Madeleine Castellanos, MD, on pelvic floor health at 50+

If you are over 50, and even if you are younger, and especially if you´ve birthed babies, you may have questions about your pelvic floor.

More women than you’d suspect suffer from incontinence, bladder leakage, difficulty in reaching orgasm and a host of other issues. They also may have a hard time telling their doctor about these symptoms.

So to help out a bit, we asked expert Madeleine Castellanos, MD some questions pertaining pelvic floor health.

Dr. Castellanos is the Founder of The Sex MD, the author of books on sexual health and is based in New York City. We hope our Q&A with her helps a bit!

Madeleine Castellanos M.D. on pelvic floor health at 50+

Pelvic floor health in midlife

Viva Fifty.-What are the most common issues women 50+ face concerning their pelvic floor?

Madeleine Castellanos.- Once women enter menopause, their level of estrogen (specifically estradiol) declines to the point where it starts to affect their genital tissue.

Since estrogen helps maintain the collagen and elasticity in the vagina and the surrounding tissues, the loss of this estrogen can manifest as symptoms of incontinence, vaginal dryness and/or burning sensation, and tightening of the vaginal opening and labia.

The pelvic floor muscles also become weaker, which results in greater difficulty holding urine as well as weaker contractions during orgasm.

As I mention in my book, Wanting to Want: What Kills Your Sex Life and How to Keep It Alive, difficulties like these create a distraction and decrease of sexual pleasure, ultimately impacting sexual desire as well.

Also Read: Benefits of BHRT in perimenopause and menopause

Viva Fifty.-Should we be doing Kegels during and after menopause, yes or no and why?

Madeleine Castellanos.- Sometimes, women can develop pelvic floor dysfunction where there is either spasm of those muscles or considerable weakness in an uneven pattern. This usually results in pain with sex or when using the bathroom, as well as problems with constipation.

This type of pelvic floor dysfunction requires physical therapy to heal properly. These women should not do Kegels until their pelvic floor dysfunction is resolved.

Unless a woman has this kind of pelvic floor dysfunction, she could be doing pelvic floor strengthening exercises (also known as Kegels) to help stave off problems with urinary incontinence and boosting her orgasmic sensations at the same time.

I recommend women do these pelvic floor exercises daily – 3 sets of 10 repetitions of contraction of the pelvic floor muscles, holding each contraction for 1-2 seconds.

A woman should be squeezing her pelvic floor muscles together tightly as well as in an upward, pulling direction. You know are doing it correctly when you can stop the flow of urine when you are using the bathroom.

Madeleine Castellanos M.D. on pelvic floor health at 50+

Viva Fifty.- What alternatives are there for women’s pelvic floor health at 50+?

Madeleine Castellanos.- The options available to women fall into the category of hormonal and non-hormonal. If a woman chooses to, she can receive hormone replacement therapy to help replenish some of the estrogen she has lost from menopause—enough to reverse her vaginal symptoms.

Non-hormonal options include the use of a vaginal moisturizer, such as Replens, to bring back some of the moisture, as well as the use of a lubricant specifically during sexual activity.

Vibrator therapy done daily can also help bring the blood flow needed to support those vaginal tissues and muscles. Usually, she needs to do some pelvic floor strengthening as well, to bring back the tone of her pelvic floor muscles.

These exercises can be done as described above, or with the use of vaginal weights created just for this purpose.

One drawback of pelvic floor exercises is that women forget to do them, they don’t do them correctly, or their muscles are so weak that they cannot get a good contraction when doing them.  

Some women may find that they can get superior results with an InTone device that is available from their gynecologist or urologist.

The InTone can help reverse urinary incontinence by delivering a gentle, repeating electrical stimulation that results in an automatic pelvic floor contraction of all the pelvic floor muscles.

It provides excellent results and can even be used to avoid surgery for incontinence.  It is available through a physician only.

Madeleine Castellanos M.D. on pelvic floor health at 50+

Vaginal rejuvenation surgery

Viva Fifty.- What do you think of the current trend of vaginal rejuvenation surgery?

Madeleine Castellanos.- Unfortunately, vaginal rejuvenation surgery is being heavily promoted in some circles and by certain doctors who perform the procedure.

Generally, I am not in favor of vaginal rejuvenation surgery because it can cause scar tissue, it removes delicate nerve endings that are involved in sexual sensations, and is most often sought out to address an unnatural idea of what a woman’s genitals are supposed to look like rather than an actual physical problem.

Women should also consider that with the decrease in estrogen after menopause, there is increasing tightness of the opening of the vagina and a decrease in the size of the labia.  

If a woman undergoes this surgery, she may experience a tightening of her vaginal opening that would make penetration painful if not impossible, as well as tension on the labia that would require future treatment to address.

Viva Fifty.- Anything you would like to add? Our main audience is 45-65 and many of our  readers are Hispanic.

Madeleine Castellanos.- Since the body works on a use-it-or-lose it principle, having regular sexual activity helps protect against the more severe vaginal and pelvic floor symptoms of menopause.

Interestingly, surveys have shown that Hispanic women tend to continue to have more sexual activity in their relationships than other groups, and that they believe that such sexual activity is a responsibility to their partner and an investment in their relationship. This could actually help preserve their sexual pleasure and ongoing sexual activity.

Viva Fifty

Viva Fifty! is an online bilingual and multicultural community that celebrates your best age. Midlife and beyond.

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