Why Vaginal Health Matters

C: Let’s get real, girlfriends—how is it that we’ve had babies, managed families, worked our butts off, and hit midlife still unclear on our own plumbing? We whisper about leaking when we laugh or cry quietly about pain during sex, all while pretending everything’s fine. But it’s not. And we deserve better. This episode of the Midlife Reset is your permission slip to get curious, get informed, and take back control of your pelvic health, your pleasure, and your confidence. 

I’m talking with the one and only Dr. Teresa Irwin—aka The Vaginacologist—about everything they never taught us in health class but should have. This conversation is bold, eye-opening, and just what midlife women everywhere need right now.I am thrilled to welcome Dr. Teresa Irwin. After initially training as a nurse, Dr. irwin became one of less than 1500 board certified specialists in female pelvic medicine and reconstructive surgery (FPMRS), AKA urogynecology.  She practices in Texas and has repeatedly been selected as the top doctor in that state and a top ob/gyn nationally as well.

T: After years of doing surgery on severe bladder and vaginal dysfunctions, I realized that many of the problems my patients were suffering from could have been prevented with education on their own reproductive health. So, I decided to become an educator to put myself out of business, just kidding (sort of). I provide preventative education in an effort to reduce the amount of women who need the surgery I perform. Ultimately, I want to drastically reduce the amount of women who suffer from vaginal and bladder dysfunctions. I am making this education accessible to increase the quality of life of women all over the world.

So I’m proud to refer to myself as a “vaginacologist”.

C: I have to be honest here.  I am getting emotional just hearing this.  You are talking about the very essence of being a woman.  And we have been socialized to ignore ourselves and feel shame about admitting we have concerns.

T: Women's reproductive health education is not easily accessible, nor is it taught adequately in school. This puts women at a higher risk for developing bladder, bowel, and vaginal dysfunctions. These disorders cost women time, money, and happiness. I want to empower women to take control of their reproductive health through essential preventative education.

C: Amen sister!  I just can’t thank you enough for going to bat for women everywhere but especially for visiting with us today.  I’m just starting on my podcast journey.  The best part has been meeting amazing women like you, Dr. Irwin.  I’m just learning so much and it’s a privilege to be able to bring this information to women like us.

So, let’s get specific about the education that you offer.  Over 50% of women will experience incontinence, at some point in their lives, but not enough seek support.  We did an episode with my pelvic floor physiotherapist (#10 if you want to look it up my friends) so I’m definitely one of that cohort.  What would you like women to know if they are leaking in their undies or afraid to be too far from the restroom?

T: There’s a lot to that question, but I’ll do a quick summary, since we’ll probably touch on more of it later in the podcast. Some of the main tips are:

* Doing proper Kegel exercises (most of us don’t do them correctly—I didn’t, until I really got into my subspecialty)

* Using correct toilet positioning for both peeing and pooping

* Avoiding certain bladder irritants that cause frequent and urgent contractions

* Learning how to drink water properly—yes, there’s actually a right way

All of this takes time, energy, and patience, but it’s important. We can mitigate, maybe not all, but some of the issues we develop as a result of childbirth, aging, and gravity.

C: And just general wear and tear! I love what you're saying. Let's start with Kegels. Are they helpful all the time? You know, so often in women’s groups, it's the go-to solution: “Are you doing your Kegels?” Can you expand on that a bit?

T: Sure. Kegels are central to many of the preventative strategies you can do, and they’re simple—if done correctly. But they’re not helpful for every woman. For example, someone with painful bladder syndrome, also called interstitial cystitis, might actually feel worse doing Kegels.

That said, for most women, they’re very important. One tip I share is this: Most people think doing a Kegel means squeezing your urethral sphincter—like holding your pee. But actually, it’s more important to squeeze your anal sphincter. That’s because the muscles around the urethra are very small, while the ones around the anus are much larger. You activate more of your pelvic floor by engaging the anal muscles.

C: Oh! In yoga, we call that Ashwini Mudra, for all my yogi listeners.

C: Now, you also mentioned correct toileting positions—can we dive into that?

T: Sure! I have some educational videos on this, but here’s a quick overview:

For peeing:Lean forward while sitting on the toilet. Rest your elbows on your knees with your feet flat on the floor. Why? Because one-third of the bladder lies below the urethra (your pee tube), and if you’re upright, that part might not fully empty. Think of pouring water from a bottle—if you don’t tip it all the way, some water stays behind.

Another position is to turn around and hug the back of the toilet bowl, leaning forward. You could also pee standing up like a guy—but that takes some technique or a device like a pee funnel to avoid accidents. These are super handy for camping or travel.

Now for pooping:The ideal position is using a squatty potty or a similar stool (7–9 inches high). You place your feet on it while sitting on the toilet, which raises your knees. This helps relax a muscle called the puborectalis, which normally kinks the rectum when you're sitting upright. Elevating your legs "unkinks" it and allows for better bowel emptying.

A lot of people don’t even realize they’re not emptying fully. If stool is higher up in the rectum, you won’t feel the urge in the same way. So this position really helps—plus it lowers your risk of a rectocele, which is when the rectum bulges into the vaginal wall from too much pressure.

C: Wow, I’ve got some research to do! Are these videos available on your website?

T: They’re actually easier to find on my TikTok, Instagram, Youtube and Facebook.

C: I also know you have educational booklets available for download, including one on toileting positions. These are really simple, common sense.  Why do we not learn this in school for heaven’s sake!

T: You know, it takes a lot of time and effort as a doctor to go over all this stuff. You can’t just say it—you actually have to explain it. And unfortunately, we’re trained in medical school to treat problems, not to prevent them. So, from a time standpoint, prevention becomes inefficient in the traditional medical model.

That’s why my rule is this: Every patient I see for pelvic floor issues is referred to a pelvic floor therapist. She has the time to go into detail and cover everything thoroughly. Honestly, I kind of joke that I’m an imposter on my own website because many of the resources I share are things I’ve learned from pelvic floor therapists!

And I’ll say this—I will not operate on someone unless they’ve seen the pelvic floor therapist at least once. Of course, they usually go for more than one session, but one is the minimum.

These practices are essential after surgery to prevent recurrence of symptoms. They truly make a difference.

(see episode 10: How I Stopped Peeing all the Time)

C: The other topic we’ve been alluding to is libido. I know you hear this a lot from midlife women. You’ve even got a downloadable booklet on your website that outlines the seven organs of sexual desire.

T: Yes! And thank you for mentioning that. One reason libido isn’t talked about more is that it’s been such a taboo subject for so long. I’m a prime example. I was raised Catholic, and in that environment, sex was taught as something only for procreation. I carried a lot of shame for a long time, even though I waited until I was in my twenties to have sex. Still, I was made to feel like I was doing something wrong.

That’s part of the issue—and the other part is education. Most research and resources around sexual function have been focused on men. There are dozens of medications and procedures approved for male sexual health. But when it comes to women? Only one FDA-approved medication exists for female libido—and it’s only for premenopausal women. Not even menopausal women.

So, let’s go through the seven organs of sexual desire:

* The Brain – This is the primary organ of sexual desire. If you’re dealing with stress, fatigue, body image issues, resentment toward your partner, or constant interruptions (hello, motherhood!), your libido is going to take a hit. You have to address these mental and emotional blocks to even begin feeling aroused.

* Vestibular Glands (Bartholin’s Glands) – These are located at the back of the vaginal opening near the labia minora and stimulate secretions during sexual excitement. They’re similar to the male bulbourethral glands.

* Skene’s Glands (Periurethral Glands or the Female Prostate) – These sit on either side of the urethra and produce prostatic-specific antigen (PSA), which plays a role in female ejaculation and helps prevent urinary tract infections.

* The G-Spot (more accurately, the G-Area) – This is a roughly 3 cm area located between the vagina and the anus. It contains erectile tissue that swells during arousal, compresses the vaginal walls, and enhances sensation for both partners.

* Clitoral Bulbs (Vestibular Bulbs) – These are elongated erectile tissues that sit on either side of the vaginal opening and connect to the clitoris. During arousal, they engorge with blood, creating a tighter cuff around the vaginal opening, which increases pleasure and sensitivity.

* The G-Area Again (Surrounding the Urethra) – During arousal, this area becomes engorged and compresses the urethra to prevent leakage during sex. Many women aren’t aware, but urinary incontinence during sex is a real issue—and this part of the anatomy helps prevent that.

* The Clitoris – The superstar! The clitoris is similar to the male penis and can measure up to 7 cm in length. It has three parts: the glans (the visible tip), the shaft, and the internal legs. It contains the highest concentration of nerve endings in the body and exists solely for pleasure. Unlike the penis, it has no role in reproduction or urination—its one job is orgasm.

C: So Mother Nature definitely had something in mind for us! I’m honestly stunned by how much is going on down there. I had no idea what most of those structures were, let alone their names.

T: That’s exactly why I created a PDF resource. You can look it over anytime as a refresher.C: One thing that shocked me was the pain during intercourse.  My tissues went from steamy jungle to the Sahara almost overnight!

T: By age 30, women have already experienced a 50% reduction in testosterone—which is wild. Age 30 is so young! And yet we’re already seeing that hormonal shift.

As you move into perimenopause and menopause, things change even more. Perimenopause refers to the years around menopause—typically lasting two to six years—and menopause itself is defined as the point when you haven’t had a period for 12 months (assuming you have a uterus).

With menopause comes a host of symptoms, and one major issue is painful sex. That pain is largely due to the drop in estrogen, which leads to vaginal atrophy. Estrogen stimulates collagen production and helps maintain the thickness and elasticity of tissues in the urethra, bladder, and vagina.

When estrogen—particularly estradiol—drops significantly from premenopausal levels, the tissues thin out, lubrication decreases, and microtears can develop. This not only causes discomfort during sex but also raises the risk of bladder infections.

The thinning and weakening of those tissues also contributes to common issues I treat regularly, like incontinence and prolapse—where pelvic organs begin to descend due to a weakening pelvic floor.

C: And I guess that early drop in testosterone helps explain some of the libido issues, too—not to mention the stress that accumulates over decades of trying to be everything to everyone. That constant push to be the perfect mother, partner, friend, or employee... it builds up resentment and emotional fatigue, and we rarely stop to process it.

C: We’ve talked about incontinence issues and opened the door to admit that sex can be complicated for midlife women.  Whew!  That’s good work. 

C: And this isn’t the end of the conversation, right?  You have some excellent resources through your website that our listeners can download right now.  I am also offering a free one hour yoga class based on what I learned from my pelvic floor physio.  This is what I did to avoid having to see a surgeon later on. 

Your pleasure and confidence are important.  We have so many more years to show the world what we’re about.  It’s not time to retire to the front porch rocking chair yet.