The Truth About Hormones, Aging, and Sexual Health | Dr. Fenwa Milhouse

There are certain conversations that seem to make people uncomfortable no matter how common the issue may be.

Sex.

Hormones.

Intimacy.

Pelvic health.

As an orthopedic surgeon, I spend much of my day talking to patients about pain, mobility, and function. Those conversations are usually straightforward. Patients come in because something hurts, and they want to know what can be done about it.

But sexual health is different.

Even though it affects quality of life, relationships, confidence, and overall well-being, many people hesitate to bring it up. They assume discomfort is normal. They assume changes in their body are simply part of aging. They assume no one wants to talk about it.

That became increasingly clear during my conversation with Dr. Fenwa Milhouse, a board-certified urologist and fellowship-trained pelvic floor surgeon whose work focuses on many of the topics patients are often afraid to discuss.

What struck me most wasn't simply how much misinformation exists around sexual health.

It was how many people are navigating these changes completely alone.

Pain during intimacy.

Vaginal dryness.

Changes in desire.

Pelvic floor dysfunction.

Questions about hormones.

Concerns about aging.

These experiences are incredibly common, yet many people suffer silently because they don't know what's normal, what isn't, or where to seek help.

Throughout our conversation, Dr. Milhouse repeatedly returned to a simple but powerful idea:

We cannot improve the parts of health we're unwilling to talk about.

Hormones Affect Far More Than Reproduction

When most people think about hormones, they think about fertility.

They think about pregnancy, menopause, and reproductive health.

But hormones influence far more than our ability to have children.

As Dr. Milhouse explained, hormones play an important role in tissue health, urinary health, sexual function, bone health, and overall quality of life. When hormone levels begin to shift, the effects often show up in ways people don't immediately recognize.

Sometimes it's discomfort.

Sometimes it's dryness.

Sometimes it's changes in sensation, desire, or intimacy.

And because many of these changes occur gradually, people often assume they're simply something they have to accept.

But understanding what hormones actually do allows patients to recognize that many symptoms are not signs of personal failure or inevitable decline. They are physiological changes that deserve attention, discussion, and, in many cases, treatment.

The Symptoms We Don't Talk About Enough

One of the most interesting parts of our conversation centered on the symptoms people often keep to themselves.

Many patients will readily discuss high blood pressure or knee pain.

Far fewer will bring up vaginal dryness, pain during intercourse, recurrent urinary tract infections, or changes in sexual function.

Yet these concerns can have an enormous impact on daily life.

Dr. Milhouse emphasized that these issues aren't simply about sex.

They affect comfort.

They affect confidence.

They affect relationships.

They affect how people feel in their own bodies.

The challenge is that many people wait years before seeking help because they assume nothing can be done.

Sometimes they feel embarrassed.

Sometimes they think they're the only one experiencing the problem.

In reality, these symptoms are incredibly common.

And perhaps most importantly, many of them are treatable.

Why Prevention Matters More Than We Realize

One of the themes that surfaced repeatedly throughout our discussion was prevention.

Healthcare often becomes reactive.

We wait until symptoms become severe before addressing them.

But Dr. Milhouse spends much of her time helping patients understand that proactive care can prevent significant problems later.

A perfect example is vaginal estrogen.

Many patients assume it is only relevant if they're sexually active.

Dr. Milhouse explained that healthy tissue affects much more than intimacy.

It plays an important role in urinary health as well.

As tissue changes occur with age and hormonal shifts, the risk of recurrent urinary tract infections can increase. Those infections are more than an inconvenience. For some patients, they become a recurring source of discomfort, frustration, and even hospitalization.

The goal isn't simply treating problems after they occur.

The goal is maintaining health before those problems develop.

That philosophy extends well beyond hormones and urology.

It's a mindset that applies throughout medicine.

The Pelvic Floor Is More Important Than Most People Think

For many patients, the pelvic floor remains a mystery until something goes wrong.

Yet it plays a critical role in everyday function.

According to Dr. Milhouse, the pelvic floor helps regulate urinary function, bowel function, and sexual health.

These systems are deeply connected.

A problem in one area often affects another.

That interconnectedness is something medicine sometimes overlooks.

Patients may seek care for urinary symptoms without realizing those symptoms are connected to pelvic floor dysfunction. Others may focus on sexual health concerns without recognizing how muscle function contributes to the problem.

The body doesn't separate itself into specialties.

And the best care often comes from understanding how those systems work together.

Intimacy Has to Evolve Throughout Life

One of the most refreshing parts of our conversation was the way Dr. Milhouse approached intimacy.

Too often, conversations about aging focus on what people have lost.

What they can't do.

What has changed.

Her perspective was different.

As our bodies change, intimacy may need to change too.

Joint pain.

Back pain.

Hormonal shifts.

Mobility limitations.

Life circumstances.

All of these factors influence relationships and sexual health.

But change doesn't mean the end of intimacy.

It means adaptation.

Healthy relationships evolve over time. Communication becomes more important. Emotional connection becomes more important. Understanding what works for your body today becomes more important.

The goal isn't recreating what intimacy looked like twenty years ago.

The goal is continuing to find connection, pleasure, and closeness in ways that fit your current stage of life.

The Communication Challenge Facing the Next Generation

One unexpected turn in our conversation focused on communication itself.

Dr. Milhouse and I discussed how different relationships look for younger generations growing up in a world dominated by social media, texting, and digital content.

Previous generations learned communication through face-to-face interactions, phone calls, and real-time conversations.

Today's environment is very different.

Many young people are learning about sex, intimacy, and relationships from online sources that don't always reflect reality.

At the same time, technology can reduce opportunities to develop communication skills that are essential for healthy relationships.

That reality creates a challenge for parents.

As uncomfortable as these conversations may be, avoiding them doesn't make them disappear.

Dr. Milhouse spoke candidly about discussing topics such as pornography, healthy relationships, and sexual health with her own children.

The goal isn't to create fear.

The goal is to provide guidance.

Because if parents don't participate in those conversations, children will still learn about these topics from somewhere else.

And not all sources are equally healthy or accurate.

Why Representation Changes Lives

Toward the end of our conversation, Dr. Milhouse shared a story that had nothing to do with hormones or pelvic health and everything to do with possibility.

When she entered medical school, she didn't even know what urology was.

After learning more about the specialty, she quickly crossed it off her list.

She didn't see herself in it.

The field appeared overwhelmingly male.

The images she found didn't look like her.

And as a Black woman, she struggled to imagine where she belonged.

Then something changed.

A Black female urologist walked into a lecture hall.

For the first time, Dr. Milhouse saw someone who looked like her doing a job she had assumed wasn't meant for someone like her.

That single moment altered the trajectory of her life.

What stood out to me about that story is how powerful representation can be.

Sometimes people don't need encouragement.

Sometimes they simply need evidence that something is possible.

As women in surgical specialties, both Dr. Milhouse and I understand the importance of visibility. We know what it feels like to enter spaces where few people look like you. We know the value of seeing someone who has already walked the path you're trying to navigate.

And we know that visibility has the power to change futures.

The Bigger Picture of Living Well

What stayed with me most from this conversation is that sexual health is not separate from overall health.

It's part of overall health.

Hormones influence much more than reproduction.

Pelvic health influences daily function.

Communication shapes relationships.

Representation shapes possibility.

And the conversations we avoid are often the conversations people need most.

Dr. Milhouse's work serves as an important reminder that medicine is not simply about treating disease.

It's about helping people live fully.

Sometimes that means talking about symptoms patients are embarrassed to mention.

Sometimes it means correcting misinformation.

Sometimes it means helping someone understand that what they're experiencing is common and treatable.

And sometimes it means helping a young student see a future they never imagined for themselves.

Want to Learn More?

Follow Dr. Fenwa Milhouse also known as @yourfavoriteurologist, on social media for educational content on sexual health, pelvic health, hormones, urology, and healthy aging.

Watch this episode on YouTube right now!

For more conversations like this, subscribe to The Resilience Factor wherever you get your podcasts, and find me @dr.pamelamehta on social media.