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Lemonada.
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Hey Midlifers, just a quick message before we get started.
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You can now listen to every episode of My so Called Midlife Ad free with Lemonada Premium on Apple Podcasts. You'll also get ad free access to.
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An exclusive bonus content from shows like Wiser Than Me with Julia Louis Dreyfus.
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Feel Better with David Duchovny and so many more. It's just $5.99 a month and a great way to support the work we do. Go ad free and get bonus content when you hit subscribe on this show and Apple Podcasts make life suck less with fewer ads with Lemonada Premium. Welcome to My so Called Midlife a podcast where we figure out how to stop just getting through it and start actually living it. I'm Reshma Sajani. Ladies. I want to tell you something that might blow your mind. Your pain is not normal. The leaking, the constant urge to pee. Discomfort during sex. So many women are walking around hurting and uncomfortable and assuming it's just part of getting older. We're taught to push through it, to adjust, to normalize, or worse, to feel embarrassed by it. Today's guest is here to call bullshit on all of that. Dr. Sarah Reardon is a pelvic floor physical therapist and one of the most trusted voices on women's pelvic health. You may know her as the vagina whisperer on Instagram, where she helps millions of women finally understand their bodies without shame or fear. In our conversation, Sarah breaks down what our pelvic floor actually does, why so many women are struggling in midlife, and.
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How discomfort is not something we have to accept.
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You also may learn you've been peeing.
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The wrong way your entire life.
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I did.
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I learned so much during our chat, and I hope you do, too. Let's get into it.
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Dr. Reardon. So we always start with the same question, which is, what's your midlife mindset right now? Are you feeling excited, sad?
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Thrilled?
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What is it?
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You know, it's interesting. I think with the state of the world and our country in particular, you can feel all of those things at the same time. I feel strong right now. I feel probably one of the strongest in my convictions, in my beliefs, in my ability to share those things on my platform confidently. And I also feel soft in this way. It feels like things are really kind of hard and rigid and so definite in what people are believing and how they're saying them. And so I also feel like there's a softness that needs to come to just continue to help care for people and care for one another.
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Ooh, Sarah.
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I feel like I identify with both those things. I, too, feel very, like, unapologetically strong and, like, clear.
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This is right. This is wrong.
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You know what I mean? We should not be, like, picking up babies and separating families.
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Like, this is not who we are.
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And soft, the sense where I feel.
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Like I'm, like, either in tears or.
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Close to tears almost every single night, you know, at what I'm seeing. And, like, I was with a friend.
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Last night for dinner who runs HR at a big company, and she just, like, people are carrying so much collective.
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Trauma, and even if they don't come into the office and talk about what's going on in Minnesota, you can see it in their body and the way.
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That they're holding themselves, that they're carrying.
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So Much fear, anger, frustration, sadness. And it's just.
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It's in our bodies right now, deeply, totally.
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And in our pelvic floors, which is.
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What we're gonna get to.
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So you're a pelvic floor physical therapist, and you're known as the Vagina Whisperer on Instagram. First of all, how did you get that name? Did you come up with it?
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Or did, like, I wish I was the creative genius, but it was my college friends. I went to wash U&St. Louis for undergrad and grad school, and summers after that, when I was already practicing pelvic floor therapy, I would end up not talking to them about what I did for work, but their moms and all of our kind of summer reunions. And so they were like, sarah's over there. She's like, the Vagina Whisperer. And so they were the ones.
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But why they're moms?
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Because no, at this time, we were in our mid-20s, and their moms were in their 40s and 50s, and they were like, so, Sarah, let's talk about our bladders or pelvic pain or menopause. And so, you know, in my 20s, I'm the only probably female at that time that was like, yes, let's. And so it was really the nickname they gave me. And then it. It just stuck. And when I started my Instagram account almost 10 years ago, it was for the same group of girlfriends. And so that's why I named it the Vagina Whisper.
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So how did you start doing your work?
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You know, I started immediately after graduate school. So I've been practicing in this field for 19 years. And I thought I was going to be a sports physical therap therapist, like many of us starting in that school do. But then I really. Throughout that graduate school education, I had a professor who taught us what was then called women's health is now called pelvic health. But I think as a woman, I really loved learning more about my own body, things that no one had ever taught me about that these muscles existed. But I particularly loved helping patients learn more about their bodies and help them with issues that were often embarrassing, often limiting in their quality of life and activity. But they made such a huge difference when they got a benefit out of therapy. So it was just, I love the patients, and I love the changes that we can help them make and the effect it has in their lives.
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Was there a moment in your own.
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Life where you, like, your body basically.
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Forced you to pay attention?
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I asked you because. So I'm seeing a pelvic floor therapist tomorrow for the first time. And I have always had a weak bladder. Like, I was always a girl, you know? I mean, at the bar, after two drinks, that was like, ah, I got it.
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You know what I mean?
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I got to go to the bathroom now. Since I had a baby via C section, and I've gotten older, it's worse. Like, honestly, I go to the bathroom at least 20 times a day.
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Oh, my goodness, Reshma.
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It's horrible. And we went to go see a play the other night at Broadway. And so to me, a play that's two hours long with no intermission. I already start getting nervous because I'm like, I'm not gonna make it. And I was sitting there in the. Went to the bathroom right before, and literally 10 minutes in, I'm like, oh, my God.
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Right?
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And I could not focus on this incredible art that I was watching. And I was like, I gotta make an appointment.
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Yeah.
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And even though I've been living right with years and years and years of going to the bathroom. You know what I mean? Three times before I go to bed.
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Right.
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It was something in that moment where I was like, this isn't right. Like, I don't need to do this. And I know what I need to do. I know I need to see somebody.
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What was it for you and what.
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Is it for sometimes for women, I.
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Think, for yourself, as you can even kind of feel this is happening for you right now. It's when it starts affecting our quality of life to the point that we can't do the things we want to do anymore. Where it's like, we can't exercise or run with our running group in the morning, where we can't be intimate with our partners because we have sexual pain, where we can't sit through a show or a movie for fear of not being able to make it to the bathroom. So it's not when it starts happening. It's when it gets so severe that it's changing the quality of our life or our behaviors. So for me, I was fortunate enough to never have. I never really had pelvic floor issues. So I feel very grateful for that until I got pregnant. And when I got pregnant with my first son, I had already been practicing for 10 years, and I was like, oh, this is terrible. I mean, I was pooping, poops the size of a baseball. I was wearing braces around my belly and my back. I was coughing and leaking. And I was like, okay, I've been doing this for 10 years, and I know all of the Right. Things to do. And this is still really hard for me. And that's when I started becoming more vocal about pelvic floor therapy and how it could help, because I could just go next door during my lunch period and meet with my therapist, and then she would do some work on me. And I ended up having a wonderful birth and a wonderful recovery. And I thought, gosh, every woman needs access to this information. Why is it that you just have to meet the right doctor who happens to refer you, or you have to happen to live in Dallas, which is where I was at the time, and get referred? It was like, this should be part of our health education, that we know that this resource is available, and these issues are common, but they're not normal. And there's a lot of resources to help us.
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Yeah. Can we just do some basics? Where is your pelvic floor?
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Your pelvic floor is at the base of that bony pelvis that we all have. So if you put your hands on your hips, that's the top of your pelvis.
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I'm putting my hands on my hips.
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Yep.
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And you feel those hip bones. That's the top of your pelvis. And if you think about your sit bones that you're sitting on right now, that's the bottom of your pelvis. At the bottom of your pelvis is literally a basket of muscles that covers the floor. It's literally the floor of your pelvis. It closes in that bowl of bones. Those muscles have three openings in the female body.
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Okay.
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One where urine exits the body, the urinary sphincter, which is where you say, I have a weak bladder. It's usually that muscle that's not working well. One is the vaginal opening for vaginal intercourse, vaginal birth, and menstruation.
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So when people say sex is painful, that's the one that's weak.
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Okay?
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Yep. Or it could be tight or tense. So it's that muscle that's kind of part. That part of the muscle that's affected. And then we have the anal opening for bowel movements. And so, again, fecal leakage, constipation, hemorrhoids, all part of the pelvic floor complex. But this muscle also helps with core support, with pelvic organ support, like holding those organs in place when we're pregnant and coughing, sneezing, running, jumping, all of those things. So they're very important muscles. We just don't even know.
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I didn't even know exactly.
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I didn't even know this.
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Oh, my God.
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This is exactly.
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Okay, so Are we born with weak muscles? Do they become weak because certain things happen or what's the deal?
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No, we're born with muscles just like every other muscle in our body. Like, we're not born with weak biceps or weak quads. These are muscles that as we grow and strengthen and move over time, they develop a certain amount of tension or tone to them to help them do their job. It's typically insidious, which means it happens gradually over time. Some of it could be childhood constipation or chronic bedwetting or neurological issues. Some of it can actually be in young female athletes is when we actually start to see these problems pop up. And we often think that pelvic floor issues happen only after birth or with aging. But over 40% of high school female athletes leak urine because of high impact activities like cheer, volleyball, basketball, tennis.
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Why does that make you leak urine?
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It's the impact, the chronic kind of constant jumping and impact that puts pressure on the muscles and they're just not trained to respond. Like if you're a runner, you train their muscles for running. But if you're doing higher impact activities, you need to also train your pelvic floor to withstand the load that you're asking it to hold.
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Something I've really learned in midlife is that low energy doesn't mean you're giving low effort. You can be doing all the right things, eating well, moving your body, getting sleep and still feel off. And ladies, not everything is hormonal. A big part of how we feel has to do with declining cellular energy. And you can't out train that it's really this simple. When your cells have more energy, everything just works better. That's why I've added my appear gummies from timeline to my daily routine. They're longevity gummies designed to support cellular energy so you can feel stronger and more vibrant as you age. They're powered by MIT Pure, an ingredient that's been studied in human clinical trials and shown to support mitochondrial health, which is a key driver of healthy aging. This has become one of the few daily habits I actually stick with. Two gummies a day. That's it.
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I keep them right next to my.
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Louis Dreyfus here from the Wiser Than Me podcast. Among other things. And I've got a bit of a hot take. Our relationship to our food can feel disconnected. We don't always know how or where our food is grown, and if we throw food scraps in the garbage, we don't think about where it's going. Or at least we try not to. One way that I get back a little of that connection is by using my Mill food recycler. Sure, Mill has totally changed my home life in a lot of practical ways. It works automatically. You can fill it for weeks. It never ever smells. But this is also really important. When I use mill, I'm participating in a circular system. All the food I don't eat is helping to grow the food that I do. It makes me feel like I'm part of something bigger. And that feels really, really good. And it's all so ridiculously easy. I just drop my scraps in my mill and it transforms them into nutrient rich grounds overnight. I have mine sent to a small farm, but if I wanted to, I could use them in my garden or for my backyard chickens if I wanted backyard chickens. And I don't know, maybe I do now, maybe I don't. Anyway, maybe mill is transforming me too, just a little. If you want to feel more connected or you just want your kitchen to feel less gross, try Mill's risk free trial and just live with it for a while. Go to mill.com wiser for an exclusive offer.
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I feel like in midlife I finally.
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Understand what I don't want in my closet. I don't want fussy, I don't want trendy for five minutes. I want pieces I can actually live in again and again. That's why I love Quince. They're all about elevated essentials that feel effortless. These are the kinds of pieces that just work for layering, mixing, and building a wardrobe that actually lasts. They've got all the staples covered. Think 100% organic cotton sweaters, premium denim with stretch so you're comfortable all day. And these luxurious cotton cashmere blends that are perfect for the in between weather we're always dealing with. What I also really appreciate is that Quince works directly with safe, ethical factories and cuts out the middle band. So you're not paying for a brand name. You're paying for quality. The fabrics, the stitching, the fit, you can tell these pieces are built to hold up season after season. So if you're ready to refresh your wardrobe with pieces that feel timeless and well made, go to quinn.com midlife for free shipping on your order and 365 day returns. They're now available in Canada too. That's Q U I n c e.com midlife free shipping and 365 day returns.
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So are you kind of saying, like, at a young age, if I'm a mother of a daughter or I should be having her do a certain exercise every day to like, start training, you know, and building that muscle?
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You should be asking your daughters first. If you are experiencing any urinary leakage, I want you to let me know because this could happen. It's common kind of in your sport. And then I would actually send them to see a pelvic floor therapist that specializes in pediatrics. So it's not all about, like, tension, like strengthening. Sometimes we need coordination, Sometimes we need relaxation. It's like if you have back pain, it's not just do a bunch of crunches. It's kind of a more nuanced situation to say, what does this one person need?
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Yeah, I'm asking you because I always have back pain. And I found, I found this video and it was like, you know, do these five things every day, like roll back your shoulders, right? Do the stretch. And I've been doing that.
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I'm like, oh. Like, I.
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This actually has really helped. So I I often think there are things that you can do with different muscle groups that, like, have, like, kind of immediate results.
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Yeah. So it's interesting when we think about, like, some of these sports and this is at any age, a lot of the exercises we do. Reshma, I mean, you're in midlife, I'm in midlife. It's all about strengthening. It's lift weights, pull in your core, tighten your tush, but it's not also focused on the relaxation piece. So when we have a muscle that gets tight and short, we also need to make sure that we're lengthening it. So if you have a. You're doing a lot of tightening or strengthening exercises, I'm like, do some yoga, stretching after, do a child's pose, a happy baby. Take some big deep breaths to kind of of soften your muscles afterwards. It's more about balance of these muscles and coordination than, especially if you haven't had an injury or, like, experienced birth or hormonal changes than it is about, like, just do a bunch of tightening. Our Kegels.
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Yeah. So I clearly have weak urinary muscle, right?
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Potentially. It sounds that way. But we'll see. I think we're gonna. We'll see what happens in episode two. We're gonna find out what should I.
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Expect when I go tomorrow.
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So these sessions are one on one with a pelvic floor. Thera, all of us have specialized training, and it's in a private treatment room. So you're not going to be in a big gym with a bunch of other, like, people with back pain.
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Not like when I go to my physical therapist.
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Right, Correct. So you're going to be in a private treatment room. The sessions are about 45 minutes to an hour. And first you're going to sit down one on one, and they're going to ask you a ton of questions. And they're not just going to ask you about your bladder leaks. They're going to ask you about your bowel movements, your C section, your menstrual health, your hormones, your medications. Like, we want to get a good, big, clear picture of what Reshma's pelvic health looks like day to day. And then they're going to do an exam externally. They're going to look at your low back and hips, ask you to make a couple movements, kind of press on some areas in your hips to see if anything's tight or tense. They're going to look at your C section scar because that could be also related to your pelvic floor health. And then they'll step out, and you'll undress from the waist down. I think the funniest question I get is, like, what should I wear? I'm like, nothing. You're going to be. You're going to be undressed from the waist down for half of the session. You're going to undress from the waist down and lay on a comfortable mat covered with a sheet. And then they're going to do an intravaginal muscle examination. So with a glove, lubricated finger, they insert a finger into the vaginal opening, and they'll ask you to squeeze like you're doing a Kegel contraction, and then relax. They'll press on the side walls of the muscles to see if you're tight or tender, and then they'll check your strength. This is the way that we test the pelvic floor muscles. This is the way that we access them. You don't have to have an internal examination. It is absolutely up to you, and with consent only. You could also have a second person in the room if you'd like. But this is just kind of a standard way to check these muscles. And then we know, like, does Reshma have weakness and she needs strengthening, or does Reshma have tension and we need to relax that tension first and then kind of retrain her strength?
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And so will I be healed after that? Is there, like, a set? So, like, with my physical therapist, here's a set of exercises. Go do them, and if you do, you'll be good. Like, am I gonna be able to.
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Sit through a Broadway show?
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Eventually, yes, and I can't wait until that happens for you. So it will take time. I mean, these symptoms didn't start overnight. Right? You've experienced these for years. So they'll also teach you a lot of things, like, are you peeing properly? Are you pushing when you pee? Are you sitting and relaxing to make sure you've emptied your bladder? Well, are you constipated? Because constipation can put pressure on your bladder and cause more urgency. What medications are you taking? All of those things. And then they'll teach you exercises that you'll do at home. And they may do some, like, intravaginal and external exercises. It's like massage to the pelvic floor muscles internally and then to the hips and glutes and back and all that stuff. So I would say most patients, it takes between three to six months. We see you once a week, but it starts maybe once a week for four to six weeks. And then you go down to every other week, and then every couple weeks as you start to make improvements, and then you may just come back in for a tune up every once in a while. I have a ton of patients that every three to six months, they check in like, I'm the dentist, and they're like, I'm training for a 10k, how's my pelvic floor? Or I just started hormones. Like, what's going on? Or I'm having more dryness. Like, is everything okay? So it should be something that's integrated into our healthcare as women, because our body is changing in every season of life, as is our pelvic floor.
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I mean, I'm just kind of fascinated listening to you.
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Right.
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Because it's like people start to pay attention to that part of their body in a way that I think women often ignore it because we're taught to be ashamed of that part.
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Right. We don't talk about it. When we don't talk about something, it's like, well, maybe because we're embarrassed or it's. It's shameful or. So we're. We don't have these open conversations, which is changing because here we are talking about it. So, yeah, that's the first step, is normalizing these conversations. Yes.
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I've told everybody about my problem, which I love.
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I'm like, I love how open this is. So I think, to answer your question, pregnancy, childbirth, and menopause are the three biggest risk factors for developing a pelvic floor issue within our lifetime. It's a huge physical transformation. You potentially have surgery or a tear to the muscles with birth, and then menopause or perimenopause is the biggest hormonal change you'll go through. And then it's progressive. It doesn't get better with time. It only gets worse.
C
Wait, Sarah, how do your hormones weaken.
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Your pelvic muscles or tighten them so it typically weakens? Estrogen, as we know, is a very hot topic right now, particularly in the perimenopause and menopause space. And estrogen helps lubricate the vaginal walls and also plump up the vaginal walls, which are the pelvic floor muscles. So the vagina is part of the pelvic floor muscle complex. So when you have lower estrogen levels, whether you're postpartum and breastfeeding, whether you're on hormonal birth control, or whether you're in perimenopause and postmenopause, less estrogen cause thinner, drier, weaker pelvic floor muscles, and that will lead to leakage that will lead to pelvic organ prolapse. It will lead to more bladder urgency and frequency and urinary tract infection.
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Yeah.
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So as you're aging, you can see it starts getting worse. And it's a funny story, because I'm 43, and I've been in this field forever. Never, you know, 20 years, never had a problem. And at the age of 40, I started playing tennis. Me too. Me too. I love it. It's the best. And so a year ago, I was on the tennis court, and I took a quick step, and I felt a bladder leak. And I was like, oh, my gosh. I was like, I'm the vagina whisperer. I can't pee my pants out here. You know, like, this is bad for my brand. And so. But the whole time I was thinking, can you see it through my pants? Is it gonna happen again? What if I make a quick move? Like, it's so consuming, right?
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Yeah.
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Yeah.
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And then I realized, like, I'm aging. I'm perimenopausal and have less estrogen. My muscles are weakening as I get older. Like, and I'm doing a new sport. I have to train my muscles for what I'm asking them to do. And as we're strength training, as we're older and we have less estrogen, we have to train these pelvic floor muscles to be able to support us even more than our premenopausal years.
C
And going back to this point about shame and, like, not talking about this openly, like, I actually. As we're talking, I'm sure every single one of my friends has probably experienced.
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Some sort of leakage.
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Right.
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They coughed.
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The tennis story. I don't think a single one of my friends have ever. We've ever talked about that. And we're talking about a lot of things.
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Yeah, yeah. Because it's embarrassing. Right. And so. Or we. We talk about it, and then we kind of laugh it off.
C
You know, like, I peed on myself or whatever it is.
D
Right. I mean, now I think people find me and a ton of other pelvic floor therapists on social media, which is. You know, it used to be you'd have to see a doctor who just happened to refer you. And it was often after you had gone through a ton of tests or taken a lot of medications, and it was the therapy of last resort. What we want is for this to be integrated sooner. So. And also, when you do talk to a mom friend, they will tell you, oh, I went to a pelvic floor therapist. I went during pregnancy, I went postpartum. I went after menopause. So it's our girlfriends, our friends telling us. And now we're looking forward on social media and finding out about literally our healthcare through me. A dancing vulva on Instagram.
C
Yeah, you're so right. It is like a friend of mine is who recommended me to the woman I'm seeing tomorrow. I feel like millennial women, quite frankly, are so much more braver or so much more, like, honest about this kind of stuff. Like. Like, do you find it's a lot of midlife women who are coming to you? Younger women, older women.
D
Oh, all. I mean, I think that older generations find out clearly later in life and they're frustrated. They're like, why didn't anyone tell me about this sooner? Why didn't I know about you 20 years ago or 40 years ago? I think it's not just that we in our millennial generation are braver. We're fed up. We're fed up with people telling us like, oh, this is just part of leaking's part of being a lady, or diapers are your destiny, or you're just gonna have to deal with this, or this is normal postpartum, when all of that is wrong, I think there's a little bit of a we deserve better, and we are gonna fight for that. And that's kind of where I feel like I am, is that we do deserve better. I mean, we are making the world move and grow and our population grow, and we shouldn't have to be penalized for these physical experiences that we're going through.
C
Yeah, you said it's like, you know, biology is just part of the story, right? And it's like. It's so much of what you're talking about, too, is just how un. Uncomfortable we are kind of naming something that probably most of us are experiencing and how we're told to just minimize that. How do we change that culturally? I'm just laughing. I mean, could you imagine like a. I don't know, a campaign which is like, raise your hand if you've ever, you know, I mean, like, had leakage or something. It's just like there's some sort of. You saw this happen with menopause, right? There's just this normalization and it opened up an entire conversation. Is that possible here, you think?
D
Yeah, I mean, I think we're doing it right now. You know, I mean, I have over 750,000 people following me on social media because they wanna learn about their pelvic floor. So I Think that we are hungry for the information. We are kind of like the boots on the ground saying, like, we deserve this care. And so I think it's a bottom up approach, but I think it's also top down. I think that this training needs to get medical providers in their residencies. You need to be trained on how to do this. You know, hospital systems need to find out how to integrate this better for postpartum care immediately. I think we need these touch points so that it's not kind of we're just putting out fires all the time, that we can proactively help women care for their pelvic floors. But I also think that it's our generation who's gonna change this reshaut because we can have the conversations with our kids of like, oh, if you're leaking when you're playing volleyball, like, oh, there's a physical therapist, let me take you to them. Or if you have pain inserting a tampon, it might be your pelvic floor muscles. Let's kind of figure out how to coach you through this. Or if you're sexually active and having pain. Oh, that's not normal. Let's talk about it. So it's really opening up the conversations between us, but cracking the doors for the next generation. But we can't teach them unless we know better as well.
E
Yeah.
C
So, Sarah, are you saying, like, for everyone who's listening, if you're gonna have a baby or you're about to have a baby, like, basically book that appointment with the pelvic floor specialist one month.
D
After now as part of your pregnancy care, you know, your pelvic floor is changing during pregnancy. Whether you have a C section or a vaginal birth, your pelvic floor is, is getting weaker. You have a risk of leakage and back pain and all these things that again, we just chalk up to being normal, but they actually can be addressed. And the research is clear. If you receive that training during pregnancy, your postpartum outcomes are better.
C
And then on the flip on menopause, I don't really see this as part of the menopause conversation.
D
I know. It's so frustrating for me.
C
So now that we're talking about, I'm like, why isn't every single one of these menopause influencers also saying, talking about pelvic floor? Cause they're not. Because I need all of that.
D
I'm begging.
C
That never actually came up.
D
I know, and I think they don't know. Again, this is a generation of medical providers that didn't have this training. And so I'm talking with Kelly Casperson and Mary Claire Haver and Dr. Menow from Alloy. So all of them, I'm like, hey, you know, I've been on Tamson Fadal's show. Like, hey, we have got to pay attention to this, because more women leak urine than have osteoporosis, high blood pressure, and diabetes together. So this is a silent epidemic of women's health. And again, it's a topic we're not always comfortable talking about, but it deserves care. And the only way we can start is by having these conversations.
C
I mean, it's something we've just really normalized. I know. Like, my friends and I were like, okay, sleep on the left side of the bed that's closest to the bathroom. Or like, when you're staying at a hotel, leave the light on because you're gonna have to pee three times.
D
Or, like, when you're booking a plane ticket, get an aisle seat. Right.
C
We've normalized it and we've shifted our behavior. And it's as if, like, I really never thought I had another option. But, you know, it's not that it goes away because your estrogen's never coming back. It just gets worse.
D
Correct. It's progressive. And, you know, it's. When you see the stats of, like, 50% of women over the age of 65, lake urine. One of the number one reasons to, you know, nursing home admission later in life, I'm like, people, stop the train. Like, we gotta do our pelvic floor exercises.
C
We'd say that again, Sarah. One of the number one reasons.
D
One of the number one reasons for admission to a nursing home later in life is urinary incontinence and fecal incontinence. So, like, this is a pelvic floor problem, and we've got to get comfortable talking about these issues, or else we're not going to get the support that we need.
A
Yeah. There's one thing that all people on earth have in common. We move through the world in a human body. Bodies ache, they bleed, they desire. They hold the stories of our lives. And when people have power over their bodies, when they can access the care their bodies need, they can begin to write their own stories. International Planned Parenthood Federation, or ippf, is the world's largest network for sexual and reproductive health rights and justice. They are sharing real stories of people around the world. People like Alina in Malawi who walked miles to the nearest clinic to birth her baby, only to give birth along the way. Every body holds a story and you can read just a few of them now@ippf.org everybody.
F
Hey, I'm Rachel Banner.
D
And I'm Ari MacDonald.
F
And welcome to Ari and Rachel Unfiltered at Unrivaled, a show where we give.
D
You all you need to know from Unrivaled and more.
F
This season, we're talking to some of the best athletes. I'm trying to watch my language.
D
You good be you. It's unfiltered. That's what we're here for.
F
And coaches in women's basketball like Paige Beckers and Lee Rue. Hey, it's Paige.
D
Hi, it's Lee.
F
And celebrity Unrivaled fans about games news, all for the fans to learn more about our journey and the folks who make Unrivaled the great league.
D
It is.
F
I'm super unfiltered. Arie's gonna be super unfiltered because I'm going to force her to be. We'll also be talking to you and answering your questions. So tune in every Thursday and find us on social and all your favorite podcast platforms.
C
So you feel like the exercises that you could do actually make a real difference?
D
Oh, a hundred percent. I mean, there's research to back this up, but it's not just the exercises. I think, you know, when I think about what we're teaching our next generation of kids and even learning ourselves, it's like, how do you pee properly? My most viral reel, 45 million views, was don't push when you pee.
C
All right, so tell me how you pee.
A
Let's go through it.
C
How do you pee properly?
D
The first thing is go when you have the urge to go. Try to avoid going just in case. So if you're going all the time just in case, your bladder will shrink and then you'll have to go to the bathroom more often. When you do go to the bathroom, sit down. Don't hover over the toilet unless it's really yucky, but sit down, lean forward, and just relax. Don't push. Or what I call power peeing, because that can weaken your pelvic floor muscle and lead to incomplete bladder emptying. So you're not even, like, also causing harm, but you also could just be not emptying. And then you have to pee again really quickly after. So don't push when you pee. And if you don't feel like you emptied well, you wipe, you stand up, sit down again. It's called double voiding. And then you wipe and walk away. Wow.
C
I do not pee like that. Okay, wait, second question. Going back to my Broadway story, The show was two hours long. I felt like 10 minutes in and I'm like, oh my God, I have to go to the bathroom. And I went, looked. I'm like, I can't. These people are gonna kill me.
D
I can't.
C
And I held it the whole time and I was fine. So in some ways I didn't really have to go. What is that? Is that a mental thing?
D
So the normal frequency to pee, what's considered normal range, is every two to four hours. So your bladder should be able to fill in that period of time. You should be able to sit through a movie or a Broadway show and then get up and empty and then come back and go. So the way that your pelvic floor muscles and your bladder work together is that if your bladder's really full, your pelvic floor muscles tighten up and they're like, okay, chill out, Reshma. You're in a show, you can't bother these people next to you. Clench your pelvic floor, take some deep breaths, and that quiets the bladder down. Right? So if you have weak pelvic floor muscles, those muscles can't contract as well to tell the bladder to chill out. Or if you have tense pelvic floor muscles, they're like, I'm already tight, but I'm still not working well. So. So one, you have to kind of figure out which pathway you need. But two, your muscles and your bladder work together. And so you're able to do it. You can distract yourself, you can take deep breaths. You know, if you just start playing on your phone, the urge goes away sometimes. Right. If you fall back asleep, you're like, oh, I ended up sleeping four hours without having to go. So you can do it. It's just a little bit of mind over matter.
C
Yeah. So like, I almost have to test myself, like if, like, okay, I'm gonna wait two hours.
D
I actually tell people to wait 15 minutes. Just like, like, can I hold it 15 minutes? And if the urge is gone, you're like, okay, I'm good. And then wait 15 more minutes. So take like smaller bite sized breaks, like to kind of push yourself and then see if you can make it then. But if it's so strong, you're like, I'm gonna pee my pants, get up, walk calmly to the bathroom and go, yeah.
C
Yeah.
A
This is really, really, really interesting.
C
When you've seen women get control over their life, meaning take control over their pelvic care, what changes for them?
D
Oh, it's amazing. I mean, I. There is you know, a young woman I'm seeing today in my office when I go in after this call, and she had two babies, and she couldn't run a race without pee dripping down her leg. And she was finally able to run her 10k. And I saw her afterwards, and it was just such an amazing thing to have someone be able to do what they love, what makes them feel like them, and to not feel like, oh, I just need to bring a change of pants and I'm just gonna pee down my. Into my sock, the whole race. So, I mean, having somebody feel confident in their bodies and to trust their bodies again. I have another young woman, never had kids, but she had severe sexual pain. She had a condition called vulvodynia. And she eventually was able to have sex for the first time. And she wrote me this message. She was like, for the first time in my life, I feel like a woman.
A
Yeah.
D
And just these experiences that they have where, you know, they've never even shared what they are going through with anyone else. They're trusting you with their most kind of. Of intimate details of their life and health. And to see such dramatic shift to help them again, just live the life they want to live is so rewarding.
A
When it comes to sexual pain, what are women often hearing from doctors that.
C
Minimize what they're feeling?
D
This is normal. Give it more time, relax, just drink a glass of wine and use a little bit more lubricant. I mean, complete gaslighting that there could be any issue going on. You know, they may run a culture for an infection, and they're like, oh, I'm not finding anything. Well, keep looking. You know, do a pelvic floor assessment. Send them to a pelvic floor therapist. Like, I think that if one medical provider doesn't have the answer, you can't minimize a woman's pain. This is a very real experience for them, and it's limiting for them. I mean, I have a young woman. I wrote about this in my book, you know, Young Woman. She was an immigrant to this country, new white, had never been able to have sex. And she came to see me at my practice in Austin at the time. And I remember after six months of seeing her, she was finally able to have sex. And I mean, she came in, her husband came in, the biggest smiles ever. And then six months later, I ran into her in the grocery store and she was pregnant.
C
That's amazing.
D
Yeah, it's amazing to see the changes that people are able to make in their life by addressing their sexual pain or their Pelvic floor health. I mean, I always say I have the best job in the world.
C
So what is the biological. If you have sexual pain, what's the biological reason? That's often happening.
D
So again, we've talked a lot about muscle weakness. These muscles can also be tighter, tense. So an analogy is I have really tight neck and shoulder muscles. Right. I have to get acupuncture and massage and do yoga because I'll get migraine headaches. It's the same thing for your pelvic floor. These muscles can get too tight or tense, and it's almost like they can close up when something's trying to enter the vagina. So whether it's your partner, whether it's a speculum for a pelvic exam, whether it's a. A tampon, whether it's a finger, the muscles kind of tense up and guard, and it feels like something's hitting a wall. So it's training these muscles to soften and relax. When something is entering into the vagina, it can also be a hormonal issue. Again, low estrogen can cause dryness, which can cause pain.
C
This also kind of shows up again during menopause. You have a lot of women talk about sexual pain.
D
Yep, sexual pain because it's dryness of the vagina. And then the last thing is also there could be an injury, like after childbirth. You could have a perineal tear. Over 90% of women have a small tear in the pelvic floor muscles, and that could cause scar tissue, which could also cause pain.
C
What is one belief about women's bodies that you would want to most dismantle?
D
That a tight vagina is what every woman needs. Because it's actually, we need a functional vagina. We need one that can contract and relax. I think it's this myth that, like, oh, we need to, like, tighten everything up down there. And I'm like, no, we need to contract it and relax it. So many people have tension and pain from over tensing their pelvic floors, from sucking in their cores for so long from.
C
But wait, we just talked about sexual pain as a result of too tight of a vagina. So what do you mean? So what is. So what's this tightening it up thing?
D
Those are doing the wrong thing. They're focusing all on this tension where I'm like, the tight vagina is a myth. It's a. It's this kind of thing of like, oh, this is what's supposed to be, like, a strong sexual being. When I'm like, no, we need to relax, we need to get blood flow. We need to, like, have lubrication. Like. Like, it's a softer approach than, like, tight vagina is what we need as women.
B
Right.
C
Because, I mean, how does pelvic floor issues kind of really affect intimacy and desire then?
D
Well, if you think about it, if you have painful intercourse, which many one in three women will have pelvic pain at some point in their life, you don't want to have intimacy. Right. It's like putting your hand on a hot stove. You don't want to just keep putting your hand there. So it makes you avoid it. You couple that with, you know, postpartum, it could be sleep deprivation, hormonal changes, postpartum depression in menopause, low libido. The other thing is that also it can affect orgasms. Like, these pelvic floor muscles are the ones that contract and relax during an orgasm. So if you have weaker orgasms, especially with aging or after birth, the inability to have an orgasms, a lot of it is a muscle issue.
C
So what do you think most surprises women when they start doing this work?
D
How easy it is. It's not rocket science. Like, these are muscles, right? Like, if you had back pain, you're like, oh, I'll go see a therapist. They'll give me some exercises, and we'll do some stretching and massage, and, like, I'll be better. And these are muscles, like every other muscle in your body. They just need training. And so I think it's how quickly you can get results. I mean, I saw a postpartum woman who had painful sex for 11 months, and I saw her three times, and her pain was resolved. So it's not rocket science. It's just underutilized. Yeah.
C
You know, to close.
A
I would love, Sarah, for you to.
C
Kind of give us one thing. You want every woman in midlife to hear about her body.
D
I want you to feel empowered to be proactive in taking care of it. I mean, I think of how much time I spent on my skincare regimen and my hair regimen and my strength training. And I want you to focus on your pelvic floor, the way that you focus on your skin care. Like, this is such an important part of our bodies, and we have to train it. It's changing over time, and so don't neglect it because it allows us to live the life we want to live in this second half of our lives. Like, to have partners and that we can have sex with, to travel, to sit through Broadway shows, to go to lunch with our girlfriends. And have wine and giggle and not leak. So it's gonna give us the longevity in our lives that we all desire. We just gotta do the work.
C
Thank you, Sarah. This was incredible. It was wonderful. I'm so happy we got a chance to do this.
D
Thanks for having me.
A
I'm so grateful to Sarah for this conversation and for the work she's doing to help women reconnect with their bodies and trust what they're feeling. You can find more of Sarah's work and resources on her site, thevagewhisperer.com or on her Instagram. And remember, stop power peeing. Thanks for listening. I'll see you next week. Before you go, thank you for listening to My so Called Midlife. If you haven't yet, now's a great time to subscribe to Lemonada Premium. You'll get bonus content you can't hear anywhere else. Just hit the subscribe button on Apple Podcasts. Or for all other podcast apps, head to lemonadapremium.com to subscribe. That's lemonadapremium.com My so called Midlife is brought to you by Moms First. Come see what we're all about at MomsFirst US. I'm your host and Executive producer, Reshma Sajani. Our senior producer is Katie Ecstak Cordova, our producer is Beth Rowe, and our sound engineer and editor is Mary Kelly of Sweater Weather.
C
Our theme music was composed by Ivan.
A
Kuryev and performed by Ivan with Ryan.
C
Jewell and Karen Waltock.
A
Scheduling support from Cindy Co Cook. Sales and distribution is by Lemonada Media. Help others find our show by leaving a rating and writing a review and let us know what you're doing in Midlife. Follow My so Called Midlife wherever you get your podcast or listen. Ad free on Amazon Music with your prime membership and be sure to follow Me, rashmistajani and moms first on Instagram, LinkedIn, and substack. See you next week.
D
Foreign.
B
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Are you looking for ways to make your everyday life happier, healthier, more productive, and more creative. I'm Gretchen Rubin, the number one bestselling author of the Happiness Project, bringing you fresh insights and practical solutions in the Happier with Gretchen Rubin podcast. My co host and happiness guinea pig is my sister, Elizabeth Craft. That's me, Elizabeth Craft, a TV writer and producer in Hollywood.
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Join us as we explore ideas and.
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Hacks about cultivating happiness and good habits. Check out Happier with Gretchen Rubin from Lemonada Media.
This episode tackles the widespread but misunderstood issue of women’s pelvic floor health, especially during midlife. Reshma and Dr. Sara Reardon (a leading pelvic floor physical therapist known as “The Vagina Whisperer”) break down why so many women silently accept urinary issues, sexual pain, and discomfort as “normal” rather than treatable health problems—and outline what every woman needs to know to reclaim comfort, confidence, and agency in her body.
| Timestamp | Topic | |-----------|-------| | 04:00 | Reshma & Dr. Reardon: Mindset and midlife reflections | | 05:23 | “The Vagina Whisperer” origin story | | 06:14 | Dr. Reardon’s PT journey and passion | | 07:06 | Reshma’s personal urinary struggles | | 10:00 | Pelvic floor 101: location & function | | 12:05 | High school athletes and pelvic issues | | 17:28 | How to talk to daughters; when to seek therapy | | 19:16 | What to expect at a therapy appointment | | 21:12 | Recovery & home exercise expectations | | 23:23 | Estrogen, menopause, and pelvic changes | | 26:25 | Millennial women, fed up and demanding change | | 31:02 | Incontinence and nursing home admissions | | 33:12 | How to pee correctly (“Don’t push when you pee”) | | 36:00 | Life-changing effects of pelvic health care | | 37:10 | Medical gaslighting of women’s sexual pain | | 39:24 | Myths about tightness vs. function in pelvic health | | 41:34 | Final empowering message |
This episode boldly confronts the widespread normalization of pelvic pain, bladder leakage, and shame that affects women throughout their lives, emphasizing that these problems are common but not normal. Dr. Reardon urges women to take charge, break the silence, and seek help—demonstrating that even deeply embedded problems can often be swiftly improved with the right care.
Women deserve comfort, confidence, and full access to their lives at every age—and it starts by owning and honoring pelvic health as a core priority.
Find Dr. Sara Reardon: