Pelvic Pain Unpacked, Episode 19 — with Tamar Hill and Dr. Amanda Olson, DPT, PRPC
🌿 Key Takeaways
- Vaginal dryness is not just a menopause issue — postpartum changes, oral birth control, stress, antihistamines, and antidepressants can all cause it at any age.
- Being emotionally and physiologically aroused and still not producing adequate lubrication is completely normal — arousal and moisture are not the same response, and neither signals a problem with attraction.
- Water-based, silicone-based, and oil-based lubricants each serve different purposes — knowing which to use and when makes a meaningful difference in comfort and sexual pleasure.
- Vaginal moisturizers and lubricants are not the same product — one restores tissue health over time, the other provides temporary relief in the moment.
- Discomfort during sex is never something women simply have to accept. There is always a driver, and there is almost always a solution.
If you’ve ever Googled “why does sex hurt” at 2 AM because you were too embarrassed to bring it up at your last appointment, this article is for you. Vaginal dryness is one of the most common — and least discussed — issues affecting women’s intimate health and sexual pleasure, and most women either assume it’s just part of getting older or quietly endure the discomfort without knowing that effective solutions exist.
In Episode 19 of Pelvic Pain Unpacked, host Tamar Hill of MedRoots — a company specializing in CBD products for pelvic discomfort relief, sexual pleasure, menopause support, muscle discomfort, and overall wellness — sat down with Dr. Amanda Olson, DPT, PRPC, President and Chief Clinical Officer of Intimate Rose. Dr. Olson is a pelvic health physical therapist, author of Restoring the Pelvic Floor for Women, and internationally recognized educator who teaches clinicians on pelvic health topics worldwide. In 2025, she received the Elizabeth Noble Award — the highest honor from the APTA Academy of Pelvic Health Physical Therapy — for her contributions to patient care, education, and innovation. The two met as neighboring vendors at pelvic health conferences and have been collaborators in the space ever since.
What’s Actually Happening When a Woman Says “I’m Dry”
The conversation starts with the most basic question — and the answer is more layered than most people expect.
Dr. Amanda Olson: “Usually what’s happening is they are in a low estrogen state. Hormone effect is often a driver of vaginal dryness, and someone could be in that state after having a baby, in perimenopause and menopause — but also during times of stress, when cortisol levels increase, estrogen levels can decrease as well.”
Stress as a driver of vaginal dryness is something most women have never been told. When cortisol rises, estrogen can fall — which means a high-pressure period at work or a difficult season of life can contribute to dryness entirely outside of any hormonal life stage.
Medications are another lesser-known culprit. Over-the-counter antihistamines — the allergy medications many people take daily — list vaginal dryness as a side effect. So do certain antidepressants and oral birth control pills. Dr. Olson noted that she regularly sees younger women in her practice who are experiencing low estrogen states specifically because of hormonal suppression from oral contraceptives — a population that often doesn’t expect to be dealing with vaginal dryness at all.
The top three causes, in order of frequency in Dr. Olson’s practice: perimenopause and menopause, postpartum, and hormone suppression from oral birth control.
Lubrication vs. Tissue Health: Why the Distinction Matters
Before diving into solutions, Dr. Olson made an important distinction that shapes the entire approach to treatment.
Vaginal lubrication levels fluctuate day to day based on stress, hydration, and hormonal shifts. Tissue health is a deeper, more chronic issue — the elasticity and integrity of the vaginal walls themselves, which changes more slowly over time as estrogen declines. The two are often connected, but not always. What matters is this: if dryness leads to friction, and friction leads to irritation, the discomfort cycle begins.
The cycle looks like this: dryness creates friction, friction creates irritation, irritation triggers pelvic floor guarding, guarding creates more discomfort, and discomfort reduces arousal — which leads back to more dryness. Once that cycle starts, lubricant alone may not be enough to interrupt it.
Arousal and Moisture Are Not the Same Thing
One of the most validating moments in this conversation came when Dr. Olson addressed a question that causes enormous confusion and relational tension: can a woman be fully aroused and still not produce adequate lubrication?
Dr. Amanda Olson: “Absolutely. A lot of people start to get frustrated, and there can be conflict within the partnership because the partner is saying, ‘Why aren’t you moisturized? Aren’t you attracted to me?’ And the person is emotionally and physiologically aroused, but the tissue is just not producing that lubricated state.”
There’s also a mechanical piece that doesn’t get nearly enough attention: women physiologically require something like 35 to 40 minutes of warmup to reach full arousal — enough blood flow to the area for the tissue to be soft, pliable, and naturally moisturized. When that warmup is rushed, the body simply hasn’t had enough time to respond, regardless of desire or attraction. As Dr. Olson put it simply: you have to preheat the oven.
This is one of the most practical reasons to keep lubricant on hand — it bridges the gap between where the body is and where it needs to be, without putting the entire burden on the warmup period.
The Three Categories of Lubricant — And How to Choose
Dr. Olson broke down the lubricant landscape into three broad categories, and the shampoo-and-conditioner analogy she used is worth keeping: we all have different hair and different goals, so we pick accordingly. Lubricants work the same way.
Water-based lubricants are the most versatile and generally the safest for sensitive tissue. They’re compatible with condoms, silicone tools, and toys — and they won’t stain sheets. The trade-off is absorption rate: they absorb into the tissue relatively quickly, so reapplication may be needed during longer sessions. They tend to be the best starting point for anyone with sensitive skin or a history of irritation.
Silicone-based lubricants are prized for longevity and slip. Many people prefer them for intimacy specifically because of how long they last and how they feel. The limitations: they cannot be used with silicone tools or toys (silicone on silicone degrades the surface), and they cannot be used with condoms. For intimacy without those constraints, they’re a popular choice.
Oil-based lubricants have a natural feel and good longevity, and some people swear by them. Coconut oil is the most common example — and it works beautifully for some women. For others, it can disrupt the vaginal pH and flora, triggering bacterial vaginitis or yeast overgrowth. Oil-based options can be used with tools and toys but not with latex condoms, which they can degrade. Sheet staining is also a real consideration.
One often-overlooked factor across all three categories: vaginal pH. The vagina’s natural pH is approximately 4.3 — not neutral in the traditional sense. Products that aren’t formulated close to that range can disrupt flora and increase susceptibility to infection. When evaluating any lubricant, pH-appropriate formulation is a meaningful baseline criterion.
What Intimate Rose Offers — And Where MedRoots Fits In
Dr. Olson walked through Intimate Rose’s lubricant lineup: an FDA-cleared, paraben-free, glycerin-free water-based lubricant designed to pair with their therapeutic tools and enhance slip for intimacy; a silicone-based lubricant for recreational use only (not compatible with their silicone tools); and the Enchanted Vulvar Balm — an organic, oil-based product for external use on the vulva and perineal tissue. The balm is particularly helpful for postpartum and perimenopausal women, as well as anyone with vulvodynia, lichen sclerosus, Sjogren’s syndrome, or sensitive skin from waxing or shaving. It’s also safe for consumption.
MedRoots offers both water-based and oil-based lubricants, both formulated with CBD — which plays a specific role beyond moisture. As Tamar noted, CBD is designed to help manage discomfort during intimacy, not just provide lubrication. For women who experience pelvic tension or guarding that makes intercourse uncomfortable, the muscle-relaxing and anti-inflammatory properties of CBD add a layer of support that standard lubricants don’t provide. MedRoots’ hormone-free vaginal moisturizer suppositories can also be used on alternating days alongside topical vaginal estrogen, supporting tissue health without interfering with hormonal treatments.
How Pelvic Floor Physical Therapy Addresses the Root Cause
Lubricants and moisturizers address the surface of the problem. For many women, the pelvic floor muscles are also involved — and that’s where PT comes in.
The pelvic floor muscles sit just on the other side of a thin layer of tissue from the vaginal walls. What affects one almost always affects the other. In perimenopause and menopause, the pelvic floor can simultaneously clench in response to chronic stress, lose tone as estrogen declines, and develop tender points and restrictions that make any kind of insertion — speculum, tampon, or partner — uncomfortable.
Pelvic floor PT works to restore muscle function through manual therapy, exercise, and home-use tools. The approach depends on what’s actually happening: some muscles need to be strengthened, others need to be lengthened and released. Dr. Olson is clear: lengthen before you strengthen. Attempting to build strength in a pelvic floor that is already overactive can drive more tension and more discomfort.
Two therapeutic tools she highlighted specifically:
The pelvic wand — which Dr. Olson designed and patented — allows patients to reach inside the vagina and gently work out trigger points, the same way you’d massage a knot in your neck or back. The curvature of her wand is specifically designed to reach the obturator internus, a deep pelvic floor and hip muscle that is a common driver of deep pelvic discomfort and is frequently misidentified as a piriformis issue. Standard figure-four stretches don’t reach it. The wand does.
Dilators are used when there is discomfort with insertion of any kind. As low estrogen causes vaginal walls to stiffen, dilators work progressively to restore elasticity, length, and width to the vaginal canal — in service of comfortable, pleasurable penetration. They’re also used for anyone who has undergone pelvic radiation, which makes tissue exquisitely dry and inelastic.
On the topic of radiation: Dr. Olson emphasized strongly — and Tamar echoed it from a recent episode with oncology PT specialist Dr. Alexandra Hill — that patients undergoing pelvic radiation should demand a pelvic floor PT referral at the time of diagnosis, not after treatment ends. Preventative PT during radiation produces dramatically better outcomes than triage afterward.
Myth-Busting: The Questions Women Are Afraid to Ask
Tamar ran Dr. Olson through a rapid-fire true-or-false on the most common misconceptions about vaginal dryness and sexual pleasure:
Vaginal dryness only happens after menopause — False. It happens postpartum, on oral birth control, during high-stress periods, and as a side effect of common medications.
If I’m dry, I’m not aroused — False. Arousal and lubrication are separate physiological responses. You can be fully aroused and still need lubricant.
More lube always solves discomfort during sex — False, but use more anyway. Lubricant addresses friction, but discomfort can also come from pelvic floor tension or tissue stiffness that requires a different approach. Use a generous amount — Dr. Olson recommends a tablespoon on each partner — but also investigate other potential drivers.
Vaginal moisturizers and lubricants are the same thing — False. A lubricant provides temporary slip for the moment. A moisturizer actually replenishes dermal health over time, the way lotion restores dry hands rather than just coating them temporarily.
Painful sex is something women just have to tolerate — Never. Not postpartum, not in perimenopause, not in menopause. There is always a cause, and there is almost always a path toward sexual pleasure that feels good again.
Pelvic floor PT is only for women who’ve had babies — False. All genders, all ages. Everyone has a pelvic floor, and there are countless ways for it to not function optimally.
Building a Vaginal Dryness Toolkit: Dr. Olson’s Recommendations
When asked to build the ideal toolkit for a woman experiencing vaginal dryness, Dr. Olson’s list in priority order:
- Topical vaginal estrogen — strongest evidence base; stays local and doesn’t circulate systemically; used daily for two weeks to restore moisture and tissue lining, then twice weekly for maintenance
- Vaginal moisturizer — for ongoing tissue care or when estrogen isn’t an option (MedRoots’ CBD-infused suppositories pair well on alternating days with topical estrogen)
- Lubricant — for intercourse and tool use; use generously
- Vulvar balm — for external tissue health and sensitivity
- Dilators — for anyone with radiation history, perineal scarring, or menopausal tissue stiffness
- Therapy — cognitive behavioral therapy or relationship counseling when relational or psychological dimensions are part of the picture
- Stress reduction — because cortisol suppresses estrogen, small daily pleasures matter more than most people realize
Your Comfort and Pleasure Deserve Real Support
Vaginal dryness is common, treatable, and nothing to push through alone. Whether you’re postpartum, navigating perimenopause, on medication that’s affecting your tissue, or simply ready to reclaim sexual pleasure that feels good — MedRoots has products designed to meet you where you are. Our CBD lubricants, vaginal moisturizer suppositories, and wellness products are formulated to support pelvic health from the inside out, and they work beautifully alongside PT and medical care.
📞 Call us: 833-797-7576
🌐 Contact us online: medroots.com/pages/contact
Don’t wait to feel better. Your comfort, your pleasure, and your wellbeing are worth it.
This article is based on Episode 19 of Pelvic Pain Unpacked featuring Dr. Amanda Olson, DPT, PRPC, President and Chief Clinical Officer of Intimate Rose, and author of Restoring the Pelvic Floor for Women. It is for informational purposes only and does not constitute medical advice. Please consult your healthcare provider before making any changes to your treatment regimen.