Your Middle Age Vagina: Urogynecologist Dr. Besty Greenleaf on Pelvic Health

Ever wondered why your bladder seems to have a mind of its own after 40? Dr. Betsy Greenleaf, the first female board-certified urogynecologist in the United States, joins ThirtyFiveSixtyFour to answer every pelvic health question you’ve been too embarrassed to ask. From UTIs to sexual satisfaction, from the right way to wipe to whether your underwear is sabotaging your health, this conversation covers it all. Karen and Dr. Betsy dive deep into the changes that happen during perimenopause and menopause, debunking myths and offering practical solutions that don’t require surgery. Dr. Betsy’s refreshing approach removes the shame and awkwardness around these topics, delivering medically sound advice with humor and compassion. Her mantra? Just because something is common doesn’t mean it’s normal or that you have to live with it.

Ready to reclaim your pelvic health and sexual confidence? Dr. Betsy shares game-changing insights about Kegel exercises, revealing that most women are doing them wrong and explaining the milkshake straw technique that actually works. She exposes the truth about popular lubricants (KY Jelly gets thrown under the bus), explains why vacation sex is better, and introduces listeners to boric acid as a vaginal reboot solution. The conversation takes empowering turns as Dr. Betsy discusses everything from the best underwear choices to why sexual pleasure should be considered pelvic physical therapy. She challenges outdated beliefs about female desire and provides actionable strategies for improving intimate satisfaction at any age. Listeners will walk away with practical tips they can implement immediately, from bladder retraining techniques to understanding which products actually support vaginal health.

Dr. Betsy Greenleaf is a pioneering triple board-certified physician and the first female in the United States to achieve board certification in urogynecology. Her specializations include obstetrics and gynecology, female pelvic medicine and reconstructive surgery, and procedural medicine and aesthetics. With decades of clinical experience, Dr. Betsy has become a leading voice in women’s pelvic health education. She is the CEO and founder of the Pelvic Floor Store, an online resource providing carefully curated products that support pelvic wellness. As a bestselling author and award-winning speaker, she’s dedicated to removing the stigma around pelvic health issues and empowering women with knowledge. Dr. Betsy also operates the Pause Institute, where she treats both men and women for hormonal and pelvic health concerns. Her innovative approach combines medical expertise with practical solutions, and she’s even released a menopause rock album called “Menopause Memo.” Dr. Betsy’s mission is to become the next Dr. Ruth, making conversations about intimate health accessible, accurate, and shame-free.

In this episode:

• (00:00) Introduction to Pelvic Health with Dr. Betsy Greenleaf
• (03:20) What Is Pelvic Health and Why It Matters
• (04:38) Bladder Health, Incontinence, and What’s Normal
• (07:15) UTIs and Hormonal Changes During Perimenopause
• (10:45) Stress vs. Urge Incontinence Explained
• (12:02) Surprising Causes of Pelvic Floor Damage
• (14:15) The Freeze and Sneeze Reality
• (15:01) Kegel Exercises: Are You Doing Them Right?
• (17:40) The Milkshake Straw Technique for Kegels
• (19:30) Bladder Retraining and Hydration Tips
• (21:07) Difficulty Emptying Your Bladder: Causes and Solutions
• (24:00) Practical Tips for Better Bladder Function
• (24:06) How to Know If You’re Doing Kegels Correctly
• (26:27) Should Men Do Kegels Too?
• (27:54) The Power of Emu Oil for Pelvic Health
• (31:45) Choosing the Right Lubricant for Sexual Health
• (36:32) The Truth About Flavored Lubes
• (40:35) Does Your Underwear Cause Problems?...