Pelvic Health & Intimacy in Midlife: What No One Talks About (But Should)

HonorYourBody
Aug 6
4 min read

Updated: Aug 16

Pelvic Health & Intimacy in Midlife, skeleton of pelvis

There are things we talk about in hushed tones — or not at all — even though they affect most of us:

Leaking when you sneeze or laugh
Pain during intimacy
A sense that something feels “off” down there
A shifting relationship with your body, desire, and comfort

Midlife is full of hormonal changes, emotional transitions, and physical adjustments — but no one hands you a manual for pelvic health or intimacy.

So let’s change that.

In this blog, we’ll talk about:

What changes in pelvic health and intimacy during midlife (and why)
How to support your pelvic floor with food, movement, and care
Why pain or discomfort is common — but not normal or untreatable
How to reconnect with your body and feel more at home again

No shame. No fear. Just honest education and empowering support.

Why Pelvic Health Deserves More Attention

Your pelvic floor is a group of muscles that support your bladder, uterus, rectum, and core. It plays a key role in:

Continence (avoiding leaks)
Core strength and posture
Sexual function and comfort
Organ support and alignment

As estrogen declines in perimenopause and menopause, the pelvic tissues — including the vaginal wall, urethra, and pelvic floor muscles — may become thinner, drier, or less elastic. This can lead to:

Urinary incontinence
Pelvic heaviness or pressure
Discomfort with penetration
Decreased libido or arousal

But many of these changes are treatable and manageable — with the right support.

What’s Normal (and What’s Not)

Common (but not “normal”) midlife pelvic symptoms include:

Leaking urine with coughing, sneezing, or exercise
Pain or burning with intercourse
Vaginal dryness or irritation
Pelvic heaviness or bulging
Frequent UTIs or urgency

These are not just part of aging you have to live with. And you don’t need to wait until things get “bad enough” to seek care.

If any of these sound familiar, you’re not broken. And you deserve support.

How Hormones Impact Pelvic and Sexual Health

Estrogen supports the elasticity, blood flow, and moisture of pelvic tissues. As estrogen levels drop during perimenopause and postmenopause, changes can include:

Vaginal atrophy: thinning and drying of vaginal walls, leading to discomfort
Urethral changes: leading to more urinary urgency or leaking
Reduced collagen: making tissues feel weaker or more fragile
Lower lubrication and arousal: which can affect desire and pleasure

Testosterone also declines with age, which can influence libido and sexual response. These are medical — not moral — changes. And they can be addressed.

Ways to Support Pelvic Health Naturally

1. Nutrition that supports connective tissue and circulation:

Vitamin C and collagen-supportive foods (like bone broth, citrus, berries)
Omega-3s (from fish, flaxseed, walnuts) to reduce inflammation
Hydration to support tissue elasticity and bladder health

2. Fiber to support bowel health:

Straining with constipation can weaken pelvic muscles. Add fiber-rich foods like beans, berries, chia seeds, whole grains, and veggies.

3. Pelvic floor awareness (not just Kegels):

Kegels aren’t always the answer. Some people need strengthening. Others need release and relaxation. A pelvic floor physical therapist can assess your needs.

4. Gentle movement + core support:

Walking, Pilates, yoga, and strength training with a focus on breath and core engagement can support pelvic stability without strain.

Devices like a pessaries can provide support and help prevent leaking while engaging in physical activity. These can be a helpful tool to use while addressing symptoms and working on pelvic floor strength.

What About Intimacy?

Changes in hormones, stress, body image, and fatigue can all affect intimacy — both physical and emotional. If your relationship with touch or desire has shifted, you’re not alone.

Here are a few supportive reminders:

Pain is not normal. There are effective treatments for vaginal dryness, tightness, and discomfort — including vaginal estrogen, lubricants, and pelvic PT.
Communication matters. Talk with your partner (and provider). You don’t have to figure this out alone.
Desire may look different now. That’s okay. Slower arousal or changing patterns are normal. You’re still worthy of pleasure and connection.

How to Advocate for Pelvic Care

Many midlife women aren’t screened for pelvic or sexual health — unless they bring it up. Here’s how to start the conversation:

Ask your provider about your pelvic floor during annual visits.
Request a referral to a pelvic floor physical therapist if you experience symptoms.
Ask about localized estrogen if vaginal dryness or UTIs are ongoing.
Bring up intimacy challenges — they’re valid and treatable.

You don’t need to be embarrassed. These are real health concerns — and they deserve real care.

Q&A: Pelvic Health in Midlife

Q: Is leaking during exercise just part of getting older?No. It’s common, but not inevitable. Pelvic floor therapy can often resolve or reduce leaking.

Q: I’ve lost interest in sex. Is that a hormone issue?It can be. Estrogen and testosterone both influence desire — but stress, sleep, and relationship dynamics matter too. It’s worth exploring.

Q: Are vaginal estrogen creams safe?Yes, for most women. Localized estrogen has very low systemic absorption and is generally considered safe, even long-term. Talk to your provider.

Q: Should I be doing Kegels every day?Not necessarily. Some pelvic floors are tight, not weak. That’s why assessment from a trained PT is so helpful.

Q: What kind of movement is best for pelvic support?Low-impact, core-aware movement like walking, Pilates, yoga, and glute strengthening are great starting points.