If I could sit down with my 30-year-old self over a cup of coffee, there are so many things I would tell her.
Don't worry so much about the number on the scale. Stress steals more joy than wrinkles ever will. Protect your sleep. You can't heal a body you hate and continuously criticize.
You are worthy.
And I would definitely tell her this: take care of your bladder, your pelvic floor, and your intimate tissues long before you think you need to.
Because here's the truth no one told me — the changes that make intimacy uncomfortable, that make you cross your legs when you sneeze, that quietly chip away at your confidence? They don't happen overnight. They happen gradually, in whispers, over years. And by the time most women notice something is off, the changes have already been building for a long time.
What's Actually Happening in Your Body
As both an OB-GYN and a woman approaching 60 who has navigated these changes herself, I want to give you the honest explanation most women never receive.
Hormonal shifts during perimenopause and menopause affect nearly every tissue involved in intimacy and bladder health: the vaginal walls, the urethra, the vulva, the pelvic floor, and the connective tissue holding everything in place. Estrogen, progesterone, DHEA, testosterone, collagen production, blood flow, and even your vaginal microbiome all work together to keep these tissues resilient, lubricated, and functional. When they begin to shift, as they do in the years surrounding menopause, the downstream effects are real.
Women often notice:
Vaginal dryness and thinning of intimate tissues
Painful or uncomfortable intercourse
Bladder leaks with laughing, sneezing, or exercise
Increased urgency — needing to find a bathroom quickly
Recurrent urinary tract infections
Decreased sensation and lower libido
Reduced confidence in the body
Yet most women go through all of this without any education about what is happening or what they can do about it. We've normalized the suffering. We've been told 'that's just what happens after babies' or 'that's just menopause' or 'that's just aging.' These experiences are common. But common does not mean inevitable or irreversible.
The Statistics Are Eye-Opening
Urinary incontinence is one of the most widespread conditions affecting women as they age — and one of the least talked about.
Research from NCBI StatPearls estimates that between 24% and 45% of women experience urinary incontinence, with prevalence increasing significantly after menopause. A more recent 2025 PubMed study found the crude prevalence among U.S. women to be 63%, representing approximately 79.6 million women. Among nursing facility residents, prevalence exceeds 50%, and among long-term care residents, it surpasses 75%.
The reality
Up to three in four women in long-term care are dealing with bladder control issues — yet most never sought help until symptoms were severe, because we were taught to accept this as a normal part of aging.
Research also shows that 15-20% of married couples are in what's defined as a sexless marriage — fewer than 10 times per year — with that number rising to 25-30% for couples married 20 or more years (Indiana University National Survey of Sexual Health and Behavior, 2024). And gray divorce — divorce occurring after age 50 — now accounts for 36% of all U.S. divorces, up from just 8.7% in 1990, according to Bowling Green State University research confirmed by Pew Research Center in 2025.
None of these statistics exist in isolation. When physical intimacy disappears because of unaddressed health issues, relationships suffer in ways that are hard to reverse. That connection matters.
The Hidden Cost Nobody Talks About
What concerns me even more than the physical symptoms is what follows when women don't get support. They quietly reorganize their lives around their limitations. They stop exercising because they're afraid of leaking. They skip travel because they can't be too far from a bathroom. They stop dancing. They stop laughing freely. And sometimes, they stop being intimate — not because the love is gone, but because discomfort has slowly and silently taken over.
I've had countless women sit across from me and say: 'Dr. Anna, I thought it was just me.'
It never is. And there is so much you can do about it.
What I Would Tell My Younger Self at Every Decade
In Your 20s
Your pelvic floor is just as important as any other muscle you train. Your vaginal microbiome matters. The foundation you build now will either serve you beautifully or require significant repair later. Start caring for these tissues now — not because anything is wrong, but because you want to stay well.
In Your 30s
Recovery after childbirth is real rehabilitation, not simply 'bouncing back.' Bladder leaking after pregnancy is common but not permanent. The pelvic floor can be restored with the right attention, and the confidence that returns with that restoration is worth every bit of the effort. Prioritize pelvic floor training far sooner than you think you need to.
In Your 40s
Perimenopause often begins subtly — slightly more fatigue, irregular cycles, changes in sleep or mood. This is when the whispers start. Don't wait for them to become shouts. Supporting your hormones naturally, reducing inflammation, strengthening your pelvic floor, protecting your microbiome, and nourishing your tissues in these years creates compounding dividends you will feel for decades.
Approaching 60
Aging is not a disease. Growing older is a privilege. But aging well requires intention. Daily habits matter far more than occasional heroic efforts, and the body always tells the truth when we stop doing the things that support it.
A Practical Daily Routine for Bladder and Intimate Health
Women ask me constantly what I personally do. Here is what actually moves the needle, when done consistently:
1. Train Your Pelvic Floor Daily
Even just 3-5 minutes of intentional pelvic floor activation exercises each day. Consistency beats intensity every time. If you have never worked with a pelvic floor physical therapist, it is one of the best investments you can make in your body at any age.
2. Walk Every Single Day
Movement supports circulation, hormone balance, and connective tissue health in ways that very little else replicates. Aim for 20-30 minutes at minimum. This isn't about weight — it's about blood flow, tissue health, and longevity.
3. Support Your Vaginal and Bladder Microbiome
A healthy microbiome contributes meaningfully to comfort, resilience, and long-term bladder and vaginal health. This is an area most women have never even considered, and it makes a significant difference in both daily comfort and long-term tissue health.
4. Nourish Hormonal Balance from the Inside
Blood sugar stability, adequate protein, healthy fats, hydration, and targeted nutritional support all influence how your tissues age. I rely on Mighty Maca Plus daily for adaptogenic, alkalizing support that helps my body maintain balance.
Explore Mighty Maca Plus — Dr. Anna's daily adaptogenic support for hormonal balance → here
5. Care for Intimate Tissues Daily
We moisturize our faces every single day without question. Our intimate tissues deserve the same consistent attention. Julva is the cream I formulated specifically for this purpose — because I couldn't find anything on the market that addressed the full picture. It combines DHEA, plant stem cells, and nourishing botanicals to support tissue health, comfort, and resilience from the outside in. I use it every day.
Try Julva — daily intimate skin cream formulated by Dr. Anna with DHEA and plant stem cells → here
6. Prioritize Oxytocin Every Day
This is the one most women overlook entirely. Connection, laughter, prayer, touch, gratitude, time in nature — these are not extras. Oxytocin is one of the most powerful hormones for healthy aging, and the research supporting it is compelling. Make it a daily practice, not an occasional luxury.
The Bigger Picture
This isn't really about bladder leaks or painful intercourse or declining libido. It's about agency. It's about knowing you are not powerless over how you age, how you feel, or how fully you show up in your life. It's about refusing to normalize unnecessary suffering and choosing instead to become the example for the women coming behind us.
What if our daughters grew up watching women in their 50s, 60s, and 70s living with confidence, intimacy, vitality, and joy? What if they never learned to accept decline as something inevitable?
That is the future worth building. And it starts with the choices we make today.
Your Second Spring isn't about looking younger. It's about feeling fully alive. And it is never too early — or too late — to begin.
To your vibrant health and joyful intimacy,
Dr. Anna Cabeca
The Girlfriend Doctor
Ready to support your intimate health every day?
FAQS
Q: What causes bladder leaks and vaginal dryness during menopause?
A: The primary cause is the decline of estrogen and other hormones, including DHEA and testosterone, during perimenopause and menopause. These hormones are essential for maintaining the thickness, elasticity, and lubrication of vaginal and urethral tissues. As levels fall, tissues become thinner and less resilient, the pelvic floor can weaken, and the urethral sphincter loses some of its ability to hold. The result is symptoms like vaginal dryness, urgency, leaking with physical activity or laughter, and discomfort during intercourse. These changes are common but can be meaningfully supported with the right daily care.
Q: Is urinary incontinence after 50 normal, or is it a medical problem?
A: Urinary incontinence is extremely common — research estimates it affects 24-45% of women, with prevalence rising after menopause — but it is not simply a normal and unavoidable part of aging. It is a sign that the tissues and muscles supporting your bladder need support. Pelvic floor physical therapy, daily training exercises, microbiome support, hormonal balance, and topical intimate care can all make a significant difference. Many women experience meaningful improvement when they address the root causes rather than accepting symptoms as inevitable.
Q: Can intimacy after menopause be comfortable and enjoyable again?
A: Yes. While hormonal changes during menopause can make intimacy uncomfortable, these changes are addressable. Daily care for intimate tissues — including appropriate topical support, hormonal balance strategies, and pelvic floor training — can restore comfort and confidence over time. The key is consistency and starting as early as possible, though it is never too late to begin. Many women report significant improvement in intimate comfort with targeted daily care.
Q: What is DHEA and why does it matter for intimate tissue health?
A: DHEA (dehydroepiandrosterone) is a hormone produced naturally by the adrenal glands that serves as a precursor to both estrogen and testosterone. Levels decline significantly with age. In intimate tissues, DHEA plays a role in maintaining thickness, moisture, and elasticity. Topical DHEA applied to vulvar tissues has been studied for its role in supporting tissue health and comfort. Dr. Anna Cabeca formulated Julva with a gentle concentration of DHEA specifically for daily intimate skin care support.
Q: What is a pelvic floor and why does it matter for bladder health?
A: The pelvic floor is a group of muscles, ligaments, and connective tissue that forms the base of the pelvis. It supports the bladder, uterus, and rectum and plays a critical role in controlling urinary and bowel function. When the pelvic floor weakens — through childbirth, hormonal changes, aging, or lack of targeted training — women can experience bladder leaks, urgency, prolapse symptoms, and reduced sensation during intimacy. Daily pelvic floor activation exercises, ideally guided initially by a pelvic floor physical therapist, can meaningfully restore strength and function at any age.
Q: How does Mighty Maca Plus support hormonal balance?
A: Mighty Maca Plus is an adaptogenic, alkalizing green drink blend formulated by Dr. Anna Cabeca. It contains maca root — an adaptogen studied for its role in supporting hormone balance — alongside a blend of antioxidant-rich superfoods. Adaptogens help the body respond to physical and hormonal stress. Mighty Maca Plus is designed to support overall hormonal health, energy, and vitality as part of a daily wellness routine. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.
References
1. Urinary Incontinence in Women — StatPearls, NCBI (NIH). Prevalence 24-45% among women; over 50% in nursing facilities; above 75% in long-term residents. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559095/
2. Post-Pandemic Prevalence of Urinary Incontinence Among Women in the United States and Associated Risk Factors. PubMed, October 2025. Crude prevalence 63% (approx. 79.6 million U.S. women); age-adjusted prevalence 47.6%. Available at: https://pubmed.ncbi.nlm.nih.gov/41081813/
3. Gray Divorce Statistics — Brown, S. & Lin, I.F., National Center for Family and Marriage Research, Bowling Green State University. Gray divorce rose from 8.7% of all divorces in 1990 to 36% by 2019. Confirmed by Pew Research Center, October 2025. Available at: https://www.pewresearch.org/short-reads/2025/10/16/8-facts-about-divorce-in-the-united-states/
4. Sexless Marriage Statistics — Indiana University National Survey of Sexual Health and Behavior (NSSHB), 2024 update. Approximately 15-20% of married U.S. couples have sex fewer than 10 times per year. Cross-referenced with Psychology Today clinical review. Available at: https://oneextraordinarymarriage.com/sexless-marriage-statistics/ and https://www.psychologytoday.com/us/blog/the-myths-of-sex/202309/how-common-are-sexless-marriages
