Speaker
Dr Rachel Rubin
Appearances over time
1 episodes
Episodes
1
Podcasts
Quotes & moments
Only 1.7% of women who should be offered hormone therapy prescriptions are actually receiving them, according to Dr Rachel Rubin.
Estradiol vaginal cream costs as little as $14 on Mark Cuban's pharmacy website, lasts about 2.5 months, and can prevent UTI deaths among other benefits.
Up to 75% of women will report that sex is painful at some point in their lives, yet pain during sex is chronically under-diagnosed.
In 2026, the word 'clitoris' does not appear in the checklist of what an OB-GYN must learn during their training.
Research since the 1990s shows that vaginal hormones prevent urinary tract infections by more than half.
About 23% of women have a clitoral adhesion where the hood is stuck to the head, which goes undetected because doctors never examine the clitoris.
Published data shows that removing clitoral adhesions in a simple procedure produced improvements in orgasm, arousal, and satisfaction of 60–70%.
A survey of 1,000 women who had taken GLP-1 weight-loss drugs found that about 25% reported sexual side effects.
Unlike estrogen, which falls at menopause, women's testosterone begins to drop precipitously in their 30s — with effects on libido, orgasm, and arousal starting before perimenopause.
Dr Rachel Rubin is one of only 80 doctors in the US trained to treat both male and female sexual health.
Oprah had to see five doctors before her heart palpitations were correctly attributed to perimenopause and menopause, illustrating widespread medical ignorance on the subject.
More than 75% of people in large database collections are not receiving prescriptions for vaginal hormones despite clear evidence of benefit.
Science shows the average duration before male orgasm during penetrative sex is about 5.5 minutes — yet women typically need over 13–15 minutes of clitoral stimulation to orgasm.
The most affluent, well-connected women in the world can't access basic hormonal healthcare. Oprah saw 5 doctors before her heart palpitations were linked to menopause. Halle Berry was misdiagnosed with herpes when she actually had genitourinary syndrome of menopause. If the elite can't navigate this system, the rest of us don't stand a chance.
In 2026, the word 'clitoris' does not appear in the official checklist of what an OB-GYN must learn. Gynaecologists were trained in obstetrics and surgery, not sexual function. Women going to their gynaecologist expecting expert advice on orgasm, arousal, or libido are consulting someone who received essentially zero training on the subject.
The combined birth control pill works by flooding the body with synthetic hormones so high that the ovaries stop producing their own. But ovaries make three hormones: estrogen, progesterone, and testosterone. The pill adds back estrogen and progestin but not testosterone — and that missing testosterone is why up to 27% of pill users report reduced libido.
Vaginal estradiol cream costs $14 at Mark Cuban's pharmacy, lasts 2.5 months, and used twice a week it prevents UTI deaths, reduces pain during sex, improves arousal and orgasm, and helps with urinary leakage. It's safe for cancer survivors, breastfeeding mothers, and nursing home residents. More than 75% of women who need it are never prescribed it.
In the early 2000s, a major NIH study was stopped early and a press conference announced that hormone therapy causes cardiovascular disease and breast cancer. Overnight, prescriptions crashed. The same authors published in 2025 that below age 70, that therapy had no increased risk of either. Only 1.7% of eligible women now receive HRT — a generation of doctors never learned how to prescribe it.
Hormone therapy falls into four categories: whole-body estrogen (hot flashes, bone loss, brain health), progesterone (uterine protection, sleep, anxiety), testosterone (libido, orgasm, body image), and vaginal hormones (local estrogen or DHEA for UTIs, pain, dryness). Understanding which bucket you need changes everything about how you approach treatment.
About 23% of women have a clitoral adhesion — where the hood gets stuck to the head of the clitoris. No gynaecologist exam ever checks for this. Published data shows that removing these adhesions in a simple office procedure improves orgasm, arousal, and satisfaction by 60–70%. Women have been told they're broken; they just needed this fixed.
The clitoris is the female equivalent of the penis — same tissue, same function, same need for direct stimulation to produce orgasm. Penetrative sex does not stimulate the clitoris for most women. Men last an average of 5.5 minutes; women need 13–15 minutes of clitoral stimulation. The orgasm gap isn't biological inevitability — it's an education failure.
Testosterone isn't a male hormone — it's simply a hormone. Women produce it, and it starts dropping precipitously in their 30s, long before menopause. The result: lower libido, slower orgasm, reduced engorgement and lubrication. Meanwhile, almost every medical textbook on the female hormonal cycle omits testosterone entirely.
The pelvic floor is a ring of thick muscles that must contract and relax for arousal, penetration, and orgasm. Tight pelvic floor muscles make penetration painful and orgasm difficult or impossible. Yet pelvic floor physical therapy is rarely prescribed for sexual dysfunction. A specialist exam can diagnose the problem — and Kegel exercises aren't always the solution.
About 70% of men experience spontaneous desire — arousal that arises without any stimulus. Only 10–15% of women do. Most women (40–50%) experience responsive desire, meaning arousal kicks in after stimulation starts. Framing a woman's lower spontaneous desire as 'low libido' or 'not interested' is a category error that destroys relationships.
A patient came to Dr Rubin refusing hormone therapy due to cancer fears. Starting with just vaginal hormones, her orgasms returned, her UTIs stopped, and her pain resolved. She then added estrogen and progesterone. Six months after starting testosterone, she enrolled in law school, competed against 22-year-olds, and finished top of her class.
About 65% of Pornhub traffic is male, and 75–95% of men aged 18–35 watch porn regularly versus only 34% of women. Platforms built for male arousal teach men that penetration produces female orgasm — the opposite of how most women's bodies actually work. Women then believe they're broken when they can't replicate what they saw on screen.
When you asked someone on a date, you were scheduling potential sex. In long-term relationships, the stage-setting disappears but the need doesn't. Dr Rubin recommends quarterly 'partner days' — a full day blocked off on the calendar — as a minimum investment in erotic connection. Spontaneous vacation sex isn't magic; it's the product of unscheduled time.
Dr Rubin's core thesis: women's sexual dysfunction starts with biology, gets compounded by medical ignorance, and is then buried under communication failure. When all three are addressed — proper hormonal care, partner education in biology, and open conversation — the outcomes are transformative. Most couples never have the conversation because they don't have the words.
Analysis
What they talk about
- Health & Fitness 85%
- Society & Culture 15%
Connections
Shows they appear on and people they share episodes with. Drag to explore.
