Why Does Sex Hurt In Midlife? Painful Intercourse After Menopause, And Where Yoga Helps

Painful intercourse after menopause: the short answer

Painful intercourse after menopause is common, and most women never say so. Lower oestrogen and vaginal dryness are part of it. But not all of it is hormones. A pelvic floor that is too tight, or has forgotten how to let go, can cause pain with sex too, and squeezing exercises can make that worse.

Yoga works on the part hormones do not reach: a softer breath, a pelvis that can widen, and muscles that can both lift and let go. Here is the article in short form:

• Pain with sex is common in midlife, and treatable.
• Lower oestrogen thins and dries the tissues.
• A tight pelvic floor can hurt too, hormones or not.
• “Healthy pelvic muscles should be pain-free.”
• 24 trials: yoga improved vaginal and bladder symptoms.
• Your teacher can adapt the class for a tight pelvic floor.

A quick word on Iyengar yoga. Iyengar yoga is the style developed by Mr BKS Iyengar. In the 20th century he did more than anyone to set down traditional Indian yoga, through his books and his teaching, and he pioneered the use of props. It is the style we teach at Flametree, in Darwin and live online.

Why does sex hurt after menopause?

Partly because of oestrogen. Oestrogen keeps the tissues of the vagina, the bladder and the pelvic floor thick, moist and springy. As it falls through perimenopause and menopause, those tissues can become thinner, drier and more tender. Sex that was comfortable can start to sting or ache.

That part is well known: sex hurts after menopause for many women simply because the tissues are thinner and drier. There are medical treatments for it.

But there is a second cause that is far less talked about. It is the muscles.

Can a tight pelvic floor cause pain with sex?

Yes. Leslie Howard is an American yoga teacher who trained for many years with senior teachers in the Iyengar tradition, and now works only on pelvic health. Her book Pelvic Liberation (2017) starts with her own surprise.

In her 40s, after a year of daily pelvic floor strengthening, sex began to hurt. She wondered if it was menopause. Then long drives brought a burning feeling between her sitting bones. A pelvic floor physiotherapist examined her and told her the opposite of what she expected: her muscles were too tight.

“I didn’t even know a woman could be too tight,” she writes. She had believed that every woman’s pelvic floor sags with age, and had been squeezing hard every day.

Her lesson is that a pelvic floor can be “too tight, too loose, and often a combination of both.” And a tight muscle is not a strong muscle. Sometimes the job is to learn to let go.

Should sex ever hurt?

Howard’s rule of thumb is simple: “Healthy pelvic muscles should be pain-free.”

That matters, because the usual advice, more squeezing, suits a weak pelvic floor and can make a tight one worse. Howard and the physical therapist Judith Hanson Lasater both make this point.

Howard also writes, with great frankness, about how slowing right down with her husband, and making it a shared project rather than her private problem, turned things around for them. Their motto became “How slow can we go?”

How does the breath affect the pelvic floor?

Directly. The diaphragm, the big breathing muscle under the lungs, and the pelvic floor move together. On the in-breath both move down and soften. On the out-breath both lift. It happens about 20,000 times a day.

Many women do the opposite without knowing it, pulling the belly in on the in-breath after a lifetime of holding the stomach flat. That stops both domes moving. A held, tense breath goes with a held, tense pelvic floor. A soft belly on the in-breath lets the whole system move and soften again.

Stress plays in too. A long, slow out-breath is the body’s brake, moving it from “rev up” to “rest”. In our experience, many women in these years carry far more tension in the pelvis than they realise until it lets go.

Does yoga help vaginal dryness and menopause symptoms?

The trials say yoga helps across many menopause symptoms. A 2025 review of 24 trials, with 2,028 women, found yoga improved symptoms overall, and mood, anxiety, sleep, bladder and vaginal symptoms, and blood pressure.

No trial has yet tested yoga for painful sex on its own. That is a gap in the research, not a sign yoga does not help. The yoga tradition has worked with women through these years for a very long time. Geeta Iyengar, Mr Iyengar’s daughter, gave standing poses to women with bladder leaks, bladder infections and vaginal dryness. She taught a reclining pose with the leg out to the side, saying, “The pelvic and vaginal opening helps to cool down the system.”

What does a yoga class do for the pelvis in midlife?

It teaches the pelvis to widen, soften and lift. In her women’s classes, Chris Lalor comes back to two actions again and again.

Spread, don’t tuck. Many women tuck the tailbone under out of habit. Chris told one class that in the era she grew up in, jeans were “exceptionally tight” and “everything was squeezed in”. That squeezing habit “has huge ramifications” for pelvic health. In class she raises the props until the buttocks can spread.

Tone, don’t flop. Opening is only half of it. The pelvic floor needs life and lift as well, not just looseness.

Supported poses such as Bound Angle Pose on bolsters let the pelvis open with no effort, while the breath slows. Read more about the pelvic floor in Yoga For Pelvic Floor, and about closeness and libido in Yoga For Intimacy.

Where can I get menopause help in Darwin?

For menopause help in Darwin, come to class.

Flametree teaches Iyengar yoga at Woolner in Darwin and live online, including women’s wellness classes with Chris Lalor, a Senior Iyengar Yoga Teacher and certified yoga therapist.

Frequently asked questions

Why does sex suddenly hurt in my 40s or 50s?

Falling oestrogen can thin and dry the vaginal tissues, which is part of it. But a pelvic floor that is too tight, or cannot let go, can cause pain with sex too, hormones or not. Leslie Howard found this out herself in her 40s after a year of daily squeezing exercises.

Can a tight pelvic floor cause painful intercourse?

Yes. A tight pelvic floor cannot let go fully, and pain with sex is one of the signs. For a tight pelvic floor, learning to relax and soften matters more than squeezing harder.

Is painful sex after menopause normal?

It is common, not something you have to put up with. Leslie Howard’s rule of thumb is that healthy pelvic muscles should be pain-free.

Can Kegel exercises make sex more painful?

For some women, yes. Kegels help many women with stress leaks. But for a pelvic floor that is already too tight, Leslie Howard and Judith Hanson Lasater both say more squeezing can make things worse. Find out which you have first.

Can yoga help vaginal dryness?

A 2025 review of 24 trials with 2,028 women found yoga improved vaginal and bladder symptoms, along with mood, anxiety and sleep. Geeta Iyengar gave standing poses to women with vaginal dryness.

Does stress affect the pelvic floor?

In our experience, yes. A held, tense breath tends to go with a held pelvic floor, and many women carry tension there without knowing. The diaphragm and pelvic floor move together, so a soft belly on the in-breath and a long out-breath help both let go.

Should I stop having sex if it hurts?

Pain is a signal, not something to push through. Leslie Howard describes slowing right down with her husband and making it a shared project. Their motto became “How slow can we go?”

Where can I get menopause help in Darwin?

Flametree Yoga Studio teaches Iyengar yoga at Woolner and live online, including women’s wellness classes with Chris Lalor.

Where to next

• New to yoga, or coming back? Start with our half price 10 class pass with 2 classes free, in Darwin or live online.
• For a workplace, team or group: book private yoga classes for groups, online, at a Flametree studio or at your venue.
• Want to see class times first? Look at the beginner timetable.

Flametree Yoga Studio, Darwin and live online. This article is general information, not medical advice. Feel free to check with your professional advisers if you wish, but also give yoga a try.

Sources: Wang and colleagues, review of 24 trials of yoga for menopause symptoms, 2025; Leslie Howard, Pelvic Liberation: Using Yoga, Self-Inquiry, and Breath Awareness for Pelvic Health (2017), with a foreword by Judith Hanson Lasater; Hjartardottir S and colleagues, The female pelvic floor: a dome, not a basin, 1997; Geeta S Iyengar, menopause teaching; Chris Lalor, women’s class recordings. Background on menopause: Jean Hailes for Women’s Health. Full references are in the Cool, Calm And Strong ebook.