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

Women's hormonal health is dynamic and complex, influencing well-being from early adulthood through menopause and beyond. Misconceptions, stigma, and gaps in physician training often leave women without access to effective treatments. Understanding the roles of hormones such as [restricted term], estrogen, and progesterone—and the options for hormone therapy—empowers women to make informed decisions about their health.

[restricted term] Declines in Women Starting In Their Thirties, Affecting Sexual Function Beyond Menopause

[restricted term]'s Role in Women's Libido and Body Image

[restricted term] is often perceived as a "male" hormone, but as Rachel Rubin and Steven Bartlett discuss, it is crucial for women as well. [restricted term] supports libido, arousal, orgasm, and overall sexual satisfaction in women. It also plays a significant role in body image and psychological well-being. In clinical practice, Rubin administers carefully dosed [restricted term]—about one-tenth the male dosage—to women experiencing low libido or other sexual concerns, with many reporting improved sexual response and body confidence within three to six months.

[restricted term] Drop in Women's 30s Lowers Libido, Arousal, Engorgement, and Lubrication, Often Mistaken for Other Causes

[restricted term] levels in women are relatively stable throughout the menstrual cycle but peak during ovulation, supporting evolutionary drives for reproduction. However, [restricted term] production begins to decline in women's thirties, well before menopause. This decrease can manifest as reduced libido, lessened arousal, longer time to orgasm, diminished engorgement and lubrication, and changes in clitoral function—akin to how erections work in men. These subtle but impactful changes are often unrecognized by women and physicians, who may only focus on estrogen and progesterone and overlook [restricted term]'s significance.

Birth Control Pills Suppress Ovarian [restricted term], Causing Low Libido and Painful Intercourse, Though Alternative Methods Might Not Have the Same Effect

Combined birth control pills deliver synthetic estrogen and progestin at levels that suppress ovarian hormone production altogether—including [restricted term]. Rubin notes that in a subset of women, this suppression leads to diminished libido and even pain during sex. Studies indicate up to 27% of those on birth control report reduced sexual drive. Rubin highlights the importance of discussing alternative contraceptives for those negatively affected, as non-hormonal or different hormonal methods may not suppress [restricted term] as much. Real-life experiences, such as Bartlett’s fiancé regaining libido after stopping the pill, reinforce the importance of awareness about this side effect.

Perimenopause and Menopause: Critical Transitions With Declining Estrogen and Progesterone

Perimenopause Typically Occurs Between Ages Thirty-Five and Forty-Five as Hormonal Fluctuations Begin, Causing Symptoms Like Temperature Regulation Issues, Fatigue, Memory Problems, Low Libido, Dry Eyes, Joint Pain, Irregular Periods, Pain During Sex, and Increased Urinary Tract Infections Often Misattributed

Perimenopause, spanning ages 35 to 45, marks the beginning of hormonal fluctuations. Symptoms vary widely—ranging from temperature regulation issues, fatigue, memory problems, and low libido, to dry eyes, itchy ears, joint pain, irregular bleeding, painful sex, and increased incidence of urinary tract infections (UTIs). Many of these symptoms are attributed to other causes or overlooked due to insufficient focus on hormones in medical education.

Menopause: Estrogen Drops to Zero Causing Hot Flashes, Night Sweats, Osteoporosis, Depression, Low Libido, Vaginal Tissue Dysfunction, and Metabolic Syndrome Affecting all Systems

True menopause—typically between 45 and 55—occurs when ovarian estrogen production ceases entirely. This dramatic loss, a “castration event,” triggers classic menopause symptoms: hot flashes, night sweats, osteoporosis or bone density loss, depression, low libido, vaginal tissue atrophy, and metabolic syndrome, affecting everything from sleep to cardiovascular function.

Progesterone Decline Can Disrupt Sleep and Increase Anxiety; Distinguishing Between Progesterone and Estrogen Symptoms Is Challenging

The decline of progesterone, which begins in perimenopause, can lead to sleep disturbances and heightened anxiety. Distinguishing symptoms caused by declining estrogen from those caused by dropping progesterone is not straightforward, so individualized therapy may combine both, addressing sleep, anxiety, and uterine protection.

HRT Is Unfairly Stigmatized Due to Misinterpretation of the Women's Health Initiative Study, Denying Many Women Access to Safe, Life-Changing Treatment

2000s WHI Study Misrepresented: Hormone Therapy Wrongly Linked To Cardiovascular Disease and Breast Cancer, Affirmed Safe For Women Under Seventy

A pivotal moment of confusion arose from the early 2000s Women's Health Initiative (WHI) study, which hastily linked hormone therapy to cardiovascular disease and breast cancer. The study, enrolling women aged 50–79 and using hormone formulations uncommon today, was stopped early and publicized as evidence against hormone therapy. However, data analysis and subsequent publications corrected this, clarifying that hormone therapy is safe for women under 70, with no increased risk of breast cancer or cardiovascular events. Despite these clarifications, the initial panic persists.

1.7% of Eligible Women Receive Hormone Therapy Due to Physician Training Gaps, Misinterpretations, and Safety Misconceptions

Today, only 1.7% of eligible women receive hormone therapy. This extreme underuse results from gaps in physician training, lingering misconceptions, and safety fears propagated by outdated or misinterpreted studies. Rubin highlights how misinformation from previous generations still shapes present attitudes, as patients refuse therapy due to unfounded cancer concerns.

Hormone Therapy: Tailor Options to Symptoms and Preferences—Estrogen for Hot Flashes/Bone Health, Progesterone For Sleep/Uterine Protection, [restricted term] For Libido/Arousal, and Vaginal Hormones For Bladder/Sexual Health

Hormone therapy is not one-size-fits-all and is best individualized. Four major components are used depending on a woman's needs:

• Estrogen: For hot flashes, night sweats, bone health, hair/skin/nails, and metabolic support; but must be paired with progesterone if the uterus is present to prevent excess uterine growth.
• Progesterone: Used for uterine protection, sleep augmentation, and anxiety reduction.
• [restricted term]: Specifically for libido, arousal, and overall sexual well-being, with a robust evidence base in postmenopausal women.
• Vaginal hormones: Local microdoses (estrogen or DHEA), support bladder and vaginal health—improving dryness, pain with sex, reducing UTIs, and restoring sexual function without systemic risk.

Treatment can start with vaginal hormones for sexual and urinary comfort, progress to systemic estrogen for vasomotor and bone symptoms, and add progesterone for uterine safety and sleep if the uterus is intact. [restricted term] may be added if libido remains low.

Vaginal Hormones Safely Prevent and Treat Genitourinary Syndrome of Menopause and Urinary Tract Infections Across all Ages

[restricted term] Cream or Tablets Twice Weekly, Costing Ninety Cents To Fourteen Dollars, Prevent UTIs By Over Fifty Percent, Reduce Urinary Issues, Eliminate Pain and Dryness During Sex, Improve Arousal and Orgasm, and Are Safer Than [restricted term] for This

Vaginal hormones—microdosed [restricted term] creams or tablets used twice weekly—cost between 90 cents and $14 for several months’ supply. These treatments:

• Lower the risk of UTIs by over 50%
• Significantly reduce urinary frequency, urgency, and leakage
• Eliminate pain and dryness during sexual activity
• Enhance arousal and improve orgasm
• Are described by Ru ...

Orgasm Gap Due to Misunderstanding Female Anatomy, Not Physiological Inability

Rachel Rubin, a sex doctor and urologist, highlights that about 20% of women report never experiencing orgasm, a stark contrast to men, for whom orgasm problems are much less common. Rubin stresses this gap is not caused by female physiology, but by a lack of education around sexual anatomy and pleasure. Many women believe orgasm should result from penetrative sex because this is the dominant narrative, but for most women, clitoral stimulation is key. The misconception is so widespread that women frequently see themselves as "broken" when they do not orgasm from penetration, even though direct or indirect clitoral stimulation is typically necessary.

Rubin explains that penetration alone often brings as little chance of orgasm as rubbing a thigh, drawing a clear analogy to overturn entrenched beliefs. Vibration on the clitoris, manual stimulation, or use of specific devices commonly produce pleasure and orgasm, while some women find direct clitoral stimulation too intense and prefer different approaches—demonstrating diversity in needs and sensitivity.

Penetration can still be pleasurable or emotionally meaningful for some women, especially when nerve endings on the inner vagina or cervix are particularly sensitive, yet this is only a subset. Rubin suggests that women who orgasm from penetration may have heightened sensitivity, similar to the small percentage of men who experience very rapid ejaculation. In the vast majority, orgasm results from focused clitoral stimulation—penetration is often only one element among many that make up satisfying sexual encounters. She insists every woman's experience is unique and discourages one-size-fits-all assumptions about sexual pleasure.

Time frames for orgasm also differ significantly: men average five and a half minutes from penetration to orgasm, while women, when they do orgasm through penetration (which is uncommon), require much longer—often over 13 to 15 minutes, usually with added clitoral focus. Rubin asserts that high-rate, clockwork-like orgasms for women during penetration are often faked, as many women wish to please their partners or avoid discomfort in communication.

Rubin emphasizes the urgent need to shift focus from penetration to pleasure and clitoral attention, advocating a view of penetration as “part of the story” rather than the central event.

Lack of Basic Anatomical Education Leads Most Women to Associate Orgasm With Penetration

Educational gaps are glaring. Most women cannot locate their clitoris and don’t realize it plays a central role in orgasm. The word “clitoris” is still omitted from required training checklists for OBGYNs—Rubin underscores that no field of medicine systematically teaches its examination or prioritizes its health.

The Clitoris Is Large, Extending Internally With 10,000 Nerve Endings

Rubin dismantles the myth of the clitoris as a small, external “button.” It is a vast organ, extending internally down to the butt bones and composed of the same erectile tissue as the penis. Under a microscope, the clitoris closely resembles the penis in structure and function, containing approximately 10,000 nerve endings. Yet, medical practitioners rarely examine it or routinely discuss its function or possible dysfunction.

Clitoral Adhesions Go Undiagnosed, Untreated, Impairing Sexual Function

Roughly 23% of women can develop clitoral adhesions, where the hood becomes stuck to the clitoral head. This issue is often undiagnosed, as doctors rarely examine the clitoris. When identified, a straightforward office procedure can remove these adhesions, leading to substantial improvements in arousal, orgasm, and satisfaction in 60–70% of affected patients. Despite these benefits, lack of provider training and patients’ unfamiliarity with their own anatomy are common barriers to diagnosis and treatment.

Rubin observes that many women (and their partners) have never even seen or discussed their own clitoris, as genital exams are usually performed without patient observation or participation. She encourages open discussion and joint exploration as foundational for understanding pleasure.

Pelvic Floor Dysfunction Hampers Sexual Function Via Pain, Reduced Blood Flow, and Impaired Orgasm, Requiring Specialized Physical Therapy

The pelvic floor consists of strong muscles encircling the bones of the pelvis, capable of contracting and relaxing. These muscles can become dysfunctional due to surgery, childbirth, trauma, hormonal changes, or overuse. Poor pelvic floor function can impair sexual pleasure by causing pain, reducing blood flow, and disrupting the brain-genital connection needed for arousal and orgasm.

Tight pelvic floor muscles result in burning, soreness, and penetration pain, and may cause weak or absent orgasms and diminished arousal. Pelvic floor dysfunction is correctable: specialized physical therapists can assess muscle strength and coordination, teaching patients to strengthen or relax these muscles for better sexual function and less pain. Both strengthening and relaxation may be needed, depending on individual assessment.

Pain During Sex Affects 75% of Women and Has Multiple Physiological Causes

Painful intercourse is prevalent: up to 75% of women experience it at some point in their lives, and 10–20% suffer from chronic pain during sex. During menopause, this number may soar to 20–50% due to hormonal tissue atrophy. Causes are diverse: skin and tissue issues (eczema, autoimmune disorders, hormonal changes), muscle dysfunction, nerve compression (such as from spinal problems), endometriosis scars, and other medical conditions.

Rubin stresses that sex should not be painful, and women deserve a thorough diagnostic workup and tailored treatment. A multidisciplinary approach may be needed, including consultations with specialized gynecologists, urologists, and pelvic floor physical therapists. Persistent pain is fixable, and repeated opinions are warranted if the first provider is not equipped to help.

Men Misconstrue Female Pleasure By Emphasizing Penile Traits Over Clitoral Stimulation, Arousal, and Mental Desire

Rubin describes a fundamental mismatch in many heterosexual encounters: men seek reassurance about the size, hardness, girth, and duration of their erections, mistakenly believing these factors drive female satisfaction. In reality, women’s pleasure is far more dependent on clitoral stimulation, foreplay, and arousal built through physical and emotional connection.

Women’s arousal styles further differ: spontaneous arousal occurs in only 10–15% of women (compared to 70% of men), while 40–50% of women require responsive arousal once physical contact or foreplay begins. Effective couples prioriti ...

The American medical system consistently fails women, particularly in sexual health, menopause, and hormone therapy. These failures stem from fundamental education gaps, outdated practices, systemic bias, and skewed research priorities—problems that persist regardless of a patient's wealth or access to resources.

Insufficient Training in Women's Sexual Health, Hormone Therapy, and Clitoral Anatomy Leads To Medical Incompetence, Even For Wealthy Women

Wealthy Women Face Systemic Medical Ignorance in Hormone Therapy/Diagnosis

Rachel Rubin illustrates that even the wealthiest and most influential women—like Melinda Gates, Oprah Winfrey, and Halle Berry—struggle to obtain competent hormone therapy and accurate menopause diagnosis. Gates had to visit three doctors to get appropriate hormone therapy prescriptions; Oprah saw five physicians who missed her perimenopausal symptoms, and Berry received a misdiagnosis of genital herpes, later revealed to be genitourinary syndrome of menopause. Rubin points out that when the richest women in society can’t access evidence-based information or treatment for their bodies, hormonal health, and sexual health, the situation is much direr for average women.

Clitoris Absent From Ob-gyn Curriculum Checklist Highlights Educational Failure in Female Sexual Anatomy

A glaring symbol of this incompetence is that the word "clitoris" does not exist on the official training checklist for OB-GYNs as of 2026. This omission means most OB-GYNs graduate with no formal education on the clitoris, the vulva, sexual health, sexual pain, libido, arousal, or orgasm. Only a few clinicians seek extra training on their own. As a result, when women and men approach physicians for answers about sexual health, they are likely to encounter providers lacking basic training in these topics.

Rubin describes the exam process: doctors typically cover the patient with a sheet, look at the genitalia, and proceed with procedures like pap smears without engaging or teaching the patient about their own anatomy. She notes that few women (or men) possess even basic language or knowledge about female anatomy because clinicians rarely teach it. In contrast, male sexual anatomy and dysfunction have entire fields dedicated to their care.

Physicians Impose Opinions and Restrictions on Women's Hormone Therapy Without Training, Unlike Men's Health With Shared Decision-Making, Revealing a Gender-Based Care Double Standard

Rubin highlights a critical double standard. Even without training or full knowledge of the data, doctors often dictate to women what they can and cannot have regarding hormone therapy, rather than engaging in shared decision-making based on risks and benefits. In men's health, practitioners routinely discuss options openly with patients. Rubin stresses that there is a lost art among doctors in writing hormone therapy prescriptions, understanding the differences between hormone types, and knowing their safety and risks. Despite new societal attention and philanthropic support, such as Melinda Gates giving $10 million to the menopause society, insufficient training means these advances do not reach everyday clinical practice.

Barriers to Quality Sexual Health Care: Physician Training, Time Constraints, Lack of Incentive

Time Limits Obstruct Quality Care: Physicians Overlook Complex Issues

Structural limitations also erode quality care. Rubin states it's impossible to provide personalized, nuanced medical advice in a standard 10-minute visit. The time constraint often leads doctors to dismiss complex issues like "not feeling like myself" (NFLM), a common complaint that frequently has a hormonal cause. Rather than exploring these causes, rushed appointments elicit dismissals or default denials of care.

Two Decades of Fear and Misinformation About Hormone Therapy Led To a Lost Art Of Teaching Doctors Prescription Writing, Hormone Types, and Risk Evaluation, Even as They Advise Against These Treatments

Twenty years of fear and misinformation about hormone therapy created a generation of providers unable to prescribe or explain hormone therapy confidently. Doctors have not been taught how to write these prescriptions, evaluate risk, or distinguish between hormone types, and this knowledge gap persists even as they tell patients what they should or should not have. Even with new research or high-profile funding, there is no system ensuring this information is taught to practicing clinicians or incorporated into medical school or residency curricula.

Efforts to Disseminate Research to Practice Often Overlook Women's Sexual and Reproductive Health

Although medical research continues to advance, translating this data into clinical reality lags. Rubin notes the massive gap between research being published and practitioners being trained. Despite abundant information about women's sexual health, inadequate educational efforts mean doctors are not using the data—“everyone forgot to teach your doctor.” The lack of infrastr ...

Open and honest communication, partnered with a willingness to be vulnerable and an investment in ongoing sexual health education, forms the foundation of fulfilling, resilient relationships. Rachel Rubin and Steven Bartlett explore how misunderstandings, medical factors, and lack of dialogue create persistent challenges—and how curiosity, education, and teamwork empower couples to overcome barriers to intimacy.

Rooted Medical Conditions Misinterpreted As Low Libido or Incompatibility

Many relationship conflicts around sex stem from misinterpreted medical issues. Rubin describes examining women experiencing vulvar pain—sometimes feeling like a sunburn when touched—while a partner is present. By allowing the partner to witness the pain firsthand, she helps reframe sexual avoidance not as rejection or personal inadequacy, but as a valid, treatable condition. This approach builds empathy, dismantles misplaced blame, and encourages both partners to seek solutions together instead of internalizing shame or resentment.

Understanding female arousal, hormones, pelvic floor function, and pain syndromes can help couples identify sources of sexual discomfort and pursue treatment rather than resigning to dissatisfaction or assuming incompatibility. For example, 20-30% of women using hormonal birth control experience decreased libido due to [restricted term] suppression. However, most are unaware that the medication—not a flaw in themselves or their partner—is to blame, leading to unnecessary relational distress.

Most Couples Never Discuss Sex or Satisfaction, Leading To Issues From Misunderstandings Over Decades

Both Rubin and Bartlett note that most couples never openly discuss their sex lives. Sensitive topics—orgasm frequency, pain, fantasies, low libido, erectile dysfunction—are buried out of shame or fear, sometimes for years. Women often fake orgasms to please partners, with statistics showing very few women orgasm reliably from penetration within the average duration of intercourse. Men and women hide dissatisfaction or challenges, convinced disclosure would result in rejection or judgment. Yet, Rubin’s experience and Bartlett’s reflections show that voicing vulnerabilities, when handled with care, typically strengthen relationships rather than weaken them.

Missed opportunities for communication often grow into decades-long misunderstandings. One example Bartlett shares is of a friend whose relationship eroded into distant parallel lives after the birth of a child and dwindling intimacy, simply because neither partner initiated a conversation about their needs or struggles. Rubin emphasizes the need for conversations “about sex when you’re not having sex,” suggesting partners debrief after sexual experiences, ask about preferences, and express curiosity spilling into daily life—not just the bedroom.

Therapists or third-party professionals can provide essential support during these conversations, helping manage difficult topics and soften the discomfort of disclosure. Rubin points out that, ironically, people are often more open during a podcast prep session than when talking to their own partner about intimacy.

Scheduled Sex Is the Best Strategy For Couples to Stay Connected

Contrary to popular belief, sexual spontaneity is rare in long-term relationships. Rubin observes that during dating, couples essentially schedule sexual opportunities—planning dates with anticipation and intention. Once cohabiting, with life’s stresses, exhaustion, and constant exposure to each other’s highs and lows, expecting spontaneous desire sets a standard few can realistically maintain.

She recommends quarterly “partner days,” where couples block off uninterrupted time to reconnect, communicate, and rekindle intimacy, whether or not sex is the explicit goal. These scheduled moments foster playfulness, conversation, and joy—often leading to better sex and renewed connection, far more reliably than waiting for spontaneous desire. For busy couples, overworked parents, or those struggling with burnout, scheduling connection is often the only viable way to maintain intimacy and satisfaction.

Understanding That Relationship Problems Stem From Differing Needs, Not one Partner Being Wrong, Creates Empathy, Reduces Blame, and Enables Couples to Become Teammates Against Problems

Conflicts around libido differences, sexual pain, or mismatched preferences are not moral failings or proof of a bad partner. Rubin and Bartlett emphasize that reframing these issues as shared challenges—“us against the problem”—transforms shame and blame into collaboration and empathy. Recognizing th ...

Modern life exerts powerful influences on sexual wellbeing, shaping libido, pleasure, and satisfaction through stress, cultural expectations, and mental health treatments.

Chronic Stress, Sleep Deprivation, Overwork, and Lack of White Space Deplete [restricted term] and Cause Burnout, Harming Libido and Sexual Satisfaction

Chronic stress, lack of sleep, burnout, and absence of personal downtime significantly drain [restricted term], leading to decreased libido and sexual dissatisfaction. Steven Bartlett describes personal experiences of lowered libido during periods of extreme overwork, noting this is common for many, including women. Rachel Rubin affirms these patterns, explaining that exhausted, overscheduled individuals lack not only the energy but also the mental space needed for sexual connection. She emphasizes this is a lifestyle issue, not a relationship problem or character flaw.

Digital stimulation before bed—such as frequent scrolling, watching porn, or constant media consumption—also depletes the parasympathetic nervous system’s capacity for sexual arousal. Rubin notes that when people consistently consume digital content or are perpetually busy, it erodes the “white space” necessary for desire and connection with partners.

Modern life fosters unrealistic expectations of spontaneous sex, despite little rest or mental space. Rubin suggests scheduling sex as a practical solution for overscheduled couples to intentionally cultivate intimacy.

Body Image Insecurity and Perfectionism Hinder Sexual Pleasure, Self-Advocacy, and Enjoyment For Women

Perfectionism and insecurity, especially around body image, diminish women’s sexual confidence, pleasure, and participation. Rubin observes that women often invest enormous energy in striving for thinness rather than strength, undermining both vulnerability and sexual self-assurance. Some women withhold intimacy and pleasure from themselves, internalizing appearance-based standards and believing they do not deserve pleasure or orgasm unless they reach a certain weight or look.

Rubin counters these beliefs by applying the standard to others, asking if a best friend—regardless of appearance or weight—deserves fulfilling sex and intimacy. The answer is always yes, reinforcing that all people are entitled to pleasure, intimacy, and connection, and that internalized shame or unrealistic standards should not block full participation in sexual relationships.

Mental Health ...