Dr Rachel Rubin: "I'm Filled With Rage!" Your Doctor Was Never Taught About Women's Bodies!

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.

>> This is super interesting to me. My team. gave me this report to show me how many. of you that watch this show subscribe, and some of you have told us, according. to this, that you are unsubscribed from. the channel randomly. So, favor to ask. all of you, please could you check right. now if you've hit the subscribe button. if you are regular viewer of the show. and you like what we do here. We're. approaching quite a significant landmark. on this show in terms of a subscriber. number. So, if there was one simple, free thing that you could do to help us, my team, everyone here, to keep this. show free, to keep it improving year. over year and week over week, it is just. to hit that subscribe button and to.

double-check if you've hit it. Only. thing I'll ever ask of you. Do we have a deal? If you do it, I'll tell you what I'll. do. I'll make sure. every single week, every single month, we fight harder and harder and harder. and harder to bring you the guests and. conversations that you want to hear. I. stayed true to that promise since the. very beginning of The Diary of a CEO, and I will not let you down. Please help. us. Really appreciate it. Let's get on. with the show. >> [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. >> There should be a button just down below. here. And if it says subscribe, you're. already subscribed. If it says. subscribe-ah, that means you're not yet.

And if you're not subscribed, please. could you do us a favor and hit that. button. It helps to show more than you. know. And according to the algorithm, you're someone that watches our show, but you haven't yet hit that button. 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. >> I don't speak Vietnamese, but this show. can because of AI video technology from.

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let it be from the greatest. pound-for-pound fighter of all time, the. guy they call Johnny "Bones" Jones. Jon's a co-owner of our show sponsor. KetoneIQ alongside myself, and when you. hear why, it probably makes a lot of. sense to you. When he's training or. fighting, he needs high-quality, steady, laser-like focus without the crash, and. ketones give him exactly that. And. unlike caffeine, ketones don't stimulate. your brain, they fuel it. So, your brain. actually loves ketones because it runs. on them much more efficiently than. anything else. And right now, KetoneIQ.

is giving away one-of-a-kind pair signed. MMA gloves from Jon Jones himself and. the upcoming gold medal wrestler he's. coaching called Gable Steveson. They are very, very rare. And if you. want your shot at winning them, go to. ketone.com/steven. to enter to win. No purchase necessary, terms and conditions apply, and you'll. also get 30% off your first subscription. order, exclusive KetoneIQ merch, and of. course, your shot at the signed gloves. 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. typically get. It allows you to use AI. to be more informed on your show, and it. has growth tools that other hosting. platforms don't have. So, podcasters. that are using Flight School have this. unfair advantage. So, go to. flightcast.com/doac. 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. >> YouTube have this new crazy algorithm. where they know exactly what video you. would like to watch next based on AI and. all of your viewing behavior. And the. algorithm says that this video is the. perfect video for you. It's different. for everybody looking right now. Check. this video out and I bet you you might. love it.