Dr Rachel Rubin: Women’s Sexual Health, Menopause, Hormone Replacement Therapy (HRT), and Orgasms!

Rachel Rubin argues that women are often denied information and treatments that could improve sexual health and quality of life. She opens with examples of vaginal hormone treatments, then says many women are not receiving prescriptions for such options. The interview frames this as a gap between available information and what reaches patients; it does not independently verify the reported prescription rate or establish that one treatment is appropriate for everyone.

Rubin also says many women expect orgasm to come from penetration, even though she describes the clitoris as the primary source of orgasm for most women. She argues that the clitoris is often missing from gynecology training and that this knowledge gap contributes to people blaming themselves for experiences that may reflect inadequate education. Her point is not that every woman has the same sexual response, but that basic anatomy and communication are often absent from care and relationships.

Rubin describes women’s health as an area where even affluent and high-profile patients may struggle to obtain menopause or hormone care. She recounts stories involving public figures who saw multiple doctors before receiving an explanation or treatment. She says medical schools and residency programs did not teach her enough about these topics, and that many clinicians have not been trained to prescribe or discuss hormone therapy. The examples are her account of gaps in care, not a systematic survey of every provider.

She contrasts the way men’s health discussions often include shared decision-making, risks, and benefits with what she sees as categorical advice in women’s health. She attributes some of this to limited training and short appointments, which make nuanced conversations difficult. She also says gynecologists may not receive specific instruction on the clitoris, vulva, sexual pain, libido, arousal, or orgasm. The discussion points to a structural issue: publishing research does not by itself ensure that clinicians learn how to apply it.

The host admits that he lacks knowledge and asks Rubin to explain basic anatomy rather than pretending to understand. They argue that this kind of curiosity should extend to patients: during an exam, clinicians can name body parts and explain what they are doing, instead of leaving patients unfamiliar with their own anatomy. Rubin says language about the labia, clitoris, and urethra can help people describe concerns and advocate for the care they want.

Rubin says the questions she hears most often concern hormones, pain during sex, and libido. She argues that people need more accessible education about how the body works and what options exist. The segment begins this discussion by framing hormones as a topic often omitted from medical training and introduces a chart of testosterone levels in women across age. The details of that chart and the clinical implications are developed in the next part of the conversation.

Rubin challenges the idea that testosterone is exclusively a male hormone. She compares menopause’s drop in estrogen to a major loss of sex hormones and lists possible whole-body effects, including changes in bone health, mood, sexual function, and metabolism. She also says testosterone may begin to decline in women during their thirties, with some reporting reduced libido, slower orgasm, or changes in arousal. These are the guest’s clinical observations; the interview does not establish a diagnostic threshold or show that every symptom reflects low testosterone.