Key Topics & Timestamps
[2:00] Dr. Rena Malik’s Journey into Urogynecology and Patient Education
[7:30] Common Bladder and Sexual Health Issues in Women and Men
[13:40] Four Pillars of Pelvic and Sexual Health
[18:50] Pelvic Floor Dysfunction: Weakness and Tightness
[25:10] Myths About Bladder Health
[30:00] Latest Treatments for Urgency and Stress Incontinence
[38:00] The Role of Hormones in Bladder and Sexual Health
[45:10] Testosterone Therapy for Women
[56:20] The Impact of Stress and Lifestyle on Bladder Function
[1:05:00] Reigniting Intimacy and Sexual Desire in Long-Term Relationships
[1:15:00] Q&A: Empowering Women to Advocate for Pelvic Health
As a gynecologist, women’s health advocate, and passionate educator, I have spent decades helping women navigate the complex journey of pelvic and sexual health—from preparing for pregnancy, to thriving through menopause, and well into the years beyond. The landscape of female pelvic health is evolving rapidly, with innovative treatments and a growing understanding of how hormones, lifestyle, and emotional well-being influence both bladder and sexual function.
In this blog post, I’ll dive deeper into the critical insights from my recent podcast episode with Dr. Rena Malik, a leading urogynecologist and sexual medicine expert. We unpack the latest science, debunk common myths, and explore empowering strategies for women facing incontinence, low libido, and pelvic floor dysfunction.
If you’re ready to take charge of your pelvic health at any age, keep reading—and don’t miss the full podcast episode for even more expert wisdom!
The Hidden Crisis: Bladder and Sexual Health After 40
Many women silently struggle with bladder leaks, urgency, dryness, or diminished sexual desire, especially as they approach menopause and beyond. These issues are not “just part of getting older”—they are medical conditions with real solutions! Yet, embarrassment or lack of awareness often keeps women from seeking help.
The Impact of Hormones and Anatomy
After menopause, declining estrogen and testosterone levels trigger profound changes in pelvic tissues. The vaginal walls thin, the clitoral hood can shrink, and the bladder itself becomes more sensitive and prone to dysfunction. The result? A perfect storm for incontinence, vaginal dryness, painful sex, and loss of libido.
But here’s the good news: Advances in both conventional and regenerative medicine are offering new hope for women at every stage of life.
Dispelling Myths: What You Really Need to Know About Bladder Health
Myth #1: “Incontinence is normal after childbirth or menopause.”
Fact: While urinary leakage is common—affecting 1 in 3 women after pregnancy—it is NOT inevitable or untreatable. There are effective therapies, from pelvic floor physical therapy to in-office procedures and hormonal treatments.
Myth #2: “Drinking more water is always better.”
Fact: Over-hydration can actually worsen bladder urgency and frequency. Listen to your body: Aim for urine the color of light lemonade, not crystal clear.
Myth #3: “Recurring UTIs and bladder leaks are just part of aging.”
Fact: Persistent urinary symptoms warrant investigation and can often be resolved—sometimes with simple changes in hormones, physical therapy, or lifestyle.
The Four Pillars of Pelvic and Sexual Health
Dr. Malik and I both advocate a holistic approach—before considering high-tech “biohacks,” focus on these four foundational pillars:
Nutrition – A balanced diet supports tissue repair, hormone balance, and optimal weight (a key factor in reducing leaks).
Exercise – Regular movement, especially targeted pelvic floor work, enhances blood flow and nerve health.
Sleep – Deep, restorative sleep is vital for hormonal balance and tissue regeneration.
Stress Reduction – Chronic stress tightens pelvic muscles and worsens bladder symptoms; practices like deep breathing, yoga, and play are essential!
Understanding Pelvic Floor Dysfunction
Pelvic floor problems aren’t just about weakness—tightness is an under-recognized culprit.
Weak Pelvic Floor: Leads to stress incontinence (leakage when laughing, coughing, or exercising).
Tight Pelvic Floor: Can cause urgency, pain with sex, constipation, and even back or hip pain.
Pro Tip: If you have symptoms, see a pelvic floor physical therapist (in-person or virtually). Most women benefit from expert coaching to learn proper pelvic floor relaxation AND strengthening techniques.
The Latest in Incontinence Treatments: From PT to In-Office Innovations
Urgency Incontinence (“Gotta Go!”)
Lifestyle Changes: Fluid management, avoiding bladder irritants, treating constipation, and weight loss.
Medications: Newer beta-agonists (with fewer side effects) are promising, but insurance coverage lags behind.
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Neuromodulation :
Sacral neuromodulation: A “bladder pacemaker” to recalibrate nerve signals.
PTNS: Minimally invasive stimulation via the ankle nerve—now available as an implantable option for continuous support.
Gene Therapy & Botox: Cutting-edge options for select cases.
Stress Incontinence (Leaks with Cough or Exercise)
Pelvic Floor PT: Gold standard first step.
Pessaries & Devices: Discreet supports that reduce leaks during activity.
Urethral Bulking Agents: Quick, in-office injections that plump the urethral wall—no surgery required.
Sling Surgery: Reserved for persistent or severe cases.
Hormones: The Unsung Heroes of Pelvic Health
Estrogen and DHEA:
Topical vaginal hormones (like estrogen or DHEA) are game changers for postmenopausal women. They restore tissue thickness, improve moisture, reduce overactive bladder symptoms, and even enhance sexual pleasure. Nearly every woman can benefit, unless there’s an active estrogen-sensitive cancer.
Testosterone:
Often overlooked, testosterone is crucial for women’s sexual health, bladder function, and pelvic muscle tone. Applied topically to the vulvar or clitoral area, physiologic doses can:
Boost libido and arousal
Restore clitoral sensitivity and orgasmic potential
Support strong, healthy pelvic tissues
Reduce stress incontinence and even improve surgical outcomes
Pro Tip: Treat the patient, not just the lab numbers! Start low, go slow, and focus on symptom improvement.
The Role of Stress in Bladder and Sexual Dysfunction
Did you know that emotional stress literally tenses your pelvic floor?
Just as stress clenches your jaw, it can tighten the muscles at your pelvic base, leading to urgency, frequency, and difficulty relaxing during intimacy.
What helps:
Diaphragmatic breathing and restorative yoga poses (like happy baby or child’s pose)
Play, laughter, and oxytocin-boosting activities
Therapy for persistent anxiety or trauma
Reigniting Intimacy & Sexual Desire in Long-Term Relationships
Sexual health is health—period!
After years together, it’s normal for couples to need a spark. The solution isn’t always “spontaneity”—sometimes, it’s scheduling intimacy, trying new things (even small changes can feel novel!), and having open conversations about desires and fantasies.
Remember:
Foreplay starts long before the bedroom
Intimacy is about connection, not just orgasm
Oxytocin (the bonding hormone) increases with touch, laughter, and sexual pleasure—helping relationships thrive well into our 70s and 80s!
Your Next Steps: Advocate for Your Pelvic Health
You deserve to be heard and helped! If your doctor isn’t taking your bladder or sexual concerns seriously, keep asking, keep searching for the right provider, and never accept “just live with it” as an answer.
Explore pelvic floor physical therapy, hormone optimization, and the innovative treatments discussed here. And if you’re ready for a deeper dive—including my holistic, step-by-step approach—check out my Sexual CPR program.
Listen to the Full Podcast!
This post only scratches the surface of our empowering conversation.
Listen now to get all the details, hear real-life stories, and discover practical tips you can use immediately.
Listen to the full podcast episode here!
Key Points: Q&A
Q: Is incontinence after menopause or childbirth normal?
A: It’s common, but not normal—or inevitable! Effective treatments exist, from pelvic floor therapy to hormonal support and innovative in-office procedures.
Q: Can hormones really help with bladder and sexual health?
A: Yes! Topical estrogen, DHEA, and physiologic testosterone can rejuvenate tissues, reduce leaks, and restore sexual pleasure for most women.
Q: What are the newest options for urgency and stress incontinence?
A: Neuromodulation (like PTNS and sacral “bladder pacemakers”), injectable gene therapy, advanced bulking agents, and new medications are transforming care.
Q: How do I know if my pelvic floor is too tight or too weak?
A: Symptoms like urgency, pain, or leaks can signal either problem. Seeing a pelvic floor physical therapist is the best way to assess and treat your unique needs.
Q: What if my doctor isn’t listening?
A: Advocate for yourself! Seek out specialists in urogynecology or sexual medicine, and don’t stop until you get answers and relief.
