during different stages of life.

There are plenty of options to explore beyond penetration, including:

Oral sex
Gentle massage
Manual stimulation
Using a vibrator or other pleasure device

Finding what works for you may take time. However, midlife can bring greater confidence and self-acceptance, making menopause an opportunity for sexual agency and renewal rather than decline.

Why you should avoid painful sex

Uncomfortable penetration during menopause is common, but it’s not something to ignore or suffer through.

If you’re experiencing pain or discomfort during penetration, modifying your sexual behavior can help reduce or eliminate pain (Matthes, 2017) (Matthes, 2017). It’s important to avoid pain until you can be properly assessed and treated for the root cause of the discomfort by your trusted healthcare professional (Matthes, 2017) (Matthes, 2017).

Mental health

The physical and psychological sides of sex are a two-way street. Depression and anxiety can cause problems in your sex life, but the inverse is also true: painful sex can negatively affect your mental health (Matthes, 2017) (Matthes, 2017).

Sexual intimacy is a valuable and important part of many relationships, and decreases in sexual activity can lead to feelings of frustration, distress, or depression (Alotaibi, 2025) (Alotaibi, 2025). Painful penetration can cause you to avoid sex entirely, amplifying the strain on your mental health and relationships.

Exploring forms of intimacy that don’t involve painful penetration can help you maintain a pleasurable sex life and ease some of the emotional burden. Many couples in midlife find they need to familiarize themselves with forms of intimacy outside of penetrative intercourse. Working with a sex counselor or therapist is often a great first step. These professionals can be found at assect.org.

Pelvic floor health

Painful penetration can sometimes lead to issues with your pelvic floor health. If you notice that your discomfort lasts for several hours, or even days, after sex, it could be a sign of pelvic floor dysfunction (Streicher, 2023) (Streicher, 2023).

When sex becomes painful, the pelvic floor muscles may seize up in a natural “protective” response. Once this happens, it can be hard for those muscles to relax on their own. Pain during sex due to pelvic floor hypertonicity will likely continue unless addressed by a trained pelvic floor physical therapist who can help release and relax those tight muscles (Streicher, 2023) (Streicher, 2023).

Prioritizing different types of sex and intimacy can help you avoid prolonged pelvic pain while still enjoying a full and healthy sex life.

Quality of life

Penetrative sex can cause physical pain and emotional distress. A 2013 survey of 4,100 women found that 25% were afraid that pain would keep them from having a sex life in the future (Simon, 2018) (Simon, 2018). However, if intimacy isn’t limited to penetration, this doesn’t have to be true.

Focusing on non-penetrative forms of intimacy can help prevent pain and its emotional effects, while supporting a more satisfying sex life and overall well-being (Matthes, 2017) (Matthes, 2017). Remember: communication is key! Openly discussing your sexual concerns with your partner can make adjusting to your sex life after menopause easier and more fulfilling (Alotaibi, 2025) (Alotaibi, 2025).

Understanding your sex life with tracking

If you’re curious about the direction of your sex life, tracking can help you understand where it’s headed. Using your smartwatch, you can track both the physical and emotional symptoms that influence your sexual experiences, and how your sexual activity, in turn, affects those symptoms.

This information can help you see patterns, such as whether painful penetration is increasing your anxiety or if anxiety is contributing to discomfort. From there, you might choose to focus on non-penetrative intimacy and monitor how your experiences change over time.

Questions to ask your provider

Discussing your sex life with your provider may feel awkward at first. However, remember that there’s nothing to be embarrassed about; your questions and concerns are valid, and your provider is there to help. Here are a few ways you can start the conversation at your next appointment:

I’ve been tracking how menopause is impacting my sex life, and I’d like to talk about the changes I’ve noticed. Can I show you my data and get your opinion on what I’m experiencing?
I’d like to continue having a fulfilling sex life throughout menopause, but my physical and emotional symptoms are getting in the way. Can we discuss any recommendations you have?

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.

Sex + Menopause: Going Beyond Penetration