I have a very young friend who, unfortunately, had to have a hysterectomy like so many of us. According to her, not long after her surgery, she started experiencing bleeding. Then came the truly scary part: incontinence. She was in pain, frightened, and uncertain about what was happening to her body.
Her doctor prescribed Kegel exercises to strengthen her pelvic floor, and it helped. Then they added vaginal estrogen cream, and that made a big difference. The bleeding stopped. The incontinence was resolved.
I was happy she got the help she needed, but it made me realize something: when I had my hysterectomy and ovary removal, my doctor simply told me to “watch for mood swings.” That was it. No mention of pelvic floor health. No mention of Kegel exercises. No mention of vaginal estrogen cream.
My friend learned about pelvic floor care after complications arose and then, she received the right interventions.
This is the reality for so many women: we often don’t get education about pelvic floor health unless something goes wrong.
Whether we receive guidance can depend on chance, which doctor we see, whether complications force the conversation, or whether someone thinks to mention it.
And that’s when it hit me: If I don’t advocate for my own health, who will? This article is part of that advocacy… for me, and for you.
What the Pelvic Floor Is
Most women have never thought about the pelvic floor until something goes wrong. The pelvic floor is a hammock of muscles, ligaments, and connective tissue stretching across the bottom of your pelvis. It acts like the foundation of your core, supporting your bladder, bowel, and reproductive organs.
This network of muscles does remarkable things:
- Supports your pelvic organs
- Controls urination and bowel movements
- Contributes to sexual function and pleasure
- Helps stabilize your core and posture
While childbirth is a well-known risk factor for pelvic floor weakening, it is not the only one. Even women who have never given birth can experience pelvic floor changes. Common reasons include:
- Age – Muscle strength naturally declines over time
- Hormonal changes – Menopause and ovary removal lower estrogen, thinning tissues and reducing muscle tone. This is what happened to my friend after surgery
- Surgery – Hysterectomy can alter ligament support and change the positioning of pelvic organs
- Lifestyle factors – Heavy lifting, high-impact exercise, chronic coughing, or chronic straining can all put pressure on the pelvic floor over time
When the pelvic floor weakens, you may notice bladder leaks, pelvic heaviness, reduced sexual sensation, or even prolapse.
Signs Your Pelvic Floor Needs Attention
- Urinary leakage when sneezing, coughing, laughing, or exercising
- Feeling of heaviness or pressure in your pelvis
- Difficulty controlling bowel movements
- Reduced sexual sensation or difficulty achieving orgasm
- A bulge or sagging feeling in the vaginal area
- Lower back pain without another clear cause
If you’re experiencing any of these, you’re not alone — and there are solutions.
What Worked for My Friend (and What I Learned)
My friend’s recovery taught me that two interventions make a significant difference:
1. Kegel Exercises
Kegels strengthen the pelvic floor by contracting and releasing the muscles. Research shows that consistent pelvic floor exercises improve muscle strength, bladder control, and sexual function.
A 2022 study in the Journal of Sexual Medicine found that combining Kegels with regular sexual activity (which naturally engages these muscles) produced even better results than exercises alone.
How to do Kegels:
- Imagine stopping the flow of urine mid-stream
- Squeeze those muscles for 5 seconds, then release
- Repeat 10–15 times, 2–3 times per day
- Don’t hold your breath or tighten your stomach, buttocks, or thighs
2. Vaginal Estrogen
For women who’ve gone through menopause or had their ovaries removed, estrogen loss causes vaginal tissues to thin and weaken, affecting sexual function, bladder control, and pelvic support.
Vaginal estrogen therapy:
- Restores vaginal tissue health in 80–90% of cases
- Improves blood flow and tissue elasticity
- Reduces incontinence symptoms
- Relieves pain and dryness
According to The Menopause Society, low-dose vaginal estrogen is safe and effective for most women, even those who cannot take systemic hormone therapy.
My friend was prescribed this cream after complications arose, and it made a huge difference — the bleeding stopped, incontinence resolved, and her confidence returned.
Seeing this, and reading the research, I reached out to my doctor to discuss starting vaginal estrogen and also ordered Kegel exercise tools to strengthen my pelvic floor.
How to Strengthen and Protect Your Pelvic Floor
The good news: a pelvic floor can be strengthened at any age. Evidence-based methods include:
- Kegels – Consistent, regular contractions of the pelvic muscles
- Weight training & core strengthening – Squats, deadlifts, and resistance exercises engage the pelvic floor while building overall strength
- Yoga & Pilates – Improve posture, stability, and pelvic alignment
- Sexual activity – Naturally engages pelvic muscles, improving tone and blood flow
- Posture awareness – Good standing and sitting posture supports pelvic organs and reduces strain
- Pelvic floor physical therapy – Specialized assessment and treatment if symptoms are present
Why It Matters for Overall Health
A strong pelvic floor contributes to:
- Bladder and bowel control – Preventing leaks and urgency
- Sexual health – Better sensation, arousal, and orgasm
- Core strength and posture – Supporting your body’s stability
- Bone and musculoskeletal health – Connected to overall wellness
- Confidence – Feeling secure and in control of your own body
Strengthening your pelvic floor now is easier than fixing problems later. Small, consistent efforts pay off over time.
Personal Insight
After my hysterectomy and ovary removal, I began noticing changes in my body that made me more aware of my pelvic floor — something I had never been educated about before surgery.
Learning about Kegel exercises and the role of vaginal estrogen therapy has shifted the way I think about my long-term pelvic and vaginal health.
After seeing how quickly these interventions helped my young friend recover, I realized I didn’t want to wait for problems to arise before taking action.
I’ve reached out to my doctor to discuss vaginal estrogen, and I’ve taken steps to begin strengthening my pelvic floor. Even taking these first steps has been empowering.
Proactive care matters. Understanding your body, knowing what to ask for, and advocating for yourself are acts of self-care that can protect your health and quality of life for years to come.
The Bigger Picture: Why We Need to Advocate
This isn’t about blame. It’s about a gap in care that affects millions of women.
We have to be informed. We have to ask questions. We have to advocate. Not because doctors don’t care, but because we live in our bodies every single day.
Call to Action
- Start Kegels – Even just 5 minutes a day makes a difference
- Talk to your doctor – Ask about pelvic floor health
- Consider vaginal estrogen – If you experience dryness, pain, or incontinence after menopause
- See a pelvic floor physical therapist
- Share this information – Other women need to know too
Sources & Further Reading
- Bhat, G.S., & Shastry, A. (2022). Journal of Sexual Medicine
- The Menopause Society (2025). Hormone Therapy for Sexual Function
- National Association for Continence – www.nafc.org
- American Physical Therapy Association (Pelvic Health) – www.apta.org
- Cleveland Clinic Pelvic Floor Disorders – www.clevelandclinic.org
A quick note: I’m not a doctor or medical professional. This article is meant to inform and empower women to ask questions and make thoughtful, informed decisions — not to replace medical advice.