In my 30 years as an OB/GYN, I have sat across from thousands of women who came in for one thing and left understanding something much bigger.
They came in for bladder leaks. Or dryness. Or low libido. Or recurring UTIs. Or intimacy that had quietly stopped feeling worth the effort.
They thought they had several different problems. What I told them — what I wish every woman knew — is that most of the time, these are not separate problems at all. They are one problem, showing up in different ways. And when we address the root, everything changes.
What Your Symptoms Are Actually Telling You
Here is something I say to every patient who walks through my door with a list of complaints: the pelvis is not a collection of isolated parts. It is an ecosystem.
The bladder, the urethra, the vagina, the vulva, the pelvic floor muscles, the local nerve networks, and the vaginal microbiome — they all share the same hormonal environment, the same tissue, and the same blood supply. When one thing is off, everything feels it.
This is why I hear things like:
"We've become roommates."
"I avoid intimacy because it's just not worth the discomfort anymore."
"I get a UTI every time."
"I leaked at my daughter's wedding when I laughed during the toast."
"I thought this was just what getting older felt like."
No, Beautiful. Your body is not betraying you. Your body is communicating. And when we listen — really listen — we can restore comfort, confidence, connection, and vitality.
The Hormone Connection Nobody Explains Clearly Enough
As estrogen declines during perimenopause and menopause, an entire cascade begins. Vaginal tissues become thinner and drier. Blood flow decreases. Natural lubrication declines. Collagen production slows. Elasticity decreases. And because estrogen receptors are concentrated throughout the vulva, vagina, urethra, and bladder — all of these tissues are affected simultaneously.
This is what medicine calls Genitourinary Syndrome of Menopause, or GSM. And it is far more common than most women realize.
27–84%
of postmenopausal women experience GSM symptoms — yet nearly 70% never discuss it with a healthcare provider (NCBI StatPearls, 2024)
That wide range reflects how differently women experience these changes. But here is the number that matters most to me: nearly 70% of women with GSM symptoms never discuss them with a healthcare provider. They suffer alone, assuming this is just aging. It isn't.
While estrogen gets most of the attention, testosterone, DHEA, progesterone, and oxytocin all play important roles in maintaining healthy tissue, circulation, and pelvic resilience. This is why dryness, bladder leaks, recurrent UTIs, reduced sensation, and changes in libido often arrive together. They share the same origin.
But here is what most women — and frankly, many healthcare providers — miss: hormones alone are not the whole story.
The Vaginal Microbiome — The Missing Piece
One of the most overlooked aspects of women's pelvic health is the vaginal microbiome.
A healthy vaginal environment is dominated by Lactobacillus species. These beneficial bacteria maintain a protective acidity, reduce infection risk, support tissue health, and promote comfort. When this ecosystem is disrupted — by antibiotics, pH-disrupting products, hormonal changes, or chronic stress — women experience bacterial vaginosis, yeast infections, recurrent UTIs, irritation, and increased discomfort during intimacy.
The connection most women never make
Many conventional lubricants contain glycerin, parabens, artificial fragrances, and high-osmolality ingredients that disrupt vaginal pH and actively harm the Lactobacillus bacteria protecting you. Products designed to help intimacy can actually worsen the very ecosystem that makes intimacy comfortable.
This is what I kept seeing in practice. A woman would use a lubricant to address dryness and then wonder why her infections were increasing. The product meant to help was quietly making things worse. This is a big part of why I created Velvé — an intimate lubricant that works with the microbiome, not against it.
The Stress Nobody Is Talking About
We cannot talk about pelvic health without talking about stress. Chronic stress elevates cortisol. Elevated cortisol suppresses oxytocin, sexual desire, natural lubrication, vaginal blood flow, and nervous system regulation.
Women today carry enormous loads — careers, caregiving, aging parents, financial pressures, relationship demands. The body responds accordingly.
Sometimes what appears to be a libido problem is actually a stress problem. Sometimes what feels like a relationship problem is actually a tissue problem. And sometimes what seems like a bladder problem is actually a microbiome problem. The symptoms look different. The root is the same.
What Actually Helps — The Three Pillars of Pelvic Wellness
After 30 years of clinical practice, I have come to think about pelvic health in three pillars:
Pillar 1 — Tissue Health
Daily support for vulvar and vaginal tissue — not just in the moment, but as a consistent practice, the way we moisturize our faces every day without question. Estrogen receptors in intimate tissues respond to daily care. This is exactly why I developed Julva, my patented daily vulvar cream with DHEA, Alpine Rose stem cells, and shea butter. Used every day, it supports tissue elasticity, collagen production, natural moisture, and bladder control — benefits that build meaningfully over time.
Pillar 2 — Microbiome Health
Supporting the Lactobacillus bacteria that protect the entire pelvic environment — from the vaginal walls to the bladder lining. When the microbiome is healthy, discomfort decreases, infections become less frequent, and the tissues have the protective environment they need to stay resilient. The VB Probiotic is formulated specifically to support vaginal and bladder microbiome balance.
Pillar 3 — Comfortable Intimacy
Having a lubricant that supports rather than disrupts the ecosystem you are working so hard to protect. Velvé is the intimate lubricant I spent years formulating because nothing on the market met the standard my patients deserved — pH-matched to the vaginal environment, hyaluronic acid-infused for lasting moisture, microbiome-conscious, and free from every ingredient that has no business being near intimate tissue.
Together, these three pillars address pelvic wellness at the tissue level, the microbiome level, and the intimate level. That is what I wish every woman had.
What the Research Says
The statistics matter, and I want every woman to see them clearly — with accurate sourcing:
27–84% of postmenopausal women experience Genitourinary Syndrome of Menopause, with 75% experiencing vaginal dryness (NCBI StatPearls, October 2024)
40% of postmenopausal women report pain during intercourse; 30–40% experience urinary urgency and frequency (NCBI StatPearls, 2024)
1 in 3 women will experience bladder leaks at some point in their lives (consistent with NCBI prevalence data of 24–45%)
43% of women with urge urinary incontinence experience sexual issues including diminished libido and painful intercourse (IntechOpen, 2025)
Nearly 70% of women with GSM symptoms never discuss them with a healthcare provider — and more than 50% use no treatment (NCBI StatPearls, 2024)
Pelvic floor muscle training has been shown to significantly improve arousal, orgasm, satisfaction, and pain scores in women with pelvic floor dysfunction — confirmed by a 2024 meta-analysis in the American Journal of Obstetrics & Gynecology
The most important number
You are not an outlier. You are not alone. And you are not out of options. These symptoms are common — but they are not something you simply have to live with.
What I Wish I Had Told Every Patient Sooner
Pelvic health is foundational health. When something is off in the pelvis, it affects sleep, confidence, relationships, physical activity, and overall wellbeing. Whether you are sexually active or not. Partnered or not. In perimenopause, menopause, postmenopause, or postpartum — pelvic health directly impacts quality of life at every stage.
And the most important thing I can tell you is this: you don't have to manage symptoms one at a time, forever. When you address the ecosystem — tissue, microbiome, and intimate comfort together — the whole picture changes.
I've seen it thousands of times. And I believe it can happen for you. Because your body deserves more than symptom management. It deserves to thrive.
With love and lubrication,
xx, Dr. Anna Cabeca, DO, FACOG
Triple-Board-Certified OB/GYN | The Girlfriend Doctor
P.S. Always keep exercising the pelvic floor — this is critical for life. The research is clear: pelvic floor training improves arousal, orgasm, satisfaction, and pain. The results are real, and they build over time.
FAQ
Q: Why do bladder leaks, vaginal dryness, and low libido often occur together?
A: These symptoms share a common root: the decline of estrogen, DHEA, and testosterone during perimenopause and menopause. Because estrogen receptors are concentrated throughout the vulva, vagina, urethra, and bladder, hormonal changes affect all of these tissues simultaneously. The result is a cluster of symptoms that appear unrelated but actually reflect the same underlying shift in the pelvic hormonal environment. Addressing the ecosystem — not each symptom in isolation — is what produces lasting improvement.
Q: What is Genitourinary Syndrome of Menopause (GSM) and how common is it?
A: Genitourinary Syndrome of Menopause (GSM) is the medical term for the range of vaginal, vulvar, and urinary changes caused by declining estrogen levels during menopause. It encompasses vaginal dryness, thinning of vaginal tissues, painful intercourse, urinary urgency, recurrent UTIs, and bladder leaks. According to NCBI StatPearls (2024), GSM affects 27–84% of postmenopausal women. Despite being one of the most common conditions in this population, nearly 70% of affected women never discuss symptoms with a healthcare provider — often because they assume these changes are a normal, unchangeable part of aging. They are not.
Q: Can the right lubricant actually make vaginal dryness and infections worse?
A: Yes — many conventional lubricants can worsen the vaginal environment. Products containing glycerin, parabens, artificial fragrances, or high-osmolality ingredients disrupt vaginal pH and damage the Lactobacillus bacteria that protect the vaginal and bladder microbiome. This can increase susceptibility to infections, worsen dryness over time, and reduce intimate comfort. Choosing a pH-matched, microbiome-conscious lubricant free from these ingredients makes a meaningful difference in both immediate comfort and long-term tissue health.
Q: What is the vaginal microbiome and why does it matter for pelvic health?
A: The vaginal microbiome is the community of microorganisms living in the vaginal environment. In healthy women, it is dominated by Lactobacillus bacteria, which maintain a protective low-pH environment that resists infection, supports tissue health, and reduces inflammation. When this balance is disrupted — by hormonal changes, antibiotics, or pH-disrupting products — women become more susceptible to bacterial vaginosis, yeast infections, recurrent UTIs, and intimate discomfort. Supporting the vaginal microbiome through probiotics and microbiome-conscious intimate products is an often-overlooked but critical pillar of pelvic wellness.
Q: Do pelvic floor exercises actually improve sexual function?
A: Yes, and the research is clear. A 2024 meta-analysis published in the American Journal of Obstetrics & Gynecology confirmed that pelvic floor muscle training significantly improves arousal, orgasm, satisfaction, and pain scores in women with pelvic floor dysfunction. The mechanism is well understood: strengthening the pubococcygeus muscle increases blood flow to the pelvis, enhances clitoral sensitivity, and supports the involuntary contractions involved in sexual response. Consistency matters more than intensity — even 5 minutes of daily practice builds meaningful results over time.
Q: What does DHEA do in a topical intimate cream like Julva?
A: DHEA (dehydroepiandrosterone) is a precursor hormone that converts locally in intimate tissues into both estrogen and testosterone. When applied topically to vulvar tissue, it supports the maintenance of tissue thickness, elasticity, and moisture — effects that decline as DHEA levels naturally fall with age. Unlike systemic hormone therapy, topical DHEA acts locally at the application site. Dr. Anna Cabeca formulated Julva with a gentle concentration of DHEA specifically for daily intimate skin care support, alongside Alpine Rose stem cells and shea butter. These statements have not been evaluated by the FDA. Julva is not intended to diagnose, treat, cure, or prevent any disease.
Q: How long does it take to see results from daily intimate tissue care?
A: Tissue changes are gradual and cumulative. Most women who use Julva consistently report noticing improvements in moisture and comfort within 4–8 weeks of daily use. The benefits of pelvic floor training typically become noticeable within 6–12 weeks of consistent daily practice. Microbiome support through probiotics can produce more rapid changes in comfort and infection frequency, often within 2–4 weeks. The key across all three pillars is consistency — daily care produces compounding results over time in ways that occasional use simply cannot.
References
1. Genitourinary Syndrome of Menopause — StatPearls, NCBI (NIH), updated October 2024. GSM affects 27–84% of postmenopausal women; 75% experience vaginal dryness; ~70% never discuss with provider. https://www.ncbi.nlm.nih.gov/books/NBK559297/
2. North American Menopause Society (NAMS) Position Statement on GSM, 2020. 'Genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women.' PubMed: https://pubmed.ncbi.nlm.nih.gov/32852449/
3. American Urological Association GSM Guideline, 2025. Confirms 27–84% prevalence range; notes only ~50% of affected patients discuss symptoms with clinicians. https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause
4. Female Sexual Dysfunction and Urinary Incontinence — IntechOpen, 2025. '43% of women with urge urinary incontinence experience sexual issues such as diminished libido and dyspareunia.' https://www.intechopen.com/online-first/1232767
5. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, January 2024. Confirmed improvements in arousal, orgasm, satisfaction, pain, and overall FSFI score. https://www.ajog.org/article/S0002-9378(24)00006-1/abstract
6. Vaginal Microbiome and GSM — NIH/NCBI research confirming association between Lactobacillus-dominant microbiome and reduced GSM symptom severity. Multiple supporting studies available at https://pubmed.ncbi.nlm.nih.gov
