Women over 40 are often given one remarkably simple piece of advice when sex becomes uncomfortable or less satisfying: use more lube.
Lubrication can absolutely help. But if sex has changed during perimenopause or menopause, dryness may be only one piece of the puzzle.
As estrogen levels decline, women can experience changes in genital blood flow and sensitivity, vaginal dryness, loss of tissue elasticity, and pain with penetration. At the same time, sleep deprivation, stress, medications, body image, relationship concerns, and pelvic floor dysfunction can affect arousal and orgasm.
So instead of asking, “What’s wrong with my sex life?” I encourage women to ask a different question:
What has changed—and what can we change with it?
Are There Really “Best” Sex Positions After 40?
There isn’t good clinical evidence showing that one named sex position is universally best for women after 40. What matters much more is depth, angle, control, and access to clitoral stimulation.
If deeper penetration has become uncomfortable, positions that give the woman more control can help.
Being on top, for example, allows a woman to control the depth and pace of penetration while adjusting the angle of her pelvis based on what feels comfortable and pleasurable.
Side-lying positions can also be useful because penetration may be shallower and easier to control. Facing one another on your sides allows both partners to make small adjustments in angle and depth.
Spooning or other positions with the partner behind can have another advantage: they leave a hand free for direct clitoral stimulation.
Women don’t need to memorize a list of “best sex positions after 40.” Instead, consider three questions:
Who controls the depth? Can the angle be adjusted? Can the clitoris be stimulated at the same time?
Those three factors are often far more important than the name of the position.
Orgasm May Require More Intentional Stimulation
One of the biggest misconceptions about female sexuality is that penetration alone should reliably produce orgasm.
For many women, it doesn’t.
Direct or indirect clitoral stimulation is important for orgasm for most women. If sensitivity or sexual response changes during perimenopause or menopause, that stimulation may need to become more intentional.
Manual stimulation, oral stimulation, vibrators, or other sexual devices can be incorporated before, during, or after penetration.
There shouldn’t be embarrassment about adapting.
Women sometimes expect their bodies to respond exactly as they did at 25. A better question at 45 or 55 is: What does my body need now?
Sexual response can change with hormones, medications, medical conditions, stress, relationships, and aging. Changing how you have sex isn’t evidence that something has failed. It can simply be an appropriate response to a changing body.
Your Pelvic Floor May Be Part of the Problem
The pelvic floor is often forgotten in discussions about sexual health, even though these muscles are involved in sensation, penetration, and orgasm.
Pelvic floor muscle training can improve sexual function in some menopausal women, but simply telling every woman to “do Kegels” can be misleading.
Some women experiencing painful sex actually have pelvic floor muscles that are too tight or have difficulty relaxing. Repeatedly contracting already-tight muscles may worsen the problem.
Pelvic floor physical therapy can help determine whether the muscles are weak, tight, poorly coordinated, or otherwise dysfunctional. Treatment can then be individualized and may include targeted exercises, relaxation techniques, manual therapy, biofeedback, or vaginal dilators.
Not every pelvic floor needs strengthening. Some pelvic floors need to learn how to relax.
If Sex Burns or Hurts, Don’t Just Change Positions
If penetration suddenly causes burning, soreness, or pain, changing positions may not address the real problem.
One common cause during and after menopause is genitourinary syndrome of menopause, or GSM.
Declining estrogen can cause vulvar and vaginal tissues to become thinner, drier, less elastic, and more vulnerable to irritation. Women may experience dryness, burning, soreness, urinary symptoms, or pain during sex.
Lubricants reduce friction, but they don’t reverse the underlying tissue changes.
Low-dose vaginal estrogen is an effective treatment for GSM and can improve dryness, tissue health, elasticity, and pain. Other prescription options include vaginal DHEA, or prasterone, and ospemifene when appropriate.
Treating pain can have benefits that extend beyond penetration.
It’s difficult for the brain to become excited about something it has learned to expect will hurt.
When pain improves, anticipation, arousal, and sexual satisfaction may improve as well.
Sometimes the Most Important Sexual Organ Is the Brain
Hormones matter, but sex and orgasm aren’t purely physical.
Stress, anxiety, sleep deprivation, medications, relationship concerns, body image, competing responsibilities, and simply not having enough time to become aroused can all interfere with sexual response.
For some women, one of the most effective changes is also one of the simplest:
Slow down.
Arousal may take longer than it once did. Longer foreplay, more direct stimulation, and less pressure to move quickly toward penetration can make a significant difference.
Depending on the underlying issue, sex therapy, counseling, cognitive behavioral approaches, mindfulness, and sexual skills training can also be helpful.
Sex after 40 may not always be as spontaneous or as quick as it was at 25. That doesn’t mean it has to be less satisfying.
Women Deserve Better Than “Just Use More Lube”
Painful or unsatisfying sex should not automatically be dismissed as a normal consequence of getting older.
The goal is to identify what changed.
If deeper penetration hurts, modify the depth and angle. If clitoral stimulation isn’t sufficient, add more direct stimulation. If pelvic floor dysfunction is contributing, consider pelvic floor physical therapy. If vaginal and vulvar changes from GSM are causing pain, treat the underlying condition. And if libido, arousal, or orgasm has changed, look at hormonal, medical, medication-related, psychological, and relationship factors.
Sex after 40 may require some adjustments, but different does not have to mean worse.
For many women, the most important shift is giving themselves permission to stop trying to recreate sex at 25—and start figuring out what feels good in the body they have today.
References
The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. doi:10.1097/GME.0000000000001609.
The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028.
Jorge CH, et al. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. Am J Obstet Gynecol. 2024.
Effects of pelvic floor muscle training on sexual function of postmenopausal women: a systematic review and meta-analysis. Sex Med. 2025;13(4):qfaf067.
Genitourinary syndrome of menopause (GSM): recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024). Sex Med Rev. 2026;14(1):qeaf055.
Psychological treatments for sexual concerns in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Published online 2025.
Effects of mindfulness-based intervention on sexual health in menopause: a systematic review. Int J Sex Health. Published online 2026.
Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. doi:10.1210/jc.2015-2236.