You rub it inside the walls of the
vagina, like that.
>> rub it in like you would rub sunscreen
on your face. And if you do that twice a
week, it makes sex not painful and dry.
It helps with arousal and orgasm. It's
literally better than Viagra. And it's
cheap. And I'm telling you all this as a
urologist that this cream can also help
prevent death from urinary tract
infections. But more than 75% of people
in large database collections are not
getting prescriptions for this. And so
women are not getting access to generic
medications that could save their lives
and also really improve quality of life.
And so I am filled with rage because
people are limiting their ability to
have great sex, great health because
they aren't having access to all the
information that they could. For
example, women are not orgasming as much
as men. The data is very clear there.
And women come to see me all the time as
I'm a sex doctor. And they say, "I'm
broken and you have to fix me. I'm not
orgasming during sex." And I think the
majority of problem is education. Women
think that orgasm comes from
penetration. But the clitoris is how
most women orgasm. And yet most women do
not know where their clitoris is. And in
fact, the word clitoris today in 2026
does not exist in the checklist for what
an OBGYN has to learn in their training.
>> And as men, what are we getting wrong in
heterosexual relationships when we're
trying to arouse our partners?
>> Well, men are constantly asking about
they want their penises bigger, harder,
straighter, girthier, lasting longer.
But none of that has anything to do with
how women experience pleasure [music]
and satisfaction in the bedroom. So
that's why I'm so loud about these
things because no one is getting good
sex ed. Because the basic information is
not being shared. And we fundamentally
don't give a crap about women's sexual
health, about their menstrual cycles,
pregnancy, menopause, hormones, pain
with sex, libido. [music]
But we actually do have a lot of
information that we are not using
because everyone forgot to teach your
doctor.
>> And I want to focus today's conversation
on women's health cuz I have so many
questions and curiosities.
>> Right.
>> So let's start with the subject of
hormones.
>> This is going to be so [ __ ] good.
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If you do it, I'll tell you what I'll
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>> [music]
>> Dr. Rachel Rubin.
Before we started recording, you said a
line to me, which I found to be very
interesting. You said, "I'm filled with
rage."
Why are you filled with rage?
>> I am filled with rage because I do think
that people are limiting their ability
to have great sex, great relationships,
and great health because they aren't
having access to all the information
that they could, and they're going to
see doctors who actually don't know how
to help them with these problems.
>> And on the subject of women's health,
sexual health, hormones, etc., can you
give me the background context of the
disservice that's been done? I remember
you you were talking previously about
how even the most affluent women in the
world are being let down.
>> Yeah, I think this is the great
equalizer in the fact that no one is
getting good medical care here when it
comes to hormone therapy, menopause, and
sexual health. Melinda Gates just came
out and said she had to see three
doctors before she got proper hormone
therapy prescriptions. Oprah had to see
five doctors and still they didn't
understand that her heart palpitations
was from perimenopause and menopause.
How about Halle Berry, right, who has
access to all the doctors in the world
and she publicly came out and said she
was diagnosed with genital herpes when
she really just had the genitourinary
syndrome of menopause. The rich people
are not getting good information about
their bodies, about their hormonal
health, about their sexual health. So,
what are the rest of us doing? We don't
teach it in medical schools, we don't
teach it in residencies. I didn't learn
anything about it and so we are actually
getting worse at this, not better at
this. And so I'm full of rage because we
actually do have a lot of data and we do
have a lot of information that we are
not using because everyone forgot to
teach your doctor.
>> It's staggering to me that, you know,
those very affluent women that you've
mentioned still are being let down by a
medical system. Um, it also sort of begs
the question that if men were in that
situation, this probably wouldn't be the
case. And that's says something about
the research and the investment that's
gone into understanding women's health
relative to men's health.
>> It's a huge problem. We don't have
enough specialties of medicine that
focus on women's health and we don't
have enough like manpower behind us. We
can throw money at the situation, but
you need physical human beings to roll
up their sleeves and do this work. Like
doing research is challenging and you
need people to actually disseminate the
research and talk about the research and
you need the training to happen so it
has to trickle down. So, just because
someone wrote a paper doesn't mean it
automatically gets downloaded into every
doctor's brains. So, someone has to
teach someone how to do something. So, I
I lecture all the time. I do a lot of
trying to teach clinicians how to do
this. I travel all over to say, "Here's
how to write prescriptions." because
that's what it's going to take. There
was so much fear and misinformation 20
years ago about hormone therapy that it
is a lost art. Doctors don't know how to
write the prescriptions. Nobody taught
them how. So, even if they see headlines
and Melinda Gates giving $10 million to
the Menopause Society, that's wonderful,
but it doesn't translate into them
knowing how to actually write the
prescription, knowing the difference
between the type of hormones, knowing
the safety, the risk, the benefits,
because they never had the class. For
example, I'm a urologist. If someone
comes in to me asking about their blood
pressure, I'm not going to pretend like
I know everything about their blood
pressure. I'm going to be very honest
that I have the limitations in my
training. But, for some reason with
hormone therapy and women's health,
every doctor you go see has strong
opinions and will tell women what they
can and cannot have with their bodies
even when they don't know the data. I
come from the men's health world. We
don't tell men you can't have this. You
can't do this. We we talk about shared
decision-making. We talk about risks. We
talk about benefits. For some reason we
don't do that enough in women's health.
>> Why?
>> I think part of it I don't think your
doctor is evil. I actually have a
thought about this. So, I think your
doctor wasn't trained. I think they're
trying to save face. And I think 10
minutes is impossible to give good
medical care. I could never get to know
you fully in 10 minutes and really give
you great advice on your life that's
customized for you. It's almost like the
difference between a viral clip that
you're going to try to do from this
episode and the long-form nuanced
conversation that you're going to have.
You love the nuanced conversation. You
love spending those those 2 hours. And I
think patients want that, too. But, when
they go to the doctor, they're getting
the 10-minute version. And instead of
doctors saying I don't know, they're
sort of saying no no you can't have this
cuz it's easier than than sort of going
into that nuance, which can take time. I
also think that people are going to
their doctor, say say you want to talk
about your orgasm or your libido. Okay?
You go to your gynecologist. Of course,
my gynecologist should know everything
there is to know about the clitoris,
about orgasm, about hormones, about
That's what they do. And the truth is
it's not what they do. And it's they
were never taught that. And they
>> taught about the clitoris.
>> They were The word clitoris today in
2026 does not exist in the checklist for
what an OB/GYN has to learn in their
training. The word doesn't exist.
>> What is an OB/GYN for anyone that
doesn't know?
>> An OB/GYN is a doctor who specializes in
obstetrics, so delivering babies, and
gynecology. So, your gynecologist has
never been taught about the clitoris,
about the vulva, about sexual health,
about sexual pain, about libido,
arousal, and orgasm. And so, the ones
who have taken it on their themselves to
get extra training, they're very few and
far between. And so, every day women,
and men too, are going to a doctor
expecting answers on a topic that their
doctor probably has never gotten
training on.
>> And I do want to focus today's
conversation on women's health. And I
want to preface all of this by saying
that I'm going to be as dumb as I am on
this subject. If you say something about
the vagina and I don't know what it
means, I'm not going to pretend to know.
I'm going to ask you what it means. And
I say that because I sometimes think
with these conversations
um the host
often
is too shy to admit their ignorance. And
I have lots of ignorance on this. But I
also have lots of curiosity, and I want
to fill those gaps. And that's going to
require me to be very, very
dumb. And also, my second reason why is
because I have so many women in my life.
Um if you just look at my company, my
entire executive team in my company are
all women. And also, I've got my fiance,
my mom, my sister. And understanding the
women in my life um one element of
understanding them is understanding
their health. Women's health isn't
something that I was ever taught in
school. It's not like a lesson I had.
So, I also think this conversation
is for men. Every man has um four
important women in their lives. So, my
question to you is if if a woman has
clicked on this conversation right now,
what are they going to get from it?
Let's start with that first question.
>> So, I think it's really important
because as men, we expect the women to
know. Surely the woman knows about their
menstrual cycle, about pregnancy, about
postpartum, about menopause, about
hormones. Surely my partner knows, you
know, or the woman in my life, my mom,
my sister, my my daughter, they know all
of that, so I don't have to. And the
truth is, they don't know. When the
women in your life go to their doctor
and they're getting a pelvic exam, say
they're getting a Pap smear, a doctor is
looking at their their genitalia,
putting a speculum in, going inside the
canal and looking around. We put a sheet
over you like we are me chanics looking
under the hood. So, we put a sheet to
keep you comfortable, to keep you
modest, but we we hide your genitalia
from you and we don't teach as we go.
So, I became famous again because I I I
when I started my practice, I didn't buy
any fancy equipment, I bought two
mirrors on Amazon and I give women a
mirror and as I'm examining them, I say
to them, "This is your labia majora.
This is your labia minora. This is your
clitoris. This is your your urethra, the
tube that you pee through." Because
women can't see it. You've got skin,
you've got bones, you've got muscles,
you've got nerves, you've got, you know,
all the organs that are on the inside
and women don't have access to this
language. Certainly men don't have
access to this language. And so, it's
that basic ability to give women
language, you can learn about your body
parts, you can learn how hormones work
in your body, and you can learn basic
medicine for you that becomes important
for how you advocate for what you want,
what you care about, and who you bring
into your medical life. You may have a
physical therapist, you may have a
mental health person, you may have a
primary care, a gynecologist, you may go
on Instagram and get great information
from people on Instagram. And so, that
doctor that makes you feel like crap
because they they tell you something
that you don't agree with, find a
different one, right? You have to
advocate for yourself and I find we are
starting to empower women to do that, um
which is very challenging.
>> What is the most popular question you
get asked now that you've been on these
podcasts and you know you're out there
and you've done millions and millions of
views all over the place and on clips
and so forth. What is the number one
most popular question you get asked?
>> I'm asked a lot about hormones. Like
people want to know about hormones.
People want to know about pain with sex.
And I think people want to know about
libido. I think those are the three I
would say most common things that we
talk about.
>> go in that order then. So let's start
with the subject of hormones. What is it
about hormones that people are so
desperate to understand?
>> So hormones are fascinating because we
forgot to teach doctors anything about
hormones.
And what we have taught about them, they
think it's dangerous, they think they're
harmful, they think that you know it's
it's almost like this thing that is
natural in your body is somehow
dangerous once you get over a certain
age. And that is all politics and bad
interpretation of science.
>> I've got this graph here which um
shows female testosterone levels by age.
And again, as someone that has started
to understand more about female
hormones, I was quite surprised because
you think of testosterone as a male
hormone.
>> Yeah, so that's the biggest
misconception is that women don't make
testosterone. Testosterone is just a
hormone. It's not a male hormone, a
female, it's just a hormone. It's also
not a menopausal hormone. We think of
menopause as estrogen starts to drop,
right? So menopause is a castration
event. If I cut your testicles off right
now, you would have hot flashes, night
sweats, osteoporosis, depression, low
libido, erectile dysfunction, metabolic
syndrome, your weight would go up and
you would be generally pretty unhappy.
It's a big deal when we castrate people.
And yet, we don't do it for men
regularly unless there's a very
significant medical reason to do so. And
yet, every woman over the age of 50,
her estrogen goes to essentially zero.
And that affects bone health, it affects
the brain, it affects the heart, it
affects sexual health, it affects UTIs
start to go up. And so it's a whole body
event that happens. Now, testosterone's
really interesting cuz it actually isn't
at menopause that you lose testosterone.
It happens in your 30s. So, if you look
at this graph, right? You can see
testosterone starts to precipitously
drop in your 30s. So, what do we see
clinically? Sometimes nothing, but we
have a lot of people who will start in
their 30s, mid-30s, late 30s start to
say, "Ooh, my libido's not as high as it
used to be. Huh, my orgasm takes a
little bit longer. I don't feel as
aroused. My engorgement is not the same.
My lubrication
>> Engorgement.
>> Engorgement of the clitoris. It's the
same as an erection, right? So, the
clitoris and the penis are the same.
They get hard with blood flow. And so,
this happens in your 30s and no one's
paying attention because if you look at
the graphs that we are taught in med
school, they look more like this. So,
the books all talk about estrogen and
progesterone. They don't talk about
testosterone very often. And there's
also a lot of things we do to worsen
this problem. When you play with
hormones, there are consequences,
sometimes good and sometimes bad because
we do so much to mess with our hormone
levels. Again, birth control pills, the
way that they work is changing hormone
levels. Medications for acne,
medications for hair loss that people
are using can affect your testosterone
levels. So, birth control is wonderful,
but there are side effects to birth
control just like there's side effects
to any medication. And so, one of the
side effects is it lowers testosterone.
And so,
that can cause low libido, pain with sex
in a small subset of people who take it.
So, if you're someone who does have side
effects, then it's worth having
conversations of different forms of
birth control which may not lower your
testosterone as much. Does that Does
that make sense?
>> It does make sense and it's
it's interesting. My My partner's talked
about this before. My fiance, she was on
birth control for a long time
and she also had concurrently libido
problems.
Now, we don't know whether it was the
birth control, whether it was something
else, but when she came off the birth
control pills, her libido
challenges also evaporated.
>> So, can explain cuz I think again,
knowing the basics and the fundamentals
give women and men access to the
information so they can make choices
with what they want to do with it. Okay,
so how do birth control pills work? Um
when you take a combined birth control
pill, it has a fake amount of estrogen
and a fake amount of progestin in it so
high that it tricks your body into not
ovulating. So, when you have so much
hormone around, your body says, "Oh, I
don't need to make my own cuz there's
plenty around." And so, the ovaries shut
down. So, your ovaries are no longer
making their own hormones because this
happens to men, too. When you take high
doses of testosterone, you become
infertile because your testicles say,
"Oh, I don't need to produce sperm right
now cuz there's plenty of testosterone
around." And so, birth control causes
your ovaries to just stay quiet. They
shut down for a bit. But, your ovary
does three things. It does estrogen,
progesterone, and testosterone. It
doesn't add back testosterone. So, her
experience possibly was because she
wasn't making her own testosterone. And
when she went off that birth control,
her ovaries woke back up and make
estrogen, progesterone, and
testosterone, which to you equaled more
pleasure. Now, because we focus on the
psychosocial, I'll have a lot of people
saying, "No, no, no, it's all
communication." And all of that is
important. Don't get me wrong. But, the
biology matters too. And we know there
is a biological basis to sexual health
for everybody.
>> I was just looking at some data and it
said that in some studies, up to 27% of
people on birth control report a
decrease in their libido/sex drive.
>> Yeah.
>> Which is shocking cuz, you know, it
varies in these studies from one to
seven people to one to that's almost
like one one in three people
are experiencing it. How does one
navigate that, you know, cuz birth
control has tremendous um upsides?
So, how do you navigate that?
>> I think that everything that we do,
there's the risk of doing something and
the risk of not doing something. No drug
is going to be without possible side
effects and so that's where becomes
important to know what are the
non-negotiables. Antidepressants is a
perfect example. We know that they can
help people, right? A lot of people, but
we know there are sexual side effects
like low libido, delayed orgasm. And so
it has to do with informed consent,
which means I Stephen, if I'm going to
give you a medicine, I want you to know
that there is the common side effects,
the less common side effects, and then
the disastrous side effects. That's why
on the commercials they talk about all
the disastrous side effects. But often
they don't even research the sexual side
effects. So for example, GLP-1s, okay?
>> What's a GLP-1?
>> Yep, the GLP-1s are the weight loss
drugs that everybody's talking about.
Ozempic, Mounjaro, all the all the
celebrities are on these injections that
are making them lose tons of weight. We
are starting to look at these drugs in
women, but they're not nobody's looking
at it for sexual health. Everyone's
looking at it for can you get pregnant?
Reproductive health. There is not a
single published paper on sexual health
side effects for women. So we did a
survey, it's not published yet, but we
presented it at a conference at a
medical conference. We surveyed a
thousand women online who have taken
these medications and about 25% report
sexual side effects from these
medications. Again, that's not to say
the medicines are good or bad, right or
wrong, but there are side effects. Now
of those 25% about 50% of those people
said it lowered their sexual function
whether it's libido, arousal, and
orgasm. And about 25% said it made it
better.
>> So carrying on in this track about
women's hormone levels through time and
through age and through life phases,
what else do I need to know or
understand about how important
testosterone is?
>> So we know we have global consensus
actually that testosterone helps for
libido in postmenopausal women, okay?
Now there is also data in perimenopausal
women as well and that is clear data. It
helps with libido, but it also helps
with arousal, it helps with orgasm, and
satisfaction. It can also help with body
image, which is like a cool a really
cool thing. In my clinic, I use FDA
approved testosterone for men, and I
give it to them in doses appropriate
like 1/10 the dose for a man, I give it
to my female patients. And I see that
over the 3 to 6 months of taking it,
they get this
it clicks. Now, does that mean every
woman on Earth needs it? No, we're not
there yet, but if you want it and you
want to try it and you're curious about
it, then you should have access to
physicians who understand how this works
and they know how to write the damn
prescription.
>> There's five life stages on here. We
have puberty, your fertile years,
perimenopause, menopause, and then post
menopause.
When you think about a woman's hormonal
journey through these different life
stages,
what is the sort of advice you would
give them to make sure they're
hormonally healthy across every life
stage? What are like the basics? What
are the tactics, strategies, medications
that they should be thinking about? And
I say this because I've got women women
in my life for every stage in this life
phase at the moment. I've got you know,
I've got my nieces in the sort of
puberty era. I've got my my fiance in
the fertile years. I've got my mom and
grandparents etc. in the peri- and
post-menopause years as well.
>> Yeah. So, if you look at your nieces for
example, when they were babies compared
to now, there are changes happening.
Their bodies are transforming because
they're getting a surge of hormones in
their body and that's estrogen,
progesterone, and testosterone. They're
cycling, which means they're getting
periods. So, let's talk about the
menstrual cycle for a second. I think
it's helpful.
>> Okay.
>> So, [clears throat] when women have
their period,
they bleed for a few days, right? And
that's when their hormones, their
estrogen and their progesterone is at
its lowest, okay? So, hormones are at
their lowest. And then
the hormones start to increase. Your
estrogen starts to go up. You don't make
progesterone yet in the beginning. Your
estrogen starts to go up and it make
there's a a follicle in your ovary which
has an egg, right? It's going to pop out
an egg.
Ovulation is when the egg pops out. So,
you get this big surge of estrogen and
then when the egg pops out of the ovary,
right? That's what's going to make a
baby if it gets fertilized, there is a
shell of the egg, right? The egg has a
shell which makes progesterone. So, the
second half of the cycle there's
progesterone around, okay? First half of
the cycle no progesterone.
>> Mhm.
>> And so, that [clears throat] second half
of the cycle the shell has making
progesterone and then when you don't
have fertilization, the shell starts to
break down.
>> Okay.
>> And that natural breakdown is a drop in
progesterone which causes the lining of
the uterus to shed and you get a period
again. And so, it's estrogen goes high
in the beginning and then pops out an
egg, progesterone gets high in the
second half and then they both fall and
you have a period. And so, the hormones
being low in the beginning, estrogen is
not zero. It's about 50, okay? So, when
we talk about numbers, if you get your
your hormones checked, if they're at
their low it's like 50, but when you
ovulate, your estrogen may be 150, 200,
300. And then when you're pregnant, your
estrogen may be as high as 3,000 or
higher, right? It's very many thousands.
And so, these hormones have actions in
our bodies. And so, the reason it's
important is cuz when we give back
hormone therapy, well, are we giving
back 10,000 like pregnancy? No, we're
giving back to be like 50, 60, 70, the
way that you are early in your cycle
kind of a thing. Now, testosterone's not
even on this graph that everybody gets
taught of estrogen then progesterone,
but we do know testosterone is pretty
stable through the cycle, although we do
believe it peaks during ovulation which
makes sense cuz you want to have a baby,
right? So, evolution says, "Okay, you
need to be horny around the time that
you are going to ovulate." And so, your
testosterone starts to go up. Now, it's
really important cuz you're probably not
having a conversation with your nieces
about their menstrual cycles, but it's a
problem because no one's talking about
it if they're painful, if they're
abnormal, if they're um uh uh uh we
don't have a lot of conversations around
what is a normal amount of bleeding. We
have so many people who have problems,
whether it's PCOS, which is now called
PMOS, which is a metabolic issue that
causes you to have irregular periods.
There's endometriosis where you have
painful periods. There are so many
medications we give to people that can
alter their hormonal health and and
sexual health for that matter. And then
it all starts to get even more chaotic
in perimenopause, which is again age 35
to 45. If menopause we say is 45 to 55,
right, is normal menopausal age. Average
age is 52, and we think perimenopause is
when things start to change for people
about 10 and it can be about 10 years.
That means 35 to 45. So, how old are
you? I don't remember.
>> 33.
>> 33. And my partner's 33.
>> All right, so 33. So, this idea that I'm
too young or it's too early or I'm not
there yet, the truth is things do start
to change.
>> What changes for a woman?
>> So, there are so many symptoms to
hormonal fluctuations. So, for some
people it's temperature changes, for
some people it's fatigue, for some
people it's remembering things, for some
people it's low libido. Some people get
dry eyes, itchy ears, burning mouth,
joint pain. Some people get irregular
periods. Some people get pain with sex.
Some people get UTIs. I would love to
talk about what why hormones are so
important for the bladder and UTI
prevention. And so, there are so many
symptoms and everyone says, "Oh, we're
blaming everything on hormones." And the
truth is, we haven't talked about
hormones enough to actually start
looking at this to figure out what is
important and what is hormonally
important.
>> So, when you start to lose progesterone,
when you arrive at perimenopause, what
are the symptoms you feel? Are they
different symptoms to decline in
estrogen?
>> So, it's hard to know for sure, but some
people think that as the progesterone,
so your sleep starts to get a little
crazy, anxiety starts to go up. And so,
some people will start with progesterone
as a support for
you know sort of perimenopausal hormone
therapy but estrogen can also help with
many of those symptoms. So it's not a
one size fits all of whether we give
people everybody gets progesterone or
everybody gets estrogen. Sometimes
people just get testosterone because
remember that falls in your 30s you know
so there's sometimes where we
do all three and there's sometimes where
we do just one or two. Now it's a very
evolving conversation because most of
the book answers most of the guidelines
really talk about menopause and how we
treat people in this menopause when
you're flatlined. Remember that
castration event where everything's zero
and then we add back hormones. So now
we're starting to talk about
perimenopause as a place to to start
giving women hormones and that's a a
very important and evolving conversation
that is happening.
>> And so this conversation that's
sort of raging on about HRT
about safety about what age you should
take it who should take it what form you
should take it in. What's your
perspective on that and what do women
need to know about that?
>> Yeah so so it's important because
>> is HRT?
>> Yeah it's a great question. So hormone
replacement therapy which is a term that
we used to use for hormones in
menopause. It has a bunch of different
names and everyone tries to change the
marketing around it but hormone therapy
in general is this idea of giving back
hormones when you have hot flashes night
sweats osteoporosis you know sort of
this over 50 crowd that has this
declining estrogen and progesterone
levels. And so typically classic hormone
therapy is estrogen and progesterone.
Now again taking just estrogen estrogen
grows things it helps your bone health
it helps your hair skin and nails it
helps you not have hot flashes it helps
you sleep. It can also grow the lining
of the uterus and so if it gets thicker
thicker thicker there is worry over
years that leads to endometrial or
uterine cancer. So endometrium is the
lining of the uterus so here I can okay
so this is a this is a vagina and then
at the the vagina's like a socket. The
very end of the socket is a tiny hole
and that hole is the the pinpoint
opening of the cervix and that hole if
you go through that tiny tiny hole, it
gets to the uterus and the uterus is a
cavity where we hold babies
where the lining comes out. That's what
period blood is is the lining of the
uterus here which we'll call the
endometrial lining. So progesterone is
very important for this lining here. If
the the lining of the uterus gets too
thick with just estrogen, that can lead
to problems, but if you match it with
progesterone, those problems go away.
>> Right. So so if you just gave someone
estrogen, then the linings of the uterus
would get so thick that that would cause
a problem, but if you give it to both
hormones together, it sort of balances
itself.
>> them out and so that's why you'll hear
hormone therapy talked about estrogen
and progesterone just like the birth
control pill your partner was on was an
estrogen and a progestin. There was a
combination.
>> Okay, got you.
>> And also the history is kind of
important here of why your mothers and
grandmothers weren't given access to
this medication and the stigma behind
it. In the late 90s, a lot of people
were on hormone replacement therapies
and they were seeing benefits. They
actually were all these observational
studies that showed wow, the heart
disease is less and like
>> During menopause.
>> during menopause and a billion dollars
went into the NIH to study this in women
and they did they that was called the
Women's Health Initiative. It was
thousands and thousands of people age 50
to 79. They gave a hormone pill like a
birth control pill almost to all of
these women and they followed them and
they stopped the study early in the
early 2000s and they did a press
conference and at this press conference
they said we're shutting down the the
study early. Hormone therapy causes
cardiovascular disease and breast
cancer. And overnight, a multi-billion
dollar industry went to nothing.
Everyone was told throw your hormones in
the garbage. This is dangerous. What was
crazy is those people who were
prescribing hormone therapy were looking
around saying, "I don't understand. My
patients aren't dying of heart disease.
They're not getting extra breast
cancers. Like, this doesn't make any
sense." And when people actually looked
at the study, it didn't say any of those
things. It was wild how misinterpreted
this study was. In fact, the same
authors of this study back in the early
2000s published this year, in 2025
actually, that below age 70 that type of
hormone therapy, which we don't really
use anymore, has no increased risk of
cardiovascular disease or stroke. And
yet now you have a generation of doctors
who weren't taught how to do this. Only
1.7% of women have are getting
prescriptions for hormone therapy who
who should be offered prescriptions. So,
it is a disaster.
>> Only 1.7%?
>> Only 1.7%.
>> Oh, really? Hmm. Wow.
>> And so, hormone therapy is not something
that I'm saying every woman must have,
but every woman should have access to
the toolbox. I like to think about
hormone therapy is really four buckets
that we talk about. Hormone therapy is
whole body estrogen, which helps with
hot flashes, night sweats,
uh bone loss, progesterone, whole body
progesterone therapy, which protects the
uterus and is this yin yang, especially
if you have a uterus, but it helps with
sleep, and it can help with anxiety
reduction in many of our patients, not
everybody, but a lot of them. The third
thing is testosterone, which we talked
about, which can help with libido. Um
that's what we have the most evidence
for. And then the fourth thing is
vaginal hormones. Now, vaginal hormones
are microdoses of estrogen or what we
call DHEA vaginally, that supports the
bladder and the vagina. So, it helps
with pain with sex, dryness, urinary
frequency, urinary urgency, leakage, and
it prevents urinary tract infections
massively. It is safe for your great
grandmother in the nursing home. It is
safe for your wife who's breastfeeding.
So, if you know anyone in your life who
is a woman, who's having urinary
frequency, urgency, leakage, urinary
tract infections, pain with sex,
dryness, there is a magical solution
that is safe for everybody on Earth um
that is microdosing these hormones
vaginally.
>> At any age?
>> At any age at all. In fact, even more
important for people who are older
because they are dying of urinary tract
infections. So, it's it's it's one thing
when a young person gets a urinary tract
infection and they go to the urgent care
and they get an antibiotic. Even they
deserve prevention and this is prevents
uh those problems in those people, too.
>> Again, what is this?
>> So, vaginal hormones. So, this is a
really important topic. It's called
genitourinary syndrome of menopause or
GSM. Say GSM loudly for your listeners.
>> GSM.
>> GSM, genitourinary syndrome of
menopause. Genital, urinary, syndrome of
menopause. But, really, it's kind of a
dumb name because it's any hormonal
changes in your body can affect the
bladder and the genitals.
>> So, UTI. What is a UTI? And what's
what's causing a UTI? U- urinary tract
infection.
>> Yeah, very good. So, urinary tract
infections are when there is bacteria in
the bladder and it can be a lot of uh of
bad bacteria that can grow and create uh
inflammation. It causes bladder pain,
pain with urination. It feels like razor
blades. Um but, it can also go into your
bloodstream and cause fevers and chills
and cause kidney infections. It can
cause something called urosepsis where
you have to go to the intensive care
unit and need uh antibiotics through an
IV and it can kill you if you have an
infection go through your whole body.
And this gets worse and worse as you get
older.
>> Why is there a link between hormones and
UTIs?
>> Yeah, because what happens is the vagina
is supposed to be acidic and healthy and
hormones help keep it. It is the
hormones, the estrogen and the
testosterone, that keep healthy bacteria
growing in the vagina and suppress or
lower the bad bacteria.
>> So, there really is a vagina microbiome.
>> There is and There's There's no
probiotic on Earth that is proven to do
what the vagina needs quite like
hormones. Hormones make the tissue go
from uh not acidic to quite acidic, and
it is that acidic environment that
protects it from infection. And so,
perimenopause and menopause or other
situations happen, and it changes that
microbiome, so the good bacteria are are
lower and the bad bacteria start to
grow, which can increase your risk of
infections. And sex Right, sex is a
contact sport. So, uh you're bringing
the outside environment into the inside
environment. Uh ejaculate is also not
acidic, and that can change the
microbiome as well. And so, we know
women who are sexually active also have
an increased risk of urinary tract
infections. So again, like a plant
needing water, vaginal hormones help
support the vagina and the bladder to
maintain that acidic environment. And
research has been clear since the 1990s
that using vaginal hormones prevent
UTIs, urinary tract infections, by more
than half.
>> So, what have we got here in front of
me?
>> All right. So, there's a bunch of
different ways you can give yourself
vaginal hormones. The most common way is
a cream. Now, this cream is uh $14 on
Mark Cuban's pharmacy, and it lasts
about 2 and 1/2 months. Now, this cream
that comes with an applicator, which you
don't ever have to use if you don't want
to, but what you can do is you want to
use 1 g of this cream. So, this amount
is 1 g of this cream. We'll put it on
this paper here to show you. 1 g of this
cream rubbed into the vagina. So, you
take it You can take it on your fingers
and rub it into the walls like you If
you put sunscreen on your face, you
don't glob it on and walk out the door.
You rub it in, so it doesn't look all
white and filmy. So, you put it in You
take it with your finger and you put it
in the vagina and you rub it into the
walls of the vagina you can rub it on
the outer this area as well at the
opening.
>> Let me try it. I don't have a vagina but
So you take the this what what is this
cream called?
>> It's estradiol cream.
>> Estradiol take it on your finger you rub
it inside the walls of the vagina like
this.
>> rub it in like you would rub sunscreen
on your face and if you do that twice a
week you can prevent death from urinary
tract infections. You can help with
urinary frequency, urinary urgency,
leakage, you make sex not painful and
dry, it helps with arousal and orgasm.
It's literally better than Viagra and
this is over the counter in the UK. In
the United States you need a
prescription um but it's as little as
$14 if you use Mark Cuban's online
website it should be covered by your
insurance. Now some women hate creams
and so we have things that are not as
messy as what you're showing right there
and we have little tablet inserts. So
here is a it comes with an applicator
and so what a woman does is put this in
her vagina and press a button
and this little tablet so instead of a
cream you could just put this little
tablet in twice a week and that does the
same thing as the cream.
>> Ah okay.
>> Okay so it's a little less messy so
people tend to like the creams better.
Now if you really don't want to do
anything twice a week this is a ring
that goes in the vagina and it can stay
in there for 3 months. Now this it's
sort of like a tampon you can kind of
put it in the vagina and the vagina does
not feel it. By the way the vagina is
not very sensitive in terms of
nerve endings and so when women put
tampons in they don't feel them. When
you put this ring in that you wouldn't
feel it either and it would stay in for
3 months at a time.
>> It's quite it's quite quite a big ring.
>> Vagina can hold like a bowling ball of a
baby can come out of a vagina so it can
actually withstand quite a lot of
volume.
>> And there's a chemical inside this ring
that's going to diffuse
>> Estradiol that slowly diffuses estrogen
for the ring. So that's nice for women
who have dementia, who have very bad
dexterity with their fingers, they're in
a nursing home, uh for someone who's on
the go and they can't remember something
twice a week. So, our ADHD patients like
things like that. And so, there's just
different It's all the same stuff. It's
just in different formulations. Now, the
one different one, this is something
called DHEA. Now, DHEA is the precursor
hormone to estrogen and testosterone.
And remember I said the vulva, the
vagina, the bladder need testosterone,
too. It So, this is a a chemical that
converts into estrogen and testosterone.
And so, DHEA is a supplement you can
buy, you know, sort of in the in the
supplement aisle, but if you put it
locally in the vagina, this is an
FDA-approved product. It's called
Intrarosa. And if you just put this in
the vagina, uh uh it's meant for every
night, but you can do it twice a week.
Um it it melts at bedtime. When you wake
up, and it prevents UTIs. It helps with
pain with sex.
>> And just to be clear again, so you think
a lot of people should be taking these
these things?
>> believe it's preventative. So, I think
And we wrote guidelines by the American
Urological Association uh why this is so
important, how to do it. So many women
have symptoms of urinary frequency,
urgency, leakage, uh urinary tract
infections, pain with sex, dryness. And
this is a safe option for all of those
women. Does that make sense?
>> It does make sense. And one of the
things that doctors sometimes tell their
patients to take to help with the UTI
situation is that?
>> Okay, this is a disaster. So,
women get urinary tract infections a
lot. And so, what do we tell women? Pee
after sex. Wipe from front to back.
Like, that's not data-driven, by the
way. That's all a folk folk tale. Like,
that's that's folklore. There is some
data that cranberry pills can help uh
with preventing UTIs, but the uh amount
that you'd have to drink is uh very
sugary and diabetes-inducing and won't
taste that good. And so, there they do
make pills, but it's a small These
things are small things that help.
Drinking lots of water can help, but
vaginal hormones, vaginal estrogen or
vaginal DHEA, which we just showed a
bunch of, prevent UTIs by more than
half. They don't just prevent UTIs, they
help with urinary frequency, urgency,
leakage, pain with sex. They help your
arousal, they help your orgasm, and
they're safe for every age with every
medical problem. If you've had cancer,
blood clot, stroke, any problems at all,
vaginal hormones are safe and could save
your life. And so this is such an
important topic.
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Thank you so much.
My my partner's 33 years old now. She's
not yet in the perimenopause stage. At
what point does someone start taking
HRT? Is it when they're in
the menopause stage, which is defined as
12 consecutive months without your
period? Is it when they're
postmenopausal? Is it in perimenopause?
>> Yeah, this is a very important question
cuz it's not a one-size-fits-all. At
this age, start this medicine. It's
really when people start having
symptoms. And so I'll give you an
example. So say your partner um
gets pregnant, okay? You decide to have
a baby. Her estrogen is going to go to
10,000 uh for 9 months. It's going to be
super super high. And the day she gives
birth, it's going to crash to zero. So
you go from super high hormones down to
zero. And if she chooses to breastfeed
or pump or or do any of that, they stay
extremely low in the menopausal range
for the entire time you're
breastfeeding. So when you are
breastfeeding or pumping or doing
anything uh and your periods don't come
back, you're basically menopausal.
>> And what are the symptoms then? So if
you just had a baby, you're
breastfeeding.
>> have hot flashes, she may have night
sweats, she may, you have urinary
frequency, urgency, leakage. There's all
sorts of symptoms that come come with
that.
>> Libido changes as well.
>> Libido definitely changes, pain with sex
goes up. And so we call this the
genitourinary syndrome of lactation. And
so there's all sorts of hormonal changes
that can happen at that time. So we see
a big need for vaginal hormones in this
patient population. It's safe for the
breast milk, it's safe for the baby, it
doesn't cause any problems, but it can
really help with all of those symptoms.
Now say she is done having babies and
now she's 30 8 39 40 and she is doing
fine and she has regular periods and she
has no symptoms and no problem. She may
not need anything at all. But what if
she starts getting a lot of urinary
tract infections or having dry scratchy
painful sex or her libido just doesn't
feel it sort of feels like back it when
it did on birth control pills. That may
be an indication where she may benefit
from whether it's testosterone or
vaginal hormones or some kind of
combination. What if she's 43 and her
sleep starts to get really bad and that
may be an indication for progesterone. I
have a patient who was
having hot flashes and night sweats and
brain fog and fatigue. I see her and she
says I will not take hormone therapy.
It's not safe. My mother told me it
causes cancer. At no point am I going to
do this. I said, okay. We had a long
conversation. I shared data and papers
and we did a shared we just worked with
each other and I wasn't pushing anything
on her, but ultimately she started with
vaginal hormones. Her orgasms come back.
Her arousal gets back and she comes back
to see me and says, "Rubin, what are you
doing here? I'm feeling much better.
Like this is you've given me my life
again. I'm not peeing in the middle of
the night so I'm sleeping better. I
don't have as much dryness. Sex is no
longer painful. I haven't had a UTI in
months. What else do you got?" Well, she
was still suffering with hot flashes and
night sweats. She had a bone density
scan which showed osteopenia and she was
worried about osteoporosis cuz her
mother died of osteoporosis fractures.
Well, if she did whole body estrogen,
she would prevent her risk of a of a
fracture. She would make her hot flashes
and night sweats go away, which would
have benefit on how she sleeps, and
ultimately probably benefit on her whole
vascular system. And so, she started
estrogen, and cuz she had a uterus, she
took progesterone at night, and she
said, "Well, my libido is still a bit
low." We looked at her testosterone. We
said, "Testosterone will likely help
with your libido, but it's going to take
4 to 6 months." So, 4 to 6 months, she
comes back to see me. Not only is her
libido so much better, but she feels
that she has the cognitive ability to
enroll in law school. Like, this woman
literally decides that she wants to
change the trajectory of her career and
enrolls in law school, and her brain is
working in like ways she hasn't seen it
in so long, and she is competing against
22-year-olds in law school. And when I
tell you she finished at the top of her
class, she finished at the top of her
class, whereas she said, "I would have
never even considered this opportunity
uh if I hadn't been doing all of these
things." So, in
>> And what age is she?
>> She's in Now, she's in her 60s.
And so, that's why I'm so loud about
these things, because what other organ
in medicine do we let fail completely
before we like do something about it. We
don't make you go blind completely
before we give you eyeglasses. We don't
let your kidneys run out completely
before we give you dialysis or
medications to help your kidneys along.
We don't let you go into full liver
failure before you get the transplant.
Like, this idea of your ovaries have to
fail, and you have to suffer for 12
months before someone intervenes is
insanity.
>> But for some women, they do start HRT
during the perimenopausal phase.
>> Yeah.
>> And for some, they start it during
menopausal postmenopausal stage.
>> Correct.
>> And it's all depending on you how you're
feeling.
>> It's all depending on how you're feeling
and what you want, what your objectives
are.
>> Okay. But it's never too early to start
necessarily.
>> not necessarily. Like, so again, we give
birth control all the time to people in
their reproductive years. Birth control
is just high-dose fake hormone therapy,
right? So, we're giving women hormone
therapy as young as in their teens,
right? To help with different things in
birth control. But, so if you think of
it as all of it is some form of hormone
therapy, it just depends are we using
the natural form of hormone therapy or
we using the synthetic hormone hormone
therapy? We have to get comfortable with
hormones at all ages. And the thing that
we see most commonly, Steven, is sort of
what we call NFLM, not feeling like
myself. I love that statement because
women are coming to the doctor every day
saying NFLM, I'm not feeling like
myself, and they're getting dismissed.
And the truth is there are often
hormonal reasons why you may not be
feeling like yourself. So, for some
people it might be musculoskeletal pain,
so we see plantar fasciitis and frozen
shoulder, and we think of as those
having underlying hormonal causes as
well. So, there's published data that
less than 9% of Medicare patients are
getting prescriptions for this.
More than 75% of people in large
database collections are not getting
prescriptions for this. And so, women
are not getting access to generic
medications that could save their lives
and also really improve quality of life.
I don't know about you, but dryness
People are not having sex anymore
because of the pain, the dryness, the
irritation when it's fixable.
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You said um earlier that one of the
questions people come to you about is
pain during sex. Why are are women
experiencing pain during sex? What is
What is What is going on there
physiologically?
>> Yeah, pain with sex is actually not rare
at all. There are some published reports
that up to 75% of women will say at some
point in their life sex is painful.
>> So, a really dumb question here.
Sex is not supposed to be painful.
>> Sex is not supposed to be painful. If
sex is painful, you need to figure out
why it's You deserve a diagnosis. You
deserve an answer. You deserve to
understand exactly why sex is painful.
You could have a problem with the
tissue. So, you could have a skin
problem, which as we know the tissue of
the vulva is very hormonally sensitive.
So, that tissue could be impacted by
hormones. It's skin. So, people can get
eczema. They can get autoimmune skin
conditions. So, you may have a skin
condition. You may have problem with
your muscles. So, remember the vagina
and the vulva are surrounded by these
big pelvic floor muscles. And just like
you can get tight muscles in your neck
and in your back, you can get tight
muscles in your pelvis. We also know
there's nerves that are involved in this
area. So, if you have a back problem and
you feel it running down your leg,
right? That's called sciatica or sciatic
pain, you can have a back problem that
actually causes you to have pelvic pain.
So, we see people with penis pain or
vulva pain because of problems in their
spines. If you have scar tissue inside
your body from endometriosis, that's
pushing and scarring this tissue from
the inside, you may have pain with sex.
And so, there are many different things
that can cause pain with sex. But
remember I said your OBGYN got almost no
training in this.
>> So, if if I'm currently experiencing
pain during sex as a woman,
what advice would you give them? What
should they do?
>> Yeah, so I would really try to see
someone who has an active interest in
this. See a specialized gynecologist or
a specialized urologist who has an
interest in pelvic pain. And you may
need a couple of opinions. Just like if
you go to the first plumber, you want to
get a couple quotes on well, who's going
to do the best job? It's okay to see a
few different people for this problem.
>> And in terms of prevalence, up to 75% of
women as you say will experience painful
intercourse at some point in their
lives. Between 10 and 20% of US women
suffer from persistent chronic pain
during sex. And during menopause, it
climbs drastically
with estimates ranging to 20 to almost
half of women
having pain during sex.
>> And that probably doesn't even add to
the people who stopped having sex
because either they don't have a partner
or because they it's too painful to even
consider it. And I think it's important
to know that hormones play a fundamental
role here. Not a like a not it's not the
whole story, but it's a huge part of it.
>> In different seasons of life, if
if a woman wanted to have the best sex
of her life, what are the fundamental
things you'd aim at to make sure she can
have the best sex of her life?
>> Yeah, so as you know, this is Diary of a
CEO. So I love how you you love the
health topics, but obviously financial
literacy is really important to for you
to help people because for some reason
people stink about talking about money
and talking about sex, and yet we all
want to be really great at both, right?
We all want a lot of money and we all
want to have great sex, and yet people
stink at talking about it. They they
don't know the fundamentals, they don't
know the basics. And so I actually use
financial literacy sort of as a as a
framework in how we talk about good sex.
And so you've got your savings account
and your you know, your your checking
account. Those are the those are the
basics. Everyone needs money in their
checking and savings account, right?
That's what everybody needs. So that's
going to be your education, your
nutrition, your exercise, your sleep,
your your your communication, uh safety.
Like are you safe in your relationship?
Like the basics. Are you doing the basic
things you need to have great sex? You
know, communication is probably the most
important thing. Can you talk about it?
Can you use words? Um can you explore?
Can you ask questions? So so that's
really important for great sex. Then
there's the 401k, right? The 401k is
something that we all want and should
have access to, right? It's important
for compounding growth and long-term
support of your financial life. Think
about hormones. Think about going to a
doctor who's going to make sure that
everything is optimized the way that it
should be. Your your pelvic muscles are
in good condition. Your mental health is
in good Do you know do you have Do you
need a sex therapist? Do you want to
bring toys into the bedroom and devices
to have even more fun? That's kind of
like the really important. Not everybody
has access to it. Not everyone's going
to do it, but I think it's really,
really important for everyone to talk
about. Then there's like crypto. Okay,
so crypto, that's not to say don't do
crypto. Like don't put all your money in
crypto. Don't do everything and don't
start with crypto. So that's going to be
when you're watching, you're scrolling
Instagram and you see these ads for do
this injection, do this, you know,
cosmetic procedure, do this supplement
that's going to make sex great again. Uh
the truth is if it looks too good to be
true on TV and in the ads like it
probably isn't going to fix what if if
other things are are are struggling. So
I think great sex is within everybody's
reach, but I think your great sex is
different than other people's great sex.
>> So let's go through these slowly and one
one at a time. I kind of broke it down
into three categories, which is there's
biological and physical blockers to
great sex, which are some of the things
we talked about, um hormone crashes,
etc. You mentioned the pelvic floor.
How is an issue with your pelvic floor
going to impact your sex? And what is
the pelvic floor? Why would you have an
issue with it? What do you see in
patients?
>> Yeah, so everyone has a pelvis has a
pelvic floor. So men have a pelvic
floor, women have a pelvic floor. It
just means the bones of your pelvis, so
your hips, right? And your pelvis bone,
your butt bones, all of this is this big
bony structure that holds all of your
organs in place. And your genitals are
attached to this pelvic floor. And the
pelvic floor is surrounded by thick big
muscles. So if we look at the inside of
the pelvic floor, it's these big thick
muscles. And muscles are just like your
biceps, right? Like muscles are
something that contract and relax and
there can be problems with muscles,
right? just like if you work out too
much and you've got a sore trap and you
got to go get it massaged and and or you
got to do physical therapy cuz your
shoulder is hurting. A lot can go wrong
with the pelvic floor. And so, sex is a
contact sport. So, if you're going to
get erections, if you're going to have
an orgasm, if you're going to allow for
penetration to happen, you have to have
healthy muscles because you're asking
your muscles to contract and relax in a
sexual way. And so, as blood is flowing
through the area, blood is going to
engorge the clitoris and it's going to
get bigger and erect, it's going to
engorge the penis, it's going to get
bigger and erect. These muscles are
going to have to relax so that you can
have penetration cuz if they're too
tight, tight muscles are painful,
they're sore, they're they're they burn.
And so, penetration can happen if you're
relaxed, but then orgasm is a series of
muscle contractions which equates to
pleasure and release, which is all has
to do with the nerves and the muscles.
Does Does that make sense?
>> I'm trying to understand how the pelvic
floor would would give me bad sex and
how I would know if the pelvic floor is
the reason I'm currently having bad sex.
>> Yeah, so if if sex hurts, so if the
muscles are too tight and you can't have
penetration but you want it, yeah, that
can be bad sex. If orgasm is painful,
weak, or impossible, it could have to do
with the muscles. It's not always the
muscles, but it could have to do with
the muscles of the pelvic floor. If
arousal, your ability to engorge and
lubricate are diminished or less, that
could be due to pelvic floor cuz you're
not getting enough blood flow to the
area. And so, there are multiple
different ways and if you're not feeling
your genitals, you watch something sexy
on TV and then you feel it in your
genitals or you see someone attractive
walking down the street and you feel it
in your genitals, there's this brain
genital connection. And sometimes that
you So, you have to have perfect wiring
and of your nerves, your hormones, and
your muscles, and so that could have be
affected by your pelvic floor. Now, we
do a lot to mess up our pelvic floor, by
the way. People do surgery, people have
babies, uh people um muscle uh health
changes for many reasons, and so when
you have problems, there may be
biological reasons to these problems.
>> Should we be going to the gym and like
doing pelvic floor exercises to improve
our sex lives?
>> You typically don't do them at the gym.
There are typically trained physical
therapists who help you know what's
going on with your pelvic floor. So for
some people it's to strengthen it and to
do like almost contractions, we call
them Kegel exercises, but for many
people it's just learn the coordination.
>> And you can go and get an exam.
>> You can go get an exam and work with a
pelvic floor physical therapist.
>> So some women, uh cuz we sometimes have
them writing with questions, talk about
the fact that they're they're not having
orgasms. Is that normal or is that not
normal as it relates to um sexual
contact?
>> So about 20% of women will say that they
can't have an orgasm. And the real
question, I'm I'm fascinated by this
data because not 20 20% of men do not
have orgasm problems. And so again, if
we go back to the financial literacy
equation, we have a pay gap in this
country, right? Women are not paid as
much as men. Well, women are not
orgasming as much as men. And so the
data's very clear there. And I think the
majority of problem is education. Women
think that orgasm comes from
penetration. Surely if the in and out
penetration is happening, I should be
able to have an orgasm. And the truth is
that's not how most women orgasm. Some
can, but the reason why women don't
orgasm from penetration is cuz the
clitoris is up here. So the clitoris is
how women orgasm, right? Penetration is
not how most women orgasm. Just like if
you rub your thigh over and over again,
you're not going to have an orgasm. Now
you could keep rubbing your thigh for
the whole duration of this podcast, you
still won't have an orgasm cuz it's
close to your penis, but it's not
actually your penis, which is where men
have orgasms from. And so the clitoris,
if you follow those labia minora, those
inner wings, you get to the hood of the
clitoris or a foreskin, we call it a
prepuce, and that, if you pull it back,
you see what is the tip of the head of
the clitoris, but that's just the tip of
the iceberg. The clitoris is this huge
structure.
My necklace is, of course, like a gold
clitoris. Um the this a huge structure
that goes all the way down to your butt
bones. It's a penis. Under the
microscope, it looks like a penis. It is
made up of the same tissue as a penis.
It works exactly the way a penis does.
It's just that we have a whole field of
medicine devoted to the male penis. I'm
a urologist. And no one is even taught
how to examine a clitoris or where it
is. So, if the penis is going in here or
a toy or a finger or a device, that is
not activating the the clitoris, which
is a mostly internal structure.
>> There's something called a clitoral
adhesion, which people don't know about
as well, which I've heard you talk about
before.
>> Yeah.
>> What is that? And how many people suffer
with that?
>> Yeah, so the clitoris has this hood to
it, okay? And about 23% of the time, the
hood can get stuck to the head. So, for
example, I'm wearing a sleeve here. So,
you should be able to pull back the hood
of the clitoris to see the whole head.
It looks like a mushroom. You know how
penises have like that almost like a
mushroom rim rim around it. So, the
clitoris should have that, too. But
about 23% of the time it gets stuck. So,
you actually cannot see the full head of
the clitoris. It's called a clitoral
adhesion. And so, you should be able to
pull it back, but in about a quarter of
the time you cannot. And we published
data that if you remove these adhesions
in an office-based very simple
procedure, we saw improvements in
orgasm, arousal, and satisfaction up to
60 to 70%.
>> Wait. So, so one
five women
>> Yeah.
>> have a clitoral adhesion. And when
solved, it improves their sexual
satisfaction by up to 60%.
>> Yes, but no one's examined any woman in
your life. No one has ever examined
their clitoris, ever. In any exam, in
any doctor's visit, and nobody's asking
women about their orgasm, about their
satisfaction. Where like they come in
with pain or they come in with libido
issues, but no one is examining this
part of the body. And so, it's this
question of is it cuz we haven't or cuz
we shouldn't? It's cuz we haven't. We
haven't We have never done this before.
>> You pulled up the sex toys though. I
think we were talking about orgasm gaps.
>> So, again, when you were talking about
orgasm and how women experience
pleasure, it's all buried inside the
body. So, if your penis was entirely
inside your body, say you gained 500 lb,
okay? And your your belly was so big you
couldn't hold on to your penis to to do
what it takes to have an How would you
orgasm?
>> Uh probably I don't know.
>> The vibrator industry would be a
gazillion dollar industry instead of
just a billion dollar industry because
vibration can help activate this blood
flow. And so, for women, vibration on
the outside can be extremely helpful cuz
remember the clitoris is kind of around
this area. And so, by putting vibrators
on the outside Now, inside, you can also
have pleasure, but not everyone
experiences pleasure the same way. And
so, understanding devices and trying
different things is really really
important.
>> I don't know. Oh, here we go. Okay, so
this is vibrating now.
>> So, this one This kind of device is
interesting because it is a wand that
can help just like with trigger points.
So, if you have pain in in these
muscles, this can go inside, vibrate to
help with engorgement, but can also get
rid of some of the tension in some of
those muscles.
>> As men, what are we getting wrong in
heterosexual relationships when we're
trying to arouse our partners um both of
the context of using sex toys, but also
without sex toys? What is it that we
just don't understand?
>> I think that men
are constantly asking about they want
their penises bigger, harder,
straighter, girthier, uh lasting longer,
and none of that has anything to do with
how women experience pleasure and and
satisfaction in the bedroom. And so, the
question needs to be how do women
experience pleasure? What is their
anatomy like? How can we activate the
clitoris, the arousal response? What are
the brain things that we need to do to
make women interested, right? What what
gets women excited cuz it's different
than what gets men excited. And your
part every partner's different in terms
of what gets them excited. And I would
love to see more curiosity. I wish
everyone was were as curious as you
about what do we need to learn about
women and how they behave and how they
act and what they want.
>> Yeah, so you need
>> I'd like to implement it tonight.
>> Communication, right? It's that question
and also understanding that your partner
never got told any of these things. And
so this is where watching this podcast
together could be really helpful to say,
"Did you know that? Was it What do you
like? Do you know? Like can we look at
your clitoris together? Like do you know
what these body parts are called? Where
is it that you experience pleasure?" Cuz
some people find direct stimulation of
their clitoris is too sensitive. Cuz we
know the clitoris has like 10,000 nerve
endings. So going directly over the
clitoris can sometimes be too much. Some
partners love it. Some partners want
more stimulation on just the outside
here. Some people need vibration. So
that's another big problem.
>> I can So she's going to orgasm at some
point if this is sufficiently
stimulated.
>> there's sort of a build-up and release
of pleasure, right? That's orgasm. And
again, that is often not happening
during penetration.
>> And once she experiences that, what
happens immediately after for her? Cuz I
know from a man's perspective, if I
orgasm, there's some kind of like
decline in arousal and I don't want you
to touch it again.
>> That's very similar in women.
>> Okay, so it's the same thing.
>> Except women can bounce back faster. Not
all of them, but but but women can have
multiple orgasms.
>> So she orgasms, it's very very
sensitive, she doesn't want me to touch
it for a while.
>> Yeah.
>> And then she could she potentially could
bounce back faster.
>> She could potentially. Some people do,
some people don't, but that's the
conversation of is this something that
is pleasurable? Is this something to try
again? Is multiple orgasms something
that you want to have or try to have?
When does penetration happen during the
dance? Because often times men orgasm
and then they're done, they all over, go
to sleep, whatever it is. Is the orgasm
happening after your orgasm, before your
orgasm? Is it happening before and after
your orgasm? Like are there cuz that
could be a nice way to sandwich it of
like there is, you know, giving the the
sensitive tissue some time to rest, then
your orgasm happens and then you
potentially go for round two.
>> So, if the
sensitive pleasurable part is on the
outside here on the clitoris, then what
do they get from penetrative sex if the
this one of main event is here in the
clitoris?
>> Many times nothing. Many times
[clears throat] connection. Many times
uh sort of this need for closeness and
pleasure. Many times there are women who
have extra nerve endings sort of inside
the vagina on the top of the vagina and
the cervix. So, there are women who love
penetration, but many women get the main
event from the clitoris and so it's part
of the whole menu as opposed to
penetration is the whole story. And I
think every woman's body is different
and so kind of making these broad
statements of every partner likes this,
but many women are asking for
penetration mainly because they're like,
"Okay, that's when you have your orgasm
it's done and then I can go to bed, I
can read my book, I can do all these
other things." But the pleasure often
comes from that clitoral stimulation.
Now, some women can orgasm from penetra-
I have a theory. It's a really
interesting theory that maybe your
listeners can prove with science or help
me prove with science.
So, you know how there's men who
prematurely ejaculate? Like who
ejaculate very quickly?
>> Yeah.
>> There are men who orgasm in a minute or
less.
That's probably [clears throat] 8% of
men, okay? So, if we think men and
women's bodies are very similar, could
we argue that 8% of women will orgasm
within a minute or less?
Theoretically, it makes sense, right? I
think those are the women who orgasm
with penetration. They're so sensitive,
their nerves are so sensitive that
penetration's very pleasurable and then
they have this magical orgasm and they
do it very quickly. So, it's good in a
way, it's often seen as like great in a
woman and not great in men. And so, I
just have this theory that like there
are women who have extra sensitive body
parts.
>> So,
I mean, one of the things I've learned
from everything you've said is just like
how much porn has messed up
our perception of sex.
>> I mean, WWF has messed up our perception
of
I don't know.
Like what people's bodies are like
exercise fighting like like it's all
manufactured. And it's all manufactured
because that's the algorithm that has
been working to get men excited. And it
doesn't like again, it's that question
of that curiosity of who's watching
porn, what do people want from porn,
what are they getting from porn because
it's not what women want typically. And
it has really messed up people's
perceptions of what is actually fun and
pleasurable for the partner. So, seeing
that curiosity of like what does my
partner actually want? You know, you can
have great sex without penetration. And
so, the question is is what does great
sex look like?
>> For you and your partner. When I look at
a website, got some data here on a
website like Pornhub, which is one of
the leading porn websites, it says that
roughly 65% of their traffic
is men. Independent surveys tracking any
regular pornography use find a similar
gap, but note that women's consumption
is highly age dependent. Men between the
age of 18 and 35,
75 to 95% of them report viewing porn
regularly, whereas women age 18 to 35,
only 34% roughly,
report viewing porn regularly. And if we
think about these systems as catering to
demand, it means that porn websites are
catering to
predominantly male
demand. And that explains why for most
young men, we learn about sex from porn
websites.
>> Right.
>> And then we assume that's the the woman
looked like she was having fun, and the
man was doing this particular thing, and
then And take that into our
relationships, and I think this is where
the misunderstanding begins.
>> And the women think they're broken
because they're not having magical
orgasms from penetration. They come to
see me all the time and say, "I'm
broken. You have to fix me. I'm not
orgasming during sex." They have wildly
good orgasms with a vibrator, with a
hand, with
a shower head, with whatever it is from
on their clitoris, and that's totally
normal, right? And then you show them
the body parts. You say, "This is right,
the clitoris and the penis are the same
thing. You activate a penis for a man to
orgasm. You activate a clitoris for a
woman to orgasm." And once you teach
them that, it makes perfect sense to
them. Like they were normal the whole
time.
>> What do you think of pornography?
>> I actually think pornography is great.
>> For relationships? For connection?
>> the right porn. Like look at Okay, let's
look at something like Heated Rivalry.
Have you heard of it?
>> No.
>> Okay, Heated Rivalry is an HBO show that
came out this year that is about two gay
male hockey players. Okay, it's based on
a romance novel book in came from
Canada, and HBO put it out there, and it
went viral in levels that the world has
never seen before. And it is about two
young men
who fall in love, but there's a very
sexual relationship between them. And
heterosexual women have watched this 10
times over. Like they are addicted to
this show. It's all over social media.
It's this huge thing. It's essentially
porn for women, right? It is women who
are watching these pornographic
episodes, and it's really important.
They love it. It's supported. Everyone's
talking about it. So, I don't think porn
in and of itself is bad. I think porn,
we, you know, watching people have sex,
watching people fall in love, watching
people with in romance. People like
that. It gets them excited. It gets them
aroused. But I think too much, if you
are watching porn because and not
interacting with humans, if you are
watching porn all the time, if you need
to if you can only watch porn to have
good sex, like then
that may not be the best, you know, and
healthiest thing to do.
>> I guess the question I was asking is, if
you're in a relationship and one partner
is using a lot of porn, won't that kill
the sexual desire to be intimate with
your partner?
>> It depends. It depends on the
relationship and it depends on what each
person needs in order to feel supported
and connected, right? I don't think we
can say blanketly it's good or bad,
right or wrong. I think if it is good or
bad, right or wrong for that couple,
then it's a problem. Cuz there are
couples who like to watch porn together.
There are couples where oh, that maybe
someone has a much higher libido than
the other person. So they said, "Okay,
the high libido person can use porn and
then once a week we'll circle together
and we'll have a great experience
together." Because it's not everyone's
job to meet each other on the libido.
>> The study that I was looking at was a
couple dozen studies including a major
meta-analysis show a consistent link
between solo porn consumption and lower
relationship and sexual satisfaction.
The erosion of intimacy is usually
driven by deception. Finding a partner
is hiding porn use is usually triggers
intense feelings of betrayal, rejection,
and insecurity.
And heavy solo use can desensitize
the brain's reward system leading to
performance anxiety and erectile issues
during real-life partner sex. It can
also create highly unrealistic
expectations regarding body types,
stamina, and performance making real sex
feel less stimulating.
>> Again, it was that deception. It's the
hiding. If your that that ex of yours
didn't tell you what was really going on
and so you felt disconnected from that
person because you didn't get that
honest truth of what was going on.
>> But also the desensitization of it. Like
it's never going to you know
I guess it depends on how you're using
pornography.
>> It depends on how you use it. So again,
that's the truth.
>> Like you can like train your brain to
get pleasure in a certain way.
And then when you're with your partner,
one could argue that it's going to be
quite difficult for them to replicate
that particular way that you've pleasure
you've learned to pleasure yourself.
>> Right. And that's a that's a problem,
right? If you're only able to do
something in one way, in one position,
with one watching one specific thing,
that may not translate into great
intimate sex with a partner.
>> For the last couple years I've been
working on something that I realized
every podcaster listening to this, but
actually probably every creator
listening to this might just need.
Podcasting is difficult for many
reasons, and one of them is that these
hosting platforms don't give you much
information, and also because they're so
fragmented, you kind of have to go
through every single platform uploading
it to YouTube and then taking the same
big old video file and uploading it to
Spotify's platform. It takes huge
amounts of time, and that friction means
most of us don't do it. That is the
problem we set out to solve, and so we
built something called Flight School,
which you can find at flightcast.com.
And today Flight School is also one of
our show sponsors, and some of the
world's biggest podcasters are now using
our platform to run their shows because
it gives you an edge. It saves you time.
It gives you analytics most people won't
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to be more informed on your show, and it
has growth tools that other hosting
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that are using Flight School have this
unfair advantage. So, go to
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now.
I've done almost 700 interviews with
some of the most interesting people in
the world, and one of the things you
learn, which is unexpected, is that
vulnerability is the doorway to
connection. And after sitting here for 2
3 hours with a guest, I feel a deep
sense of connection to them. And as they
leave, what I get them to do is to write
a question in the Diary of a CEO. We've
taken all of the questions from the
Diary of a CEO. We have put the question
here on this card with the name of the
person that wrote it. So, you can sit at
home, as I do with my fiance, and my
colleagues at work, and other people in
my life, whenever we get a minute, we
play the Diary of a CEO conversation
cards, and it is incredible what
happens. These are great if you're in a
romantic relationship and you want to
connect your partner more. These are
also great if you're in a team and you
want to bond your team together. And I
have to say they're also great for
families that want to learn more about
each other and that need a good excuse
to spend some time in a digital world in
the analog environment connecting human
to human. It is remarkable what the
right question at the right time can do.
Go to the diary.com
and you can get these conversation cards
right now.
And there's different types of arousal,
right? I was I heard from a sex expert I
spoke to that men and women often have
different types of arousal, spontaneous
and like reactive. Is it?
>> Yep. Yep. So there again, this idea of
like I want to have sex, I'm ready to go
versus I want to have sex because we've
started having sex and we've started
that process and now I can get into it.
Sort of like exercise. Some people are
like ready to go to the gym and exercise
and other people like I don't want to I
never want to exercise, but once they
start getting going, oh I know this is
good for me, I should do this. This
feels really good and that's sex for a
lot of people. But again, it's also a
question of what kind of sex are you
having? If you have sex the same way
every single time and it's not that fun
and it's not that interesting to your
partner, are they going to look forward
to it? Are they going to Are they going
to want it? Are they going to seek it
out? And is that really low libido at
all or is that sort of the product of
like we just aren't talking about it
improving. If you had the same podcast
guest on every single week and it was
the same conversation every single week,
it's not going to last you very long,
right? You do different things. You try
different things. Oh, what worked? What
didn't work? How could we do this
better? What does the algorithm want us
to do now? No one's doing that in their
sex lives. Like Like no one's even
talking about it. Like honey, what's
working? What do we like? What's going
on? I saw this thing like
>> Why? Why don't we talk about it?
>> Because we don't talk about money
either. We don't talk about sex. Because
we're trying to be a pro I don't know.
What do you think?
>> I think that's a little bit of it, but I
think the subjects are like deeply
personal, emasculating
and so intrinsically linked to like
self-esteem.
>> It's vulnerable.
>> Yeah, it's like super vulnerable. So And
if someone I remember I had a
partner turn around to me who
interestingly was going through some of
the issues that were undiagnosed, turn
around once upon a time and expressed
that she didn't like having sex and I
didn't understand that at like a 20 as a
23 22-year-old guy.
>> Yeah.
>> And so you kind of look yourself in the
mirror and go, "Oh shit." Like it's
super emasculating.
It turned out that there was actually a
physiological challenge she'd had.
>> Yeah.
>> But we'd been in a relationship for a
long time and she wasn't enjoying sex
for because there was a physiological
issue.
>> Mhm.
>> She didn't say anything to me.
>> Yeah.
>> I didn't know. And then the day she said
something to me, my I didn't know
anything about sex. So I just
interpreted it as like, "Damn, I'm not
good in the you know I might I must not
be good in the bedroom or something."
Um which is super like hurtful. Yeah.
And then that kind of breaks the
relationship down and it's all
predicated on this like
highly emotional, highly self-esteem
linked, poorly educated subject which
destroys relationships.
>> Destroys it. I
And that's such an important story,
right? Because if you had had access to
the information, she thought she was
protecting you by not telling you that
information.
>> interesting? I went to one of my friends
and one of my best friends and said,
like, "My partner's just said this to
me. Like what does that mean?" And he
went to me, he goes, "Mine too." I was
like, "What?" I was like, "So you're not
having sex with your partner?" He goes,
"No." And we And by the way, I'm talking
about 30 year olds. He was like, "No, we
haven't had sex in 3 months." And I was
like, "What What's the reason?" And he
said to me, "She said she just doesn't
like having sex." And I'm like, "Oh,
okay. So that's
that's the same in my relationship. My
my former ex-girlfriend said she just
doesn't like having sex."
And
I can't tell you how ignorant and poor
and insufficient the conclusions in such
a situation we arrive at are. We're
like, "Well, maybe maybe there's
something wrong with me. Maybe it's a
sexuality challenge. Maybe it's a
genetic thing. Maybe they were just but
they were born in didn't want to have
sex like we don't we just don't know
what it is."
From doing this podcast and speaking to
people like you, I like, "Oh my god. I
just wish like 5 10 years ago when I had
these conversations with my guy friends
and also with my the ex-partner that I'm
referencing, I just wish I knew that it
wasn't any of those things.
>> Mhm.
>> It was something that um
could have been helped.
>> Yeah.
What's so important is that you were
able to learn and see and grow in this,
right? A little bit of information gave
you empathy for this partner where you
took it on as a you problem, it became a
you problem cuz it was both of you
together, but it started with biology.
And so, if we actually taught people the
biology or to think about biology or to
like be able to talk about sex, to talk
about sexual health, to talk about
genitals, to make them not private
parts, how much better would your sexual
upbringing really have been? How much
less hurt and shame and guilt would you
have felt because it actually wasn't you
at all, right?
>> It's the horrible conclusions you arrive
at and the the conclusions you arrive at
are often seen as both unchangeable and
therefore, in my situation back then,
the conclusion was, well, this
relationship's never going to work.
Because the false conclusion we'd
arrived at was not something we could we
could change.
>> Mhm.
>> Uh whereas, when I hear about all of
these different things we've talked
about today, I go, "Oh my god, there's
so many other conclusions I could have
arrived at or my friends could have
arrived at that would have been fixable
and therefore, the relationship, which
is a perfectly great relationship with a
person, was therefore savable." One of
them is the thing we just talked about,
which is this idea that men and women
have different types of arousal,
spontaneous and responsive. And I was
looking at some of the data on the
variance, which I think is very
important for people to know.
And it says that men are highly
spontaneous in their arousal, which kind
of means, from my interpretation, and
please correct me if I'm wrong, that as
a man, I can literally be I can
literally think about something
and get aroused. And it's not to say
that women can't, but it the data
suggests that men are more that way
inclined. The data here says that their
spontaneous rate in a man is about 70%,
whereas in women, it's about 10 to 15%.
It says the responsive rate, which I
guess is like I get aroused once the
ship starts moving, once we start
foreplay, once contact starts, is 10 to
15% in men, and in women in this
particular report is 40 to 50%.
>> Mhm.
>> So, that would suggest to me that women
are much more likely to be aroused once,
you know,
foreplay or contact or the sexual
actions have taken place, I'm guessing.
>> Mhm.
>> And then the mixed style
is 15 to 20% in men and 35% in women.
Um is that all accurate?
>> It's accurate, and I think it really
comes to this idea of your path to
having a better understanding of that
prior relationship was actually
education and communication.
>> Yes.
>> Right?
>> If you had a better understanding of the
biology, if she had a better
understanding of the biology, if she
were vulnerable enough to be real with
you and honest with you up front as
opposed to kind of a bombshell that
happened too late, um all of that pain,
all of that hurt probably would have
looked different.
>> Right? It would have looked like the
world would have looked very different.
Now, that's what I'm fighting against
because I think that to your point, I
think men are suffering. They're feeling
disconnected from their partners.
They're feeling a difficulty of even
finding a partner, and part of that is
cuz they lack that curiosity of like,
what like, what do they want? What do
they need? What kind of communication
helps me get to where I want to go with
this person? And a lot of that is
vulnerability and curiosity and
interest, and I think that's what women
often are looking for in partners. Is
they're looking for someone who's going
to give a crap about them enough to care
what they specifically need and want,
not what gen What do women want, and
what is it like like, what specifically
about this person in front of me? What
does she need to feel that erotic love,
support, connection, lust? And for the
man, too. Like, what do you need to feel
all of those things? And what a good
relationship is is when people work
together to try to optimize that for
everybody.
>> are the questions that you would ask
your patients to ask their partner
to start to tease out some of these
things? Couples will come up to me when
I'm in a restaurant or something, and
they'll come up together, and they'll
always they'll often say to me that the
episode they watched together was about
sex.
So, I I literally have this image of
this particular couple that came up to
me when I was abroad, and they said, "We
were just listening on the plane about
your sex episode." So, I'm like they're
listening now.
>> Like again, I think it's that basic
thing of like what does great sex mean
for you?
>> Okay.
>> [clears throat]
>> What what do you want? Like what what is
a great time? What's it something fun?
Like what is it about sex that you
enjoy? When you ask people what do they
get out of sex, it's like 200 different
reasons. Everyone wants something
different, and everyone doesn't always
know what they want. And then having
that ability, if you don't know what you
want, is having that curiosity to
explore together.
>> So, with that said, 200 different
opinions on what good sex is. And this
is kind of what I think you find in
couples. And when I've sat with my
partner before and said like what do you
what arouses you during sex? What do you
like?
The two things can often be different.
>> Totally.
>> And so, is this not a problem that one
partner might say, "I really want you to
tie me up and da da da da da." And then
the other partner might say, "I really
want you to not tie me up and be really
soft and gentle." And there's a bit of a
dichotomy between sorts of sex
preferences,
>> Mhm.
>> which means no one's really ever getting
what they want. Like how do you navigate
that?
>> When you go to buy a house, you don't
always get to choose what house you get
unless you you know you build it
yourself. Like there are compromises in
life, and and there is no all good or
all bad. You're never going to find this
is actually the problem with pornography
is you figure out the exact porn in the
exact situation or even worse with AI.
Like you're going to have a sex robot
who's going to be able to do exactly
what you want in the way that you want
to do it and people are afraid about
what that means for intimacy and
relationships and great sex going
forward because the truth is sex is
messy, it's awkward, it's smelly,
there's fluids, there's funny noises,
there's like it's it's vulnerable, it's
like really uncomfortable sometimes for
to like have these deep conversations,
but isn't that why life exists? Like
isn't that like the most fun part is
when you can kind of have that with
somebody else where they know all of you
and they want to explore that with you.
Now, if it's not the right relationship,
it's not the right relationship, right?
Like and and figuring out if that is an
important part of your life and it's a
non-negotiable, then find the rooms
where there are other people who do that
those things too. I mean, what you will
find is that people have all sorts of
agreements and relationship setups and
as a sex doctor, like the things I hear
in a room like would, you know, are
quite wild and you you wouldn't even
believe. Like people are doing Well, I
think people have multiple like there
are there are people who have open
relationships. So, they have multiple
partners or they have certain kinks,
right? So, there are things that they
really enjoy that maybe somebody would
look at that and be like, oh, that's
very strange, but there are other
consenting people who also are
comfortable and want to do those things.
There are websites that deal with
different erotica and different kinks
and things like that. And there's also
this idea of fantasy. It's also okay to
have things that you think about but
that you don't actually want to partake
in and and that you use.
>> On this point of fantasy, what if you
have a you probably have experience
where someone's come to you and they
have a fantasy
but they don't want to tell or a kink
and they don't want to tell their
partner because they're worried about
the reaction.
>> Yeah, this is where things like sex
therapy become really helpful of how do
you have a third party? Cuz again, when
your doctor's telling you to do
something or bringing something out,
it's it's so much less
scary than if you're doing it on your
own. There are also different like apps
and things like that where you can sort
of dip a toe where you you you have
There's one called Spicer, I believe,
where you can sext each other in ways
and they'll push questions. If you both
agree, it'll tell each other that you
both agree with things. So, there's ways
to dip a toe here and sort of be curious
about it, but again, that's where
watching things together or asking the
questions. This should happen not when
you're naked in the bedroom actively
having sex. Like it's okay to have
conversations about sex when you're not
having sex, right? Like you plan these
podcasts before you actually sit down to
record. Afterwards, you talk with your
team, "Hey, this is what I liked about
it. Here's what I didn't like. Let's
change this in the future. Let's never
have Dr. Ruth Westheimer on again,
right?" Like these are the conversations
you're going to have with your team.
People don't do that about sex very
often, right? They don't actually do
after action. What went well? What
didn't go well? Do you ever want to try
this? Like what would be fun here? Like
there there is often a a lack of
curiosity.
>> And to be you are sex doctor, but people
come to you and sort of offload their
sex lives to you.
>> My job is so fun. I love my job. It's so
fun because people will talk to me about
their most Like we do 2 hours and we
talk about their lives in the context of
their sexual health for 2 hours and
people never have those types of
conversations even with their partners.
And it is incredibly vulnerable. It's
incredibly important for people to see
that and see, "Oh, that was actually
really nice to talk about. I didn't know
this, that, and the other thing about my
body."
>> And what you find that men and women
typically are hiding from their partners
when they do confide in you?
>> I think they don't tell their partners
just about anything. Like they don't
There's a lot they don't tell their
partners, right?
>> Is there a difference between men and
women what they are not saying?
>> That's a great question. I would say
that no one is talking about sex at all.
Women are hiding their pain from their
partners. Men are hiding their um
insecurities and their frustrations and
there's a lot of shame around erectile
dysfunction and sexual problems in men
and so they a lot of people just either
stop having sex or stop talking about it
or sort of have a mediocre sex because
they are not that great at talking about
these things.
>> And I imagine your I mean my first
reaction would be like, "Oh, you should
tell them."
But I imagine that doesn't necessarily
work.
>> I think it's a challenge. Like if you
have had if you have been faking an
orgasm for your entire relationship
>> And women have been.
>> Yeah, many. The statistics are quite
clear. Like if you're only having
penetration and your partner orgasms
every time and it's a perfect orgasm
every time, I would say there's a high
percentage that that's not real. Because
the truth is is orgasm often takes a lot
of arousal and a like like again,
stopwatch. Every header if a penis
enters a vagina and they orgasm about 5
and 1/2 minutes is on average how long
men last, right? Like that's science.
It's about 5 and 1/2 minutes. Now, if
you're longer, great job. If it's
shorter, it's okay. It's all within the
range of normal. Women, if penetration
is happening, almost nobody orgasms in 5
and 1/2 minutes. It's usually well over
13, 14, 15 minutes and penetration is
usually not how that happens. Cuz again,
if you're distracted while you're trying
to stimulate your penis, it's going to
take longer. Women need focus on the
clitoris. So again, if your partner is
orgasming every time within that 5 and
1/2 minutes and it's like clockwork, I
would call [ __ ] on
a high percentage of it. So but but a
partner doesn't want to tell you, right?
Like they're afraid to tell you cuz
they're they want to make you happy,
right? It's not that they're having bad
sex. They just know that that's not
what's going to get them to orgasm and
they want you to be happy and to feel
supported.
>> So
that presents a pretty good case that
the woman should orgasm first.
>> I think so because I think orgasm first
will allow for pelvic floor release and
relaxation, which will make penetration
more pleasurable, enjoyable. I think
women can have multiple orgasms, so
there's a case to be made for before and
after. Why are women having zero
orgasms, men having one orgasm when
women could be having three orgasms and
men have one orgasm? So I think we
should be actively trying to change the
orgasm gap and focus on the pleasure and
I think making penetration the main
event is where the challenge I think
penetration can be part of the whole
story but doesn't necessarily always
need to be the main event.
>> On the physical blockers you talked
about some of them like anxiety. One of
them that I think isn't talked about
enough especially in the modern world is
what they call like the dopamine drain
where you've got mental burnout or
chronic stress or we talked a little bit
about depression but I did notice that
through my life when I'm very very
overworked shall I say
my libido is not the same.
>> Yeah.
>> And this is also the case for for women
as well. Do you have a lot of women come
to you or couples come to you where this
is quite clearly the problem this sort
of like dopamine drain it's actually
their stress and lifestyle it could be
the kids it could be
>> Oh it's a huge problem right? It makes
logical sense again if we go back to the
fundamentals of if you're not sleeping
if you're overworked if you're burned
out if you have no white space for
yourself why are why are you going to
have all this excitement for your
partner and all of these things like if
we're scrolling all the time at bedtime
or if we're watching porn all the time
or we're watching reading romance novels
all the time but we're not talking to
the partner with that we're with or
we're not creating that time and space I
think there's a big opportunity for
people in our modern society which is
over scheduled to schedule sex. I mean
they do this quite well. So when you
were dating right and you would ask your
your date you know let's go out Saturday
night you were literally scheduling
potential sex. You're like I could get
lucky I'm going to plan for it all week
I'm going to get excited I'm taking this
person out I'm like it's going to be
really fun and I'm going to do whatever
it takes to sort of cross that finish
line. So we were always scheduling sex
and it was very erotic and fun when
you're in your dating life and now you
live with a person and you sort of they
see you at your best they see you at
your worst they see you at your
crankiest and your most tired and so
it's really hard to get that level of
excitement when you're dealing with
those, you know, sort of life
circumstances.
>> People will say that, you know, there's
a spontaneity myth around sex that it
should be spontaneous and that's kind of
how we see it in films. Like they grab
you in the hallway and you start kissing
and whatever else.
>> not real. It's just the same as WWF.
Like it's not real. And so that's the
truth is like you If you see your
partner every day and you see your
partner your high and your low and the
crankiest and all of these things and
you're all working like crazy, where is
the space for that? Like that's not how
humans work. So creating That's why
vacation sex is always fun for people or
they find time, you know, so again, if
you've got kids and your kids are
staying up later than you are and you
don't have a lock on your door and
you're worried about making noises and
you don't want to be too loud. Like how
are you going to have great sex in that
situation?
>> One of the I guess the challenges people
might also bring up is that if you're
scheduling sex, it puts a lot of
performance pressure on you. If I know
tonight at 8:00 p.m. I have to have sex
because that's the time we scheduled
this week,
then like, gosh, I'm going to be
finishing my work at 5:00, 6:00, 7:00. I
don't know. I need to get home. [snorts]
I need to have I need to have sex as
well. Gosh.
>> So So this is where you schedule it
around a time that you know is going to
work for you. So I do I tell people to
do things like
quarterly dates. So I get I Listen, I'm
working in DC. Everyone is very
high-powered with very busy jobs. I say
one Friday a quarter, you and your
spouse can literally block your
calendars. One a quarter cuz quarter.
Okay, that means you might have sex
every week. You might have your your
your eight late night sex whenever. You
could might have sex whenever you have
sex. But once a quarter, have a day
where you just block it out and you have
a spouse day or a partner day or
whatever it looks like and maybe do an
act It doesn't necessarily have to be a
sex day, but you actually take time of
your little mini Maybe you go on a walk.
Maybe you go on a hike. Maybe take a
bath. Maybe get a massage. You kind of
create space for you to actually say,
"Oh, wait, we like each other. Oh, we
like talking to each other. We don't
have to just talk about the kids all the
time." So again, the more you invest in
each other and in a joyful way, the
better sex you're going to have.
>> What about self-esteem issues? You
mentioned that as well. Body image
issues. How often do you see that being
the blocker to great sex?
>> It's a huge problem. Again, I wish that
the energy that my female patients put
into wanting to be skinny
is is enormous and I wish that energy
was put into wanting to be strong, but
it's kind of funny because
what people think about themselves
versus what they think for their friends
are very different. Your best friend,
say they're overweight. Do they deserve
great sex?
>> Of course.
>> Of course they do, right? Your best
friend deserves great orgasms, great
sex, no matter what they look like, no
matter what they weigh. Everybody
deserves intimacy, pleasure, and
connection with someone that they can
have intimacy, pleasure, and connection
with. But for some reason when we think
of ourselves, "Oh, I can't be naked with
this person. Oh, I can't be happy until
I lose this much weight. I don't deserve
an orgasm unless I am, you know,
skinny." And that's a huge problem.
>> So, what do we do about it?
>> I think it's empowerment, it's
communication, it's explaining to
people. I think that all of the mindset
stuff that you do and you talk about is
so important cuz look, you changed your
mind around your own situation with this
ex of yours because you got education,
right? You were able to see that it was
more complicated than that. And I do
think by educating people on bodies, on
pleasure, on joy, on connection, on
intimacy, I actually think it changes
the narrative. I think people we're in a
sex recession, okay? People are having
less sex than ever. People are not
connecting, people are scrolling and
they're on their AI chatbots instead of
like human connection. We're getting
worse at this, not better. I I I just
think that like we have to reach humans
and we have to be able to talk about it
to change the narrative.
>> What is the the most important thing we
haven't talked about that we should have
talked about as it relates to all the
work that you do?
>> I think the most important thing is that
biology matters in women and we often
spend so much time talking about
psychosocial issues, about emotions, and
all of that is true. That is important
to sexual health, but we minimize
biology when it comes to women, and we
have to let women advocate for
themselves about the biology, and we
need to train doctors to care about the
biology. I would love to find out from
all the women in your life and the women
on your team, like what experience Like
I would love for you to ask them their
experiences with medical providers, cuz
I don't think we have that curiosity of
like what are you experiencing that's
different.
>> Yeah, I think that I Yeah, I think
that's probably going to have to If for
me to have like a healthy relationship
with my partner, I think that's going to
have to be
uh practice or like part of our You
know, we check in on our relationship,
etc. But we don't really check in on the
physiology.
>> So, super interesting. So, I spend 2
hours with people, and there are times
when the partner comes to that talk. And
so, they get to hear sort of what their
partner is describing. They even get to
see the exam, and they get sort of a
tour of their own partner's body parts.
And so, it is helpful sometimes to bring
partners into those conversations, the
biology conversations, of like she
doesn't want to have sex with you not
because you're bad at sex. Look how
painful it is right here at the opening
of her vulva. It's like a sunburn. I
touch it with a Q-tip, and she's on
fire. Like, what do you think your penis
is doing? And it gives that ability to
say, "Oh, it's not a me problem. How do
I support her best knowing that this is
the issue?" So, getting partners to
understand the biology is extremely
helpful. Or, say you have a man who's
taking an antidepressant or a hair loss
medication that can cause sexual
dysfunction as well. Um say you have a
man who takes an antidepressant and it
lowers his libido. Is it, "Oh, honey,
you're not attracted to me anymore. You
must not love me." Or, is it, "I
actually understand the biology that
your libido is lower because of this
antidepressant." And two things can be
true. So, so I think understanding your
partner's biology and your own biology
is quite important.
>> Yeah, I guess that's the the crux of the
conclusion really is that both education
and communication are where it all
begins.
>> Which is the fundamentals, right?
>> Yeah. And I think here gosh, if I had
better education on these subjects got
at the start of my adult life
and also I had like figured out how to
communicate with my partner and maybe
even also with yourself. And like to be
a bit honest with yourself about how
you're feeling, not to gaslight
yourself, not to gaslight your partner.
Just It just goes to show how better
relationships would have been, not just
with your romantic partner, but really
with all the people in your lives. And
this is easier said than done. Like
especially the communication part.
Because these are very, very sensitive
subjects.
And so we we'd rather just shut up about
them and keep them as these sort of like
secrets among that we whisper about with
the closest people in our lives, maybe
our best friend.
And I just think generally one of the
things I've come to learn from doing
this podcast as well is that
you know, there was this quote I read.
It said you can predict the long-term
health of a relationship by whether each
challenge heals to 101% or 99%.
Does your conflict make you stronger?
And what it's essentially saying is like
conflict is guaranteed in life, but the
thing that's going to turn your conflict
into a strengthened relationship or a
weakened one is
your how you deal with it. Like and
that's all predicated on communication.
And so
if we can just teach people how to
communicate, if we can become better
communicators, which is both function of
speaking and listening
and I guess curiosity
then all of these downstream challenges
and misunderstandings would have a
chance of being solved for. And I think
about this all often. I think often
think, okay, how I'm communicating with
my partner currently is really going to
determine whether we have an argument in
two years time or a year's time or six
months time. Our strategy
of communication. Does she feel safe
expressing a problem? How do I receive
the problem even when it feels like I'm
being blamed? And vice versa. And then
are we open-minded about solutions or do
we come with a bias around this is the
solution, this is what I think the
correct answer will be.
I've spent a lot of time, you know, I'm
like 7 years into my relationship now,
almost.
So, I spend a lot of time thinking,
okay, like how do people go how do they
build a relationship like 50 years? And
the crux of it seems to be
conflict resolution {slash}
communication. That seems to be the crux
of it. And actually with finance issues
that we talk about with finance experts,
always sex issues, the crux of it seems
to be
conflict resolution {slash}
communication.
And I also know, cuz I know lots of
couples, that we're all living on a
different spectrum here. Some couples
are like they come home at 6:00 p.m. and
all they want to do is talk about the
most sensitive subjects. And then you've
got this other group of couples
who almost don't talk about anything.
They're kind of like strangers that are
like burying everything in the cut
cupboard.
And they think burying it in the
cupboard means that it's
out of sight, out of mind, and it's not
impacting anything.
But again, you come to learn
that any problem buried raise its head
in unexpected ways.
And you know, I'm thinking of one
particular friend of mine who was in a
relationship for 14 years, had a baby,
they kind of stopped having sex, didn't
really talk about it.
They become
like parallel lines that are drifting
apart. And they get, you know, several
years later go, "What happened?
What happened to our relationship?"
Well, they never spoke about it.
So,
>> I think you understand this perfectly,
and for you to
see it in this you can help so many
people because I think these are the
fundamentals. How do we teach young
people and old people that conflict
resolution is important in intimacy and
vulnerability are important and biology
is important, science is important, and
we can do this. I I just taught you a
few things that I know today, and you
Not only did you understand it, but you
were curious about it to ask further
questions, and you can now
figure out how it works in your own
relationship, in your own life. You're
even caring enough about thinking about
your friends' lives. And so, if you've
shown that this matters and this is
important, I just think how many people
are going to benefit by your
vulnerability and your curiosity and
saying, "Oh, I could do that, too."
>> Yeah, it's crazy, isn't it? That like if
you love this person so much,
yet you don't often love them enough
just to communicate
about some of these like sensitive,
tricky subjects, which is like craziness
when you articulate it like that. Like
I've been in relationships where I just
absolutely love this person, but no, I
wouldn't I wouldn't raise X, Y, and Z
subject. It's just
it's just too uncomfortable.
>> And the few times, I guess I will ask
that you have been vulnerable, has it
gone well or not well?
>> gosh, it's like the most important
thing. I just I always think, "Why
didn't I do this sooner?"
>> Mhm.
>> I I Yeah, okay. So, to be even more
honest, I like didn't have conversations
with my partner about sex at all. Like I
just I assumed she liked it. I think she
assumed I liked it.
And it wasn't until like a year further
into the relationship that you start
going like, "Wait, I don't
think this is how this person wants to
have sex." Or I don't know. I actually
have to give her the credit cuz she's
the one that started like pushing on the
communication. I think sometimes as men
we just
You know, that that old slightly toxic
phrase, "Happy wife, happy life." I
think sometimes as men we just kind of
assume that if no one's saying anything,
then everything's great.
But it takes two to tango.
>> And I think expecting your partner to
have all the words and to know
everything is the wrong answer. So,
that's where again, that third party,
whether people come to see me together
as a medical person or a sex therapist
or or a third party to help you have
that conversation, cuz I think we assume
our partners know everything about their
own bodies and can communicate about
their own bodies, and that's just not
true. Even showing that curiosity
makes you quite evolved, right? And I
think that that's the energy that we
need in 2026 is breaking down those
barriers because it will lead to
stronger relationships, it will lead to
stronger partnerships, and it's those
hard moments that you grow the most
from.
>> You need the words though as you say.
>> Yeah.
>> When you say you need the words, what
what what specifically do you mean by
that? You need to know how to start the
conversation, how to handle the
conversation, how to receive a subject
that might be a little bit offensive,
that might hurt your ego a little bit.
Is this what you mean by like have the
words?
>> hard to do that on your own because
people
don't want to hurt other people's
feelings. And so just saying it as it is
may not be the right approach either.
That's where again couples therapists
are very good at holding space for those
different conversations. And I think one
of the other problems here Stephen is
many times there's no bad guy. Of course
when it's obvious someone cheats on
someone, someone breaks trust, yes
there's a bad guy. But so often, you
know, say someone has a higher libido
than someone else. There's no bad guy.
That person has a high libido and that
person has a low libido. There's no evil
bad guy, but there is still conflict.
And so how do you deal with conflict
when it's not a good guy bad guy
situation, but you and how do you love
someone and evolve with them, right?
Like I think it's not easy.
>> I think your point there though is
actually
where it starts often which is this
point of empathy. The minute you realize
that there is no bad guy. Just as you
said it, I thought oh my gosh, yeah.
Back when I had those intimacy
challenges in that relationship,
it was a case of trying to figure out
who the bad guy was. I was like, is it
me? Is that me problem? Is it a you
problem? That's kind of like what the
brain jumps to. But actually now that
had time passed and we figured out what
it was, turns out that it was neither of
us. It was really the whole time not me
against her or her against me. It was me
and her against the problem.
>> Mhm.
>> And that refrain, I think removes the
like shame, the blame, and all that
stuff that gets in the way and focuses
you as a team
on resolution and conflict resolution.
Thank you. You've you know, you said
that
I will help people, but actually you're
the one that's helping people. I'm just
asking questions
and uh
>> I disagree. I think it's the simple is
the vulnerability of watching others.
It's the simple stuff that makes the
biggest change.
>> Why does this matter so much, Jack? I
can see it in your face.
>> Because so many people are hurting.
Relationships are hurting. People's
health is hurting. People aren't having
as much pleasure and joy and quality of
life that they could be having using
what we already know to be true. Simple
things, communication, connection,
education, basic medical care. These
things can bring so much joy, health,
great relationships, great living. I see
it every day in my clinical practice and
I want that. I want that for every
person out there and I want them to
fight for it and I want them to advocate
for it and I want doctors to show up in
a big way to help them and I think we
can do it. But I I I am so passionate
about this because I see all the like I
see how much it's not being done.
>> Dr. Rachel, we have a closing tradition
where the last guest leaves a question
for the next not knowing who they're
leaving it for. The question left for
you is, what would be one thing you
would like to do or improve in your life
tomorrow?
>> I would like to get better about
practicing what I preach because we
always say the shoemakers kids don't
wear shoes. I am addicted and obsessed
with what I do. I love my work so much,
but I don't necessarily spend as much
time
lifting weights that I should or not
scrolling on my phone and paying
attention to my children that I should.
I don't spend as much time, you know,
scheduling those quarterly spouse dates
that I tell other people to do. And so I
think practicing what I preach is a huge
opportunity for me.
>> Well, that's refreshing to hear cuz none
of us are perfect in that regard. So,
it's good to know that just having all
the information doesn't necessarily mean
um it's easy to execute upon.
>> Easy to do, easy not to do.
>> Amen.
Um
where do people go to find more from
you? Do they go to your Instagram, your
website, your YouTube channel? Where
should you Where should they go?
>> Yeah, our website is really fabulous. We
are very big into research, education,
advocacy, and mentorship. So,
rachelrubinmd.com
that would lead you to sign up for our
newsletter which is really an incredible
source of education. We are extending
you the the latest and greatest in
studies, research that you can be a part
of, job opportunities, um and advocacy
for clinicians. We have courses in
teaching you how to do this both free
and uh ones that come with continuing
medical education. I would say Instagram
is um the most popular for me right now.
Uh although we're trying to get louder.
If only I had your skills, I I would
love to be louder on YouTube and other
places. Uh we do have a clinical
practice both in Washington D.C. and Los
Angeles. And so, if we can help in any
way on the sexual health side, please
reach out to us because sexual health is
just health and your quality of life
absolutely matters.
>> I'll link all of that below.
And I hope people sign up for your
newsletter as well. That sounds really
interesting.
>> Thank you.
>> Dr. Rachel Rubin, thank you so much for
all of this. Um I think it's it's so
so telling that your conversations are
often the most shared on the podcast and
in generally in podcasting because the
subjects are so um so important to so
many people's lives and they can relate
to feeling not themselves as you say,
but there's very few people out there
that have the credibility, the
experience with patients, but also the
the ability to articulate it in a way
that's highly accessible like you have.
So, I know that you you know, we talked
beforehand, you don't necessarily love
doing this,
but um it's a very very important worthy
cause cuz there's very few people that
can speak to these subjects with the in
the way that you can. So, please keep
doing it.
>> So kind.
>> Anybody who's listening now, I highly
recommend if there's somebody in your
life that might want to listen to this
conversation, I think there's a reason
why Dr. Rachel's conversations are
always the most shared.
Um please do share it with them. Dr.
Rachel, thank you so much for your time.
>> Thank you.
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