Menopause and Pelvic Floor

Menopause and Pelvic Floor

By Susie Gronski

Who says sex has to stop after you hit menopause? Well, according to an international survey of 4,100 women, up to 50% said that sex was painful (1) Ouch! 50%?! That’s a whole lotta deprived vaginas.

Top 5 symptoms you might complain of in your golden years:

  • A vagina dryer than the Sahara desert
  • Getting “hot” and not it a good way
  • Waking up to a pool of sweat in your bed sheets
  • Insomnia
  • That annoying belly fat that won’t go away no matter what diet or exercise fad you try

A vagina dryer than the Sahara desert

So What Gives?

I’m not gonna bore you with the medical jargon so let’s keep it simple eh? Basically, after you hit 30yo your hormones gradually start to drop. Dr. Irwin Goldstein, sexual medicine doc, recently stated at this year’s International Pelvic Pain Society conference in Chicago that during menopause “biologically your tissue will become like the pre-pubescent days.” Remember those days? Bald vagina and small “lips”?

Your vaginal tissue health is dependent on a nice balance of testosterone and estrogen among other reproductive and stress hormones. Believe it or not the amount of estrogen you have is dependent on testosterone. Yup, it’s not only dudes that have to worry about low T. You’re heart, brain, skin, and “privates” need it too!

Your Bladder on Menopause

Your bladder, urethra (tube that empties the bladder), vaginal tissue, pelvic ligaments, pelvic floor muscles and connective tissue all depend on estrogen to keep things running smoothly. During menopause, it’s been reported that 50% of women complain of urinary symptoms that worsen over time and 9-39% over 60yo report urinary leakage (2,3).  Vaginal dryness and pelvic floor muscle degeneration is common in menopause. Besides leaking everytime you a-choo! you’re also at risk for POP. No, I’m talking about a carbonated beverage here. I’m talking about pelvic organ prolapse, POP for short.

POP is a condition where the pelvic organs start to creep down towards the vaginal opening. Some women complain of lower abdominal and pelvic pressure or feelings of something “falling out” of the vagina. Don’t get me wrong, menopause isn’t the only thing that can put you at risk for POP. Other risk factors include “hulking it” to poop, childbirth, previous abdominal or pelvic surgeries, chronic coughing, and lifting heavy weights just to name a few.

The plumbing “down below” relies on hormones to function properly and since testosterone and estrogen both decline in menopause, it’s no wonder why symptoms like leakage, low libido, vaginal dryness, and pain with intercourse just spring up outta nowhere.

Menopause Doesn’t Have to Suck

Ok, by now you’re probably thinking that a life after menopause looks depressing. It doesn’t have to be! There’s lots of options out there to help keep your hoo-ha vibrant. I’m sure you’ve heard about bioidentical hormone replacement therapy and maybe even about laser vaginal therapy (4)(5).  Although there’s conflicting research about these hot topics there seems to be benefits to both. Whoa! Hold on. I’m not promoting any of those treatment methods but I’d like you to be aware of your options, especially about the most important option which is pelvic floor muscle training! We will talk about it in a second blog post. 

And remember:

  1. Minkin, M.J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause: The Journal of The North American Menopause Society. 22(11), 1231-1238. DOI: 10.1097/GME.0000000000000464
  2. Manella, P., Palla, G., Bellini, M., & Simoncini, T. (2103). The female pelvic floor through midlife and aging. Maturitas. 76, 230-234. DOI:
  3. Pereira, V.S., Vieira, M., Correia, G.N., & Driusso, P. (2012). Long-Term Effects of Pelvic Floor Muscle Training With Vaginal Cone in Post-Menopausal Women With Urinary Incontinence: A Randomized Controlled Trial. Neurourol. Urodynam. 32(1), 48-52. Doi: 10.1002/nau.22271
  4. Kingsberg, S.A., Simon, J.A., & Goldstein, I. (2008). The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women. J Sex Med. 5(suppl 4), 182-193.
  5. Croft, S. (2105, November 15). Mona Lisa Touch Therapy- What is it? [Web log post] Retreived from:


About Susie Gronski

Dr. Susie Gronski is a licensed Doctor of Physical Therapy and a Certified Pelvic Rehabilitation Practitioner. Simply put, she’s the doctor for “everything down there.” Dr. Susie will never brag about this, but she graduated top 3 of her class and is a nerd at heart. Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren’t her thing. She provides real advice without the medical fluff. Sorta like a friend who knows the lowdown about the “down below. “

Dr. Susie created a unique hands-on training program helping men and women with pelvic pain become experts in treating themselves. She doesn’t beat around the bush, literally. She’s determined to make sure you know that there’s help for painful ejaculation, problems with the joystick, painful sex and for those embarrassing moments when you pee yourself, ah-choo!

So whatever you want to call it, shlong, ding-dong, hoo-ha or vajayjay, if you’ve got a problem “down there”, she’s the person you want to connect with. Follow her on Instagram, Facebook, or Twitter and be sure to sign-up to get the scoop on the latest sexual health topics.



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