
Imagine carrying a secret fear that you’re going to leak pee when you pick up your groceries, do a jump squat at the gym, or that you won’t be able to find the bathroom in time? These are just a few of the many symptoms that can happen when we don’t keep our pelvic floor strong throughout our adult lives. Other problems include constipation, painful sex, and uterine, bladder, or rectal prolapse. Not. Fun.
This episode of On Health is for every woman, whether you’re preparing for pregnancy, recovering postpartum, navigating menopause, or simply striving for a stronger, more resilient body as you age. Pelvic health isn’t just about avoiding discomfort; it’s about living with freedom, confidence, and independence – and I mean that literally as you’ll soon learn in this episode. But it’s such a hushed topic – because they’re not only muscles we don’t see – they surround parts of our body that have been taboo to talk about for far too long.
I’m joined by Sara Reardon, aka The Vagina Whisperer, a trailblazing pelvic floor physical therapist, to shed light on this vital topic.
We dish on:
- Why Pelvic Floor Health Matters for Every Woman
Discover how pelvic health impacts everything from intimacy to bladder control, core strength, and even preventing nursing home admissions in later life. - Practical Tools for Prevention and Healing Pelvic Floor Problems
Sara shares her expert tips on preparing your pelvic floor for birth, recovering postpartum, and strengthening these critical muscles at every stage of life. - Breaking the Silence and Shame on Pelvic Floor Health
We’ll tackle the stigma that keeps women from seeking help for issues like incontinence, prolapse, and pain—and reveal why these common challenges deserve compassion, not embarrassment. - The Connections Between Pelvic Floor Health and Everything from Pregnancy to Menopause
Learn how to use pregnancym postpartum and perimenopause as proactive times to build strength, balance hormones, and prevent long-term challenges like leakage or prolapse.
Pelvic floor issues are incredibly common, but they don’t have to be your normal. From preventing postpartum struggles to aging safely and independently, this episode offers practical, empowering solutions that can transform your life. Whether you’re 25 or 75, it’s never too late—or too early—to care for this essential part of your body.
One of the most surprising and sobering insights from this episode is the connection between pelvic floor health and aging safely and independently. Sara Reardon highlighted an important but often overlooked reality: urinary and stool incontinence are among the leading reasons older adults end up in assisted living or nursing homes.
Here’s why:
- As we age, the pelvic floor muscles naturally weaken, particularly after menopause when estrogen levels drop, leading to decreased muscle tone and tissue strength.
- This weakening can result in incontinence, which not only impacts quality of life but can also lead to falls during nighttime trips to the bathroom, one of the primary causes of hip fractures in the elderly.
- Once a fall occurs, the ability to recover and maintain independence diminishes significantly, making it a critical issue for long-term health and autonomy.
But there’s hope! Proactive care throughout life can prevent many of these challenges. Sara shared how strengthening the pelvic floor and addressing issues like leakage early can drastically improve outcomes and reduce the likelihood of needing assisted living care later in life. Simple tools like pelvic floor therapy, proper bladder habits, and even topical estrogen or hyaluronic acid (for those who choose it) can keep tissues strong and functional.
The takeaway? Pelvic health isn’t just about today—it’s about safeguarding your independence tomorrow. As Sara beautifully put it, “You could live 30 to 50 years postmenopausal, and what you do now can make all the difference in how you live those years—whether you’re traveling, hiking, and socializing, or staying home because of embarrassment or discomfort.”
Actionable Tip: Start small. Whether it’s walking daily to strengthen your core and pelvic floor, practicing proper bathroom habits (no straining!), or speaking to a provider about pelvic health therapy, these steps can build a foundation for decades of strength and confidence.
Pelvic health is the foundation for so much of our physical and emotional wellbeing. This episode is your roadmap to strength, ease, and independence for years to come.
Let’s shift the narrative: pelvic health is not just about avoiding discomfort. It’s about living with freedom, dignity, and independence—for every stage of life.
About My Guest
Sara Reardon, also known as The Vagina Whisperer, is a board-certified women’s health physical therapist on a mission to normalize conversations about pelvic floor health. Through her digital platform and upcoming book Floored, Sara is helping women feel stronger, more confident, and more in control of their bodies—one pelvic floor at a time.
Links and Resources Mentioned in the Episode:
- Follow Sara on Instagram: @thevaginawhisperer
- Check out Sara’s platform and resources: The Vagina Whisperer
- Sara’s book, Floored – coming soon!
- Aviva's Book, Hormone Intelligence
- Aviva's online pregnancy through postpartum community and courses, The Mama Pathway
Join the Pelvic Health Conversation
Have questions or an “aha!” moment from the episode? Share your thoughts on Instagram and tag me @dr.avivaromm and Sara @thevaginawhisperer.
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The Interview Transcript | Aviva Romm + Sara Reardon
This conversation has been edited for length and clarity.
Aviva: Welcome everyone to today's episode! Before we dive into what I know is going to be an amazing conversation, I wanted to share a bit of my own journey with pelvic floor health, which is why this topic feels so important to me.
After the birth of my second baby—who’s 36 now—I experienced a uterine prolapse. That means my uterus was lower in my pelvis than it should be. I had this constant, annoying, uncomfortable sense of pressure, like something was falling out of me, or like I always had a full tampon in my vagina.
I’m not even sure, to this day, what caused it. During that pregnancy, I carried my toddler in a backpack almost daily, hiked, and just kept going like some kind of pioneer woman—probably not the wisest choice in hindsight. I’m also hyperextensible, so it might have been that my pelvic ligaments are naturally a bit laxer. But back then, my midwives didn’t know what was happening. They had no training or awareness of this issue. So I looked it up myself and figured out what was going on.
It was terrifying. Everything I read pointed to surgery, pessaries, or even the idea of my uterus falling out of my vagina. On top of the fear, I felt shame. Was I weak? Was I broken? Was this permanent? And who could I even talk to? I remembered hearing a story about a midwife named Robin Lim, who had written a postpartum book before I wrote mine. I called her—not realizing she lived in Hawaii—at 3 AM her time. She had five babies, was a fit yoga teacher, and had also experienced uterine prolapse. Hearing from just one other woman who’d been through this and found options other than surgery was so reassuring.
It took me years to heal on my own. By the time I was pregnant again, I carried a lot of fear. A midwife even casually mentioned, “Oh yeah, I know someone whose uterus came out.” That really fueled my anxiety. My third birth took longer, physically and emotionally, because I was so worried. But fast forward to today, I’ve fully recovered. I learned about my core, my pelvic floor, and why Kegels aren’t all they’re cracked up to be—which we’ll discuss today. Now I don’t have any issues, and I’m so grateful. But I’ll never forget the fear and isolation I felt, wondering if this would be my new normal.
As a midwife, MD, and someone dedicated to women’s care for over 40 years, I’ve seen how pelvic health impacts our wellbeing, intimacy, and confidence. It even affects basic activities like going out without worrying about leakage or odor. Many of you have shared stories about incontinence, pain, or not quite feeling yourself after birth or during menopause. These are real and common issues that deserve thoughtful attention.
I’m thrilled to have Sara Reardon, aka the Vagina Whisperer, with us today. Sara is on a mission to normalize conversations about pelvic health and empower women to take charge of their bodies. She’s a pelvic floor physical therapist with over a decade of experience, blending expertise with humor to make complex issues approachable. You’ve probably seen her videos on Instagram, where she educates from her kitchen or even sitting on the loo. Her digital platform offers resources, virtual consultations, and guidance, and she’s been featured in The New York Times and Women’s Health. Her upcoming book, Floored, has one of the best titles ever. Sara is also a mom of two boys, bringing a relatable perspective on pregnancy, postpartum, and juggling it all. Sara, thank you for being here!
Sara: Thank you! And thank you for sharing your story. It’s incredible to hear how common these issues are and how resourceful you were—especially back in the day before Google or Siri. I’m so glad you were able to recover and even go on to have more children.
Aviva: And a fourth! And I’m so much more aware now. I was only 22 when it happened, so I was young and completely astonished. I remember checking myself and realizing my cervix was right there. I knew it wasn’t normal, but my midwives kept saying, “You just had a baby, give it time.” It was overwhelming.
Sara: You’re not alone. Statistics show one in two women visiting a gynecologist have some form of prolapse. But we don’t talk about it or the options for treatment.
Aviva: Yes. And studies show many women don’t even know the names for their body parts, let alone their pelvic floor. Can you give us a quick overview of what the pelvic floor is and why it’s so important?
Sara: Absolutely. The pelvic floor is a group of muscles at the base of your pelvis. They support your organs—bladder, uterus, rectum—and help with functions like urination, bowel movements, and sexual activity. These muscles work all day, yet we barely talk about them. They’re as important as our biceps or quads, and understanding them is the first step toward better health.
Aviva: Shame plays such a big role in why we don’t talk about these issues. What do you think is the root of that shame?
Sara: There’s a lack of education. We don’t even call this part of our body by its name—we use nicknames. When something doesn’t work, like leaking urine or stool, we feel embarrassed. Society views these functions as dirty or embarrassing. But understanding and addressing these issues can transform quality of life.
Aviva: That’s so true. We’ve talked about prolapse and leaking, but I think many people don’t realize that other issues, like stool incontinence, are also connected to the pelvic floor. And honestly, it can be mortifying to talk about.
Sara: Absolutely. Stool incontinence is one of the hardest things for women to bring up. It’s so stigmatized. But it’s more common than you’d think, and it’s often treatable with pelvic floor therapy. The shame keeps people from getting help when they really don’t need to suffer.
Aviva: Speaking of, what are some of the most common pelvic floor issues you see, and what should women look for to know it’s time to seek help?
Sara: The most common issues we see are urinary incontinence, overactive bladder, pelvic pain, constipation, and prolapse. Signs to watch for include leaking urine when coughing, sneezing, or jumping; frequent UTIs; pain during sex; or a sensation of heaviness or pressure, especially by the end of the day.
Aviva: I’m so glad you mentioned constipation because so many women think they can cure it with magnesium or fiber alone. But pelvic floor issues can play a huge role.
Sara: That’s right. Sometimes muscle tension or improper relaxation of the pelvic floor contributes to constipation. It’s not just about diet—it’s about learning how to relax those muscles. Proper posture on the toilet, using a squatty potty, and breathing techniques can help. For some, pelvic floor therapy is essential.
Aviva: I’ve been teaching the physiology of squatting for decades! A squatty potty or stool under the feet can make such a difference.
Sara: Exactly. Squatting relaxes the pelvic floor and straightens the rectum, allowing stool to pass more easily. If someone has tension in their pelvic floor, straining can worsen the problem, leading to hemorrhoids or even prolapse.
Aviva: I love that you brought up how interconnected all these issues are. You might see someone for painful sex, but their real issue could stem from bowel problems or something else entirely.
Sara: Yes! Everything is connected. It’s not uncommon for someone to come in for one issue, and we uncover tension or weakness in the pelvic floor that’s contributing to multiple problems.
Aviva: Let’s shift gears to pregnancy and postpartum. What do you wish every pregnant woman knew about her pelvic floor?
Sara: I wish pelvic floor therapy were a standard part of pregnancy care. So many symptoms we dismiss as “normal” during pregnancy—like leakage, back pain, or abdominal separation—are treatable. And addressing them during pregnancy leads to better outcomes postpartum.
Even if you have a cesarean birth, your pelvic floor goes through changes. The weight of the baby during pregnancy stretches the muscles, like a hammock carrying a watermelon. So regardless of delivery method, therapy can be helpful.
Aviva: And then there’s relaxin and all the other hormonal changes that impact the pelvic floor.
Sara: Yes, relaxin softens the ligaments, and progesterone can cause constipation, which adds strain. All of these factors make pelvic floor health crucial during and after pregnancy.
Aviva: What should women be doing to prepare their pelvic floor for the big event—birth?
Sara: I always recommend starting with pelvic floor awareness and mobility exercises. In the first and second trimesters, focus on strengthening exercises like squats or bridges. Then, in the third trimester, switch to relaxation techniques like deep squats, child’s pose, or perineal massage. I also teach women how to push effectively—practicing with a mirror or experimenting with different positions can make all the difference. The goal is to create muscle memory, so when you’re in labor, it feels more natural.
Aviva: What about birth itself? What are some things women can do to prepare their pelvic floor for labor and delivery?
Sara: In the third trimester, I focus on relaxation. Deep squats, child’s pose, and other stretches help lengthen and soften the pelvic floor. I also teach women how to push effectively—whether they’re planning for a medicated or unmedicated birth. Practicing different positions and techniques ahead of time can make a big difference.
Aviva: I always tell women to think of it as creating muscle memory for birth. It’s about minimizing resistance.
Sara: Exactly. And learning how to push without holding your breath or straining is key. Perineal massage can also help some women feel more prepared, even though the research is mixed on its benefits.
Aviva: What about postpartum care? What’s your advice for women recovering after birth?
Sara: The first six weeks should focus on rest and gentle reconnection to the pelvic floor. Even small movements, like light pelvic floor contractions, help stimulate blood flow and reduce swelling. After six weeks, you can gradually work on rebuilding strength with exercises like bridges or ball squeezes, and then transition to more dynamic movements like squats and lunges. If you’re feeling pain, though, pause and consult a pelvic floor therapist. But it’s important to individualize care. If someone has pain or tension, they might need relaxation exercises first.
Aviva: And breastfeeding can affect recovery too, right?
Sara: Absolutely. Lactation suppresses estrogen, which can lead to vaginal dryness and reduced muscle tone. This is why so many women experience painful sex or other symptoms while breastfeeding. Using a good lubricant or even vaginal estrogen can help.
Aviva: Many women struggle with painful sex, whether it’s postpartum, during breastfeeding, or after menopause. How does pelvic floor health tie into this?
Sara: Pain during sex is often due to pelvic floor tension or tissue dryness. If the muscles are tight or overactive, it can create discomfort during penetration. Vaginal dryness, especially during breastfeeding or menopause, can make this worse. Pelvic floor therapy helps by teaching relaxation techniques to release muscle tension, and using a high-quality lubricant or vaginal moisturizers can address dryness.
Aviva: Let’s talk about menopause now. How does this stage of life impact pelvic health?
Sara: Menopause brings lower estrogen levels, which can lead to tissue thinning, dryness, and muscle weakness. This can exacerbate existing issues or create new ones, like incontinence or prolapse. But perimenopause is an opportunity to prepare. Strengthening the pelvic floor and building healthy habits before menopause makes a huge difference.
Aviva: So many women don’t realize that declining estrogen levels during menopause affect not just the vaginal tissue but also the tone of the pelvic floor. What are some of the options available for women who want to address this?
Sara: Topical estrogen is one of the most effective options. It’s applied directly to the vaginal area and helps restore tissue strength, hydration, and tone without significantly increasing systemic estrogen levels. There’s also DHEA suppositories, which can help with similar benefits, and for women who prefer non-hormonal options, hyaluronic acid is a great alternative to maintain tissue health. For some women, topical estrogen or DHEA can also help restore tissue health and make intimacy more comfortable. The key is to work with a provider who can help you find the best solution for your individual needs.
Aviva: I love that you see perimenopause as a runway to prepare, not just a time of symptoms to manage.
Sara: Exactly. It’s a chance to be proactive. Strengthen your pelvic floor, manage constipation, and address any issues early. Small changes can have a big impact on quality of life down the road.
Aviva: I talk to patients all the time about bathroom habits, especially when it comes to “just in case” peeing or waiting too long. What are your tips for proper bathroom behavior?
Sara: Great question. First, avoid “just in case” trips to the bathroom. Only go when you feel the urge—going too often can actually train your bladder to signal you unnecessarily. Second, when you do go, take your time. Sit fully on the toilet, relax your pelvic floor, and don’t strain. Straining creates excess pressure that can weaken the pelvic floor over time. And for bowel movements, using a stool under your feet to mimic a squatting position is essential. These little habits make a big difference over the years.
Aviva: It’s so important to talk about these things openly. I was shocked when I learned that urinary and stool incontinence are leading reasons older adults end up in nursing homes or assisted living facilities. It’s something we rarely hear about but has such a huge impact on quality of life. Can you talk more about that?
Sara: Absolutely. It’s a startling reality, but one that really highlights the importance of pelvic health throughout life. As we age, the strength of our pelvic floor naturally declines, and this can lead to issues like urinary incontinence, stool leakage, and prolapse. Many people think incontinence is just an annoying inconvenience, but it can have serious consequences for overall health and independence.
Aviva: Like what?
Sara: For one, incontinence can lead to a higher risk of urinary tract infections. When people aren’t able to fully empty their bladder or are leaking frequently, bacteria can build up, and that increases the chances of infection. And then there’s the issue of mobility. As you mentioned, one of the main reasons older adults end up in nursing care is because they’re no longer able to manage their bathroom needs independently. This often requires caregivers or mobility aids, which can be a big transition for families.
But there’s another layer: falls. When people wake up at night to go to the bathroom, especially if they’re trying to rush because they feel urgent, it increases their risk of falling. Hip fractures, for example, are one of the most common injuries in this situation, and they can lead to long-term consequences like surgery, recovery time, and loss of mobility. It’s a domino effect that can change someone’s quality of life overnight.
Aviva: This commonly happens to patients in hospitals – trying to get to the bathroom themselves at nightl -, and it’s heartbreaking. The good news, though, is that these issues aren’t inevitable, right?
Sara: Exactly. That’s what I want people to know. These issues can often be prevented—or at least significantly reduced—by addressing pelvic health proactively. Strengthening the pelvic floor muscles, practicing good bathroom habits, managing constipation, and even considering topical treatments like estrogen or hyaluronic acid for vaginal tissue health can make a huge difference. And the earlier we start addressing these things, the better the outcomes later in life.
Aviva: It’s so empowering to think about prevention as a way to safeguard our independence as we age. For women listening who are inspired to seek pelvic floor therapy but don’t know where to start, how can they find a qualified therapist?
Sara: Great question. There are several ways to find a pelvic floor therapist, and it starts with asking your healthcare provider. If you trust your OB-GYN, midwife, or primary care doctor, they might have recommendations for local therapists they work with.
Another option is word of mouth. I can’t tell you how many times I’ve seen women post in local mom groups or community forums asking for pelvic floor therapy recommendations. People are more open about these topics now, and those referrals can be a goldmine.
Aviva: Are there specific credentials women should look for when choosing a therapist?
Sara: Yes, but I want to emphasize that a great therapist doesn’t always need an extensive list of credentials. Look for someone who specializes in pelvic health and has experience treating issues like incontinence, prolapse, or postpartum recovery. A board-certified women’s health clinical specialist (WCS) is an added bonus, as it shows advanced training in pelvic health. But the most important thing is finding someone you feel comfortable with and who listens to your needs. Therapy is highly personal, so don’t be afraid to shop around until you find the right fit.
Aviva: For many women, the idea of pelvic floor therapy might feel a little intimidating or personal. What happens during a visit, and what should they expect?
Sara: That’s such an important question, because pelvic floor therapy is still new to many women, and it can feel vulnerable. Here’s what typically happens during a visit:
Your first session is usually 45 minutes to an hour long and starts with a conversation. The therapist will ask about your symptoms and medical history, including things like pregnancy, birth, surgeries, and any pain, incontinence, or other issues you’re experiencing. They’ll also ask about your bathroom habits, menstruation, and sexual health, because all of these factors are interconnected.
Aviva: And then there’s a physical exam, right?
Sara: Yes. After the history, the therapist will do a physical exam. It starts externally, looking at your posture, abdominal muscles, hips, and lower back to assess how your body moves as a whole. Then, if you’re comfortable, they’ll do an internal pelvic exam.
This part involves the therapist inserting a gloved finger into the vagina or anus to assess the pelvic floor muscles. They’ll ask you to do things like squeeze (a Kegel), relax, cough, or bear down to see how your muscles are working. They’ll check for tension, weakness, or prolapse and use that information to create a personalized treatment plan.
Aviva: That sounds so comprehensive!
Sara: It really is. But I want women to know that it’s a collaborative process. You can always ask questions or voice concerns, and you can bring a partner or support person if it makes you feel more comfortable. A good therapist will never pressure you and will always work at your pace.
Aviva: What about after the visit?
Sara: After the evaluation, your therapist will likely give you exercises or techniques to practice at home. These might include strengthening exercises, relaxation techniques, or tips for improving bladder and bowel habits. The goal is to empower you with tools you can use every day to improve your symptoms.
Aviva: For women who might not have immediate access to a pelvic floor therapist, are there simple exercises or habits they can start at home to improve their pelvic health?
Sara: Absolutely. You don’t have to wait for therapy to get started. A few foundational things make a big difference:
- Pelvic Floor Contractions: Also known as Kegels, but with a twist. Focus on both contracting and releasing the muscles. Many women over-tighten, so practicing the release is just as important.
- Breathing with Movement: Incorporate deep breathing into daily activities. For example, when lifting something heavy—whether it’s groceries or a child—exhale and engage your core and pelvic floor as you lift.
- Walking: Believe it or not, walking is fantastic for pelvic floor health. It activates your core, improves circulation, and strengthens your pelvic region naturally.
- Posture and Alignment: Avoid slumping or crossing your legs excessively during the day, as these can strain your pelvic muscles over time.
Aviva: Are there tools women can use at home to complement therapy?
Sara: Definitely. There are weighted vaginal cones, which can help with muscle strengthening, or pelvic floor trainers with app support to guide you through exercises.
Aviva: Biofeedback is another possible tool. How can that help women who are struggling to identify or control their pelvic floor muscles?
Sara: Biofeedback is an amazing tool. It uses sensors—either internal or external—to measure muscle activity. You’ll see visual feedback on a screen, like a line moving up or down, which shows how well you’re contracting or relaxing your muscles.For women who feel disconnected from their pelvic floor or aren’t sure if they’re doing exercises correctly, biofeedback can be a game-changer. It’s like having a personal coach to guide you. But it’s important to get guidance from a therapist first to ensure you’re using these tools correctly.
Aviva: That’s incredible. I think knowing what to expect will help so many women feel less anxious about taking that first step, and knowing there are steps they can take at home starting now is empowering and hopeful.
Sara: Absolutely. I always say, “You only get one pelvic floor—take care of it!” Whether you’re 30 or 70, there are steps you can take to improve your pelvic health and maintain your freedom to live life on your terms.
Aviva: I’m so grateful for the work you’re doing, Sara. It’s empowering women to take control of their health in such a profound way. Where can listeners start if they’re feeling overwhelmed or unsure of what to do next?
Sara: Start by following me on Instagram (@thevaginawhisperer). You’ll find a wealth of resources and realize you’re not alone. Then, advocate for yourself. Ask your doctor for a referral to a pelvic floor therapist or look one up on pelvicrehab.com. And remember, it’s never too late to start.
Aviva: That’s such great advice. Thank you for sharing your expertise and making this conversation so approachable. Your book, Floored, is going to help so many people. I can’t wait to read it!
Sara: Thank you so much for having me, Aviva. This was such an important conversation.
Aviva: Thank you, Sara. And thank you to everyone listening. See you next time!