143. Why So Many Midlife Women are Misdiagnosed with UTIs

Are you constantly being told you have a UTI—only to finish another round of antibiotics and still not feel better? If you’re in perimenopause or menopause and suddenly dealing with bladder pain, urinary urgency, painful sex, or recurrent infections, you are not alone.

In this episode, I’m joined by women’s health advocate and Desert Harvest CEO Heather Florio to unpack the often-overlooked connection between hormones, pelvic health, bladder symptoms, and sexual wellness in midlife. We’re talking about why so many women are misdiagnosed, how menopause impacts urinary and vaginal tissue health, and what you can do to advocate for yourself and finally get the support you deserve.

This conversation is empowering, practical, and full of science-backed insights that every midlife woman should hear.

In this episode:

[02:00] Why recurrent UTIs in menopause are often more complicated than they seem

[03:42] The hidden risks of overusing antibiotics when cultures come back negative

[05:00] The difference between interstitial cystitis and bladder pain syndrome

[07:30] How vaginal estrogen can support both vaginal and urinary health

[08:43] Why painful sex during menopause is incredibly common—and what can help

[10:00] Heather explains the science behind Desert Harvest’s aloe vera products and bladder health support

[13:08] How to advocate for yourself when you’re not getting answers from traditional healthcare providers

[14:00] Why pelvic floor dysfunction can contribute to bladder pain, urgency, and recurrent symptoms

[18:16] How bladder pain and vaginal tissue changes can impact libido and intimacy

[20:27] The role of orgasms, vibration, and pelvic floor health in sexual wellness

[22:26] What to know about vaginal moisturizers, lubricants, pH, and osmolality during menopause

[24:25] Supportive options for painful intercourse and chronic pelvic pain

Connect with Heather Florio:

Heather Florio is a sexpert, CEO, and outspoken advocate for women’s health and leadership. As the second-generation owner of Desert Harvest, she leads a company focused on medical-grade pelvic and sexual health products trusted worldwide. She is on a mission to break stigma, reshape conversations around sexual wellness, and position women’s health as a business and leadership priority. Heather also writes “Dear Sexpert” for Bella Magazine, offering candid, science-backed advice that empowers women to take control of their bodies and boundaries. Recognized by Authority Magazine and Forbes, she is a global voice at the intersection of entrepreneurship, healthcare, and advocacy, and has presented at the White House while serving on the board of the Northern Light Health Center for Healthy Brain Aging.

• Website: https://desertharvest.com
• Instagram: @desertharvestalovera

Connect with me, Sara Poldmae:

• Website: https://risingwomanproject.com
• Instagram: https://www.instagram.com/drsarapoldmae/

If this episode resonated with you, I’d love for you to share it with someone who needs to hear it. Don’t forget to follow, rate, and leave a review—it helps more women find this space so we can all rise and thrive together

Transcript

Sara Poldmae: 0:01

Sarah, welcome to Menopause Rise and Thrive. I am Dr. Sarah Poldmay, and this podcast is your go-to guide for navigating perimenopause and menopause. If you are feeling a little overwhelmed, trust me, you are in great company. Each week, I'll bring you expert advice, raw, honest conversations and simple tips to help you stay grounded and maybe even find some humor in the process. Let's rise, thrive, and tackle this wild ride together. Hello, everyone. Welcome back to Menopause Rise and Thrive. And today I am joined by Heather Florio, you may remember Heather. She was on a show just a few weeks ago. Heather is a sexpert, a CEO, and outspoken advocate for women's health and leadership. As the second generation owner of Desert Harvest, she leads a company focused on medical grade pelvic and sexual health products that are trusted worldwide. She is on a mission to break stigma, reshape conversations around sexual wellness, and position women's health as a business and leadership priority. Heather also writes Dear Sexpert for Bella magazine, offering candid, science-backed advice that empowers women to take control of their bodies and boundaries, recognized by Authority Magazine and Forbes. She is a global voice at the Intersection event, entrepreneurship, healthcare, and advocacy, and has presented at the White House while serving on the board of the Northern Light Health Center for Healthy Brain Aging. Wow, welcome, Heather. Welcome back, I should say.

Heather Florio: 1:40

Yes, yes. Thank you for having me back. I'm looking forward to chatting with you about my most favorite topic.

Sara Poldmae: 1:46

Yeah, definitely. The last time we had you on, we were talking about leadership and the audacity to lead and women in business, but today I want to flip the lens and let's talk about women's health.

Heather Florio: 2:00

Yes, definitely. That is my most favorite topic. I have been working with women for over 33 years now, helping them on their healthcare journeys, and one of the things that we specifically focus on, and I'd love to chat about today, is urinary health as it relates to recurrent UTIs and several evil twins that go along with that.

Sara Poldmae: 2:20

Yeah, I would love that. Thank you, thank you. So we definitely see a lot of women in clinic that are constantly given rounds of antibiotics for what they think are chronic BTIs. We are seeing a lot of women that are just suddenly not feeling like themselves physically in

Heather Florio: 3:42

You mentioned that cyclical environment of recurrent UTIs, where we go in the doctor's office, we get that dipstick test, they hand us some antibiotics, we go home, but the problem is, is in most cases, you know, when we get that culture 72 hours later, a lot of the time they're not gram positive for any bacterias in a lot of cases, and as a result, we've just overused antibiotics, and it creates the cyclical environment where we're further damaging both our gut microbiomes, our bladder microbiomes, and our vaginal microbiomes, and and so it's very important that we don't just jump on the bandwagon of, oh, I need antibiotics, because that's not always the case, and in this particular case, especially when it comes in regards to menopause, you know, you need to be looking at things like vaginal estrogen, other HRT alternatives, you know, pills, transdermal things like that to continue to supplement estrogen into your body, so that that lining doesn't begin to degrade, because in some cases what that does lead to, and again, the research is little tenuous of the link between interstitial cystitis and menopause, but we know that many women that have recurrent. UTIs during menopause get diagnosed with interstitial cystitis, and it might just be a hormonal component and nothing to do with interstitial cystitis, and for those that don't know, interstitial cystitis is like having the world's worst UTI that never ever goes away, so this is typically presented in the bladder, you're going to have actual true bladder wall impact, it's going to be red, it's going to be inflamed, it could be ulcerated, and this is usually done via diagnosed via cystoscopy, in which we're looking at the bladder lining, determining how that bladder lining, that urothelial cell layer, has been impacted within the bladder to decide if that is the cause of your symptoms, but unfortunately, here in the United States, we stopped doing cystoscopies, noci udvus cystoscopy, many, many years ago in the early 2000s because they were doing cystoscopies and they were finding women with the symptom profiles related to interstitial cystitis, but no true bladder wall impact. Fast forward to 2026 and we are starting to understand now that these are two completely different conditions, so when we talk about hormonal changes, pelvic floor, maybe neuralgia type pain radiating. Let's say you had a back injury, and it's causing urinary symptoms that really falls under two separate distinct things. You see them a lot of the times together: interstitial cystitis, bladder pain syndrome, and bladder pain syndrome really kind of handles that complexity of all these other conditions, whereas interstitial cystitis is that true bladder wall impact, but in the United States, we diagnose to be an exclusion, and unfortunately that has kind of looped bladder pain syndrome and interstitial cystitis patients kind of together, and it's really hard to differentiate the two within our community, and so when you say going back to when you say vaginal estrogen, will that help at all with bladder issues, or is that only for the vaginal wall? No. So this can actually, this, what people don't know is that vaginal estrogen is also can help with those urinary symptoms, and so it is one of the things that's kind of the go-to, especially as we're trying to

Sara Poldmae: 7:30

get women back on HR, you know, oral HRT or transdermal, and to feel comfortable with that. Vaginal estrogen has been kind of that go-to to kind of initially help with those urinary symptoms, but it would be good to also then include and talk to your doctor about including, you know, either pills or a transdermal option, depending on your, your, you know, your profile and your, your history. Okay. Good to know. Yeah, I am often surprised when women come in and they are experiencing a lot of pain with intercourse, and they have yet to either have vaginal estrogen or even a vaginal moisturizer, I try to explain it's like when the skin is losing the tissues losing its integrity, it's almost like there's a million different little micro tears there, and so just like if you wanted to protect a cut with, you know, a simple barrier cream, just a covering your arm, you want, you want to do that as well with your vaginal tissue. Can you speak more on that? I know that you have a product that has aloe vera in it. Maybe if you could speak a little bit on your products, that would be helpful for the listener.

Heather Florio: 8:43

Yes, definitely. So, a couple of different things here. When you talk about vaginal moisturizers, we have our aloe glide, which is an FDA-cleared medical device as a sexual lubricant and a vaginal moisturizer. This can be inserted just to help keep tissues healthy. Aloe acts as a carrier, so you think when you have a sunburn and it goes down through all those layers and pushes the moisture up and helps with it with tissue regeneration, so it's an additional support tool, but ultimately the thing that is going to, but you're in this again this cyclical environment, if you're not replacing the hormones, then this is going to be an environment where you're just going to keep having to add moisture, add moisture, add moisture. So, the aloe glide is that that supplemental option to make it able to have comfortable sex, just to make things kind of aloe vera is naturally an anti-inflammatory and analgesic, so it has additional support benefits and can be inserted regularly just to keep those vaginal tissues healthy as you kind of explore your HRT journey and then in addition if you do get diagnosed with interstitial cystitis our SSAV capsules that we have been using. And for a support tool for interstitial cystitis patients, now for 33 years in our double blind placebo controlled studies, we have an 87.5% response rate of some or complete relief of all symptoms, which is taking our capsules, and so this is the frequency, the burning, the pain, the waking up at night, the nocturia to go to the restroom, and you've got to imagine that, that with interstitial cystitis, you can hear stories avoiding up to 50 to 80 times a day, and, and in some cases, just planning your life around your next toilet, and where you can and can't go based on the toilet. Yeah, that's not that sounds absolutely miserable. What, what is the blend that you have in these capsules? So, it starts with the aloe vera plant in Origin. So, this isn't what you'd find in the typical health food store that's like an aloe vera capsule. Those are meant for short-term uses, digestive aids, other things like that. They're not meant for long-term use and in high doses, Desert Harvest developed this patented formulation, like I said, over 33 years ago to make it safe for long term use and in high doses. Aloe vera naturally has what's called anthropomornes in them, and these are latex chemicals that over time can be an irritant to the colon, and they can be carcinogenic over time, and so that's why what you find in the health food stores is meant for short-term use, and so we are all about how we grow this. We grow it in volcanic soil, the base of all volcano to increase nutrient content. We're harvesting within 20 minutes, so that we're preserving those nutrients almost immediately, because the minute you cut a leaf off of an aloe vera plant, within six to eight hours, all of the nutrients are dead, so it just becomes expensive water at that point. Aloe vera is almost 99% water, and so the idea that, that you know, if you've ever seen the leaves in the grocery store, expensive water, because they cut off plant at that point.

Sara Poldmae: 12:07

Wow. Okay. Good to know. I didn't, I didn't know that. I knew that it was mostly water, but I didn't know it lost its value so quickly.

Heather Florio: 12:15

Yes, yes, it is one of those things in which you know malic acid immediately begins to eat away at those nutrients, and, and over time, like I said, within those six to eight hours, all the nutrients are dead. So that is why it's so important for us to preserve the nutrients and concentrate this. So, just to give you a rough idea, one of our 180 capsule bottles of SSAB. I'm sure. Oh, I have one right here. So this is our SSAB capsules, and this takes roughly 89 full-grown aloe barbed endless miller leaves, so you're talking three, four feet long leaves, 89 of those to make this one bottle. So this is all about concentrating nutrients, maximizing, and then making it safe for that long-term use in the high doses.

Sara Poldmae: 13:08

Okay, that's fascinating. And so, what would you say to a woman that is not getting the care that they need for the interstitial cystitis or those symptoms? Where would they start? Do they just go ahead and start by ordering a product from you, or like I would want them to be working with a natural health practitioner that's going to get to the root of why these things keep coming up in the first place, but if a woman is experiencing these types of symptoms, what do you recommend for them? Yes, definitely advocating for yourself within that space, knowing obviously, if you're your menopausal age, the first thing you should be addressing is your hormones, and then two, there's the first line of defense is going to be looking at this, the integrity of your pelvic floor, so you've got to think of your pelvic floor as this

Heather Florio: 14:00

hammock that it holds everything in place. All of our female organs are being held in place by this pelvic floor. Most people think, oh, it's weak, I need to go straight to Kegels, and this is what I need to do. And unfortunately, most people aren't. It's not that they're weak, it's that they're hypertonic. So imagine a really tight dish rag, and this is your, this is your pelvic floor muscles, and in a lot of cases, so that's called hypertonicity, and, and if you don't, you start doing kegels in your hypertonic, you're just going to make things worse, and so really addressing the state of your pelvic floor, the pelvic floor physical therapist is kind of like first line where you should go in in addressing this. Now, obviously, if you have gram positive bacteria, you know antibiotics are going to be the go to. We do have, you know, the standard over the counter, it's as a preventative is demanos. In clinical research, this binds just to E coli bacteria and will help flush this out, but that only accounts for it accounts for roughly 80% of gram positive bacteria UTIs, but there is a whole nother 20% that isn't being accounted for, and this is where we really get into a lot of those recurrent UTIs, and so we actually just recently released, just the end of last year, Heather's UTI defense, not named after me, and the whole point of this was we wanted to find something that would bind to more than one bacteria, and so as of right now we have clinically confirmed that it binds to three bacterias, and we're studying two more, so we're looking at both, we're E coli is definitely in there, E fascialis and P valgaris are all the three bacterias that we know clinically that it's so now you've just tripled your protection from D mannose, and you know mannose is naturally in, like, let's say our SSAB capsules. It's naturally in aloe vera. It's an extraction source. It's one of the molecules naturally in the aloe vera plant. So, if you're already on the SSAV, there's no need to supplement additional D-mannose or other things, but if you're getting additional bacteria besides E coli, that's where additional options might make sense to just kind of act as a preventative, but if you are not experiencing gram positive bacteria, then that is where you want to definitely seek out and look at whether you know the strength of your pelvic floor, the health of your urothelial cell tissues in your bladder, and that might be going to a gynecologist or urogyne. In this case, I would say that it's typically better than a urologist in a lot of cases, because urologists are not necessarily focused on these types of conditions, especially interstitial societies, the chronic conditions, and so that's where Ogun was one of the greatest things when we started developing this as a, as a discipline, and really started to make it much more prevalent here in the 2000s It was amazing, because it gave women a place to go to address these different conditions and kind of extract and wade through the various things that we can have going on down there from endometriosis, uterine fibroids. Now we've got, as of today, what is it? PMOS is the new acronym for PCOS, and so we've, we, we've got this umbrella of a lot of things going on, and when I say, you know, interstitial cystitis becomes a diagnosis of exclusion, they're looking to, you know, exclude endometriosis, but that can also be difficult, because sometimes endometriosis can actually embed on the outside of the bladder and cause these bladder symptoms, and so the great news is that we're developing diagnostic tests, looking at, like, you know, C 10 biomarkers, and things like that, that will help us, you know, diagnose endometriosis without having to, you know, exploratory surgeries, and things like that.

Sara Poldmae: 18:16

Yeah, so exactly, so a lot of women that I have seen clinically, if they're having chronic bladder pain or UTIs or their vaginal tissue is thinning, you know that can really impact a woman's libido, because if it's going to hurt, I don't want to do it. I don't know about you, but usually if something's painful, I tend to just not do that something. So, how do you advise women to navigate this with their partners? Because sometimes it's, you know, overwhelming. It's also a difficult subject to talk about, and women often feel a sense of shame, even though this is something that happens to a lot of women. So, how can women navigate this in order to also like reclaim their sexual wellness.

Heather Florio: 19:05

There are multiple things that can be done. One thing, if it's all menopause related, you know, the first thing, and obviously we have to go off label and compound it right now, but definitely testosterone is that that libido seeking. We also now have additional tools like Addi and other pills that can stimulate libido, per se, but if it's the uncomfortable aspect and not just feeling, you know, that you can have penetrative sex, there are alternatives to penetrative sex that you can still enjoy and have pleasure and, and even with yourself, vibration is great for the pelvic floor, and so utilizing the vibrator and other tools, or just a little bullet, or something like that for clitoral stimulation is really good for the pelvic floor, but you also have to think of. What an orgasm does to the body, because you're, you're, you're thinking about, you know, contracting and then releasing, contracting and releasing. So, when we're, we're orgasming, we're doing world of health benefits to the body, to the pelvic floor, you know, stimulating that vagus nerve at the same time, and that that is our super highway of function for our entire body. So beneficial is is to still make sure that you're orgasming, even if you're in a chronic pain state, and realize that it doesn't have to be penetrative sex, but if it is penetrative sex that you are looking to have, there one thing is always, especially for menopausal women, lubricate, lubricant, lubricant, lubricant, but let's talk lubricants, because most lubricants that are out on the market are not meant for the vaginal microbiome, so we talk about pH levels, but we don't talk enough about osmolality, and this is how the fluid flows in and out of your vaginal wall, your epithelial cell layer of of your vaginal wall, and if you start using something that is not iso osmol, or it's either hyper too high or hypo too low. What happens is, is your vaginal wall begins to dry out, those epithelial cells begin to dry out, and then they were literally fall out, and you have just lost your barrier of protection to bacteria, fungal infections, and STIs, and so it's very important that you maintain the integrity of that layer. So, one of the things, ideal vaginal osmolality, so we know pH needs to be acidic, around 4.5 for any kind of lubricant that you're using, but it also needs to be iso osmolar, roughly 290 plus or minus 80 points, which was set by the World Health Organization, the only one that has done a true study regarding osmolality, and this was for third world country sex workers, and they were trying to figure out how to prevent STIs in different ways, and they strictly went to go look at lubricants, and that is where we got that, that 290 that ideal vaginal osmolality. You want anything that you insert into your vagina to only be plus or minus 80 points, and so, like, for instance, I think our aloe glide is right up there, that is at 308 and and at iso aus molar at 308 and pH balanced at 4.5 so very important that you maintain the integrity of that. You've also got to think of things like if you do have penetrative sex, sperm is not, is alkaline, you've just introduced alkalinity to a very acidic vaginal microbiome is very important to think about afterwards, you know. We always think that we need to urinate and clean out the, you know, the urethra, but the one of the most important things is we also need to think about how we reset that vaginal microbiome, and so you can insert that's where glide, something that is iso, osmolar like that makes a huge difference to offset that alkalinity of sperm. The other thing that you can do is like we have, they're called aloe fresh whites, and they are meant, they have lactobacillus, they are acidic, and their whole point is to use for cleanup, but also to help reset the kind of that vaginal pH, and so they are really great and reintroduce healthy bacteria, and so they are really great on the go, like even if you have a UTI, anything else like that. I have them in my car, my purse, my office, take your pick, they're everywhere, they're in every bathroom in my house, and, and so they, they are good on the go to just kind of help keep, keep things balanced, and those are just a few things that you need to think about, is is definitely what kind of lubricant you're using. We do have an option for those that are in a true chronic pain state that want to have penetrative sex. There is an option where you can utilize. We have what's called relievium, and this is typically used for cancer patients undergoing radiation treatments, but it helps with skin regeneration, tissue regeneration. But it also has 4% lidocaine in it, and so it can be used right there at the vestibule to kind of help and realize everybody thinks lidocaine is going to numb sensation, it does not, and for a man all it's going to do is extend his erection, it is not going to, it is not going to descend. It ties anything in this situation, and so you can put that right on the vestibule. However, make sure there are a lot of people that are very lidocaine sensitive, and so I always tell, before you put it down there, just take something as simple as just putting it right here. Your skin is equally as thin as your vaginal tissues right here, and make sure you don't have lidocaine sensitivity, because it's a lot easier to get it off of here than it is down there, and Heather is pointing, for those of you that don't see this video, Heather's pointing towards her inner arm by her elbow. Yes,

Sara Poldmae: 25:35

so many of these products that you have, I feel like a lot of my patients could use, so I would love for you to share how we get in touch with you, how we find your products, and just anything else you would like for the listeners to stay in touch.

Heather Florio: 25:51

Oh, yes, they're welcome to check us out. We're on Instagram, we're Desert Harvest Aloe Vera. I am Hm Florio. You're welcome to check out. I'm usually posting content and amazing podcasts like this, and as well as Desert harvest.com You're welcome to go on there and check out any of our products. Reach out anytime with any questions. We like to maintain that we direct you towards the resources that you might need, because as women we are a collective, this is a journey together, and most of us are are on this in some way or another, in which we're trying to address our own health needs and figure out those really unmet needs, and so just realize that that we can help you on that journey.

Sara Poldmae: 26:38

I love that. I love that. Well, thank you, Heather. It's been a pleasure to have you on the show once again. I may reach out again for a third time, and I hope you all check out her products. It sounds like an amazing line, very researched, well thought out, lots of science behind it, which is something I love. But thank you for tuning in, everybody.

Unknown: 27:01

Bye.