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

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0:00You rub it inside the walls of the
0:01vagina, like that.
0:02>> rub it in like you would rub sunscreen
0:04on your face. And if you do that twice a
0:06week, it makes sex not painful and dry.
0:08It helps with arousal and orgasm. It's
0:10literally better than Viagra. And it's
0:13cheap. And I'm telling you all this as a
0:14urologist that this cream can also help
0:16prevent death from urinary tract
0:18infections. But more than 75% of people
0:21in large database collections are not
0:23getting prescriptions for this. And so
0:25women are not getting access to generic
0:27medications that could save their lives
0:29and also really improve quality of life.
0:32And so I am filled with rage because
0:34people are limiting their ability to
0:36have great sex, great health because
0:38they aren't having access to all the
0:39information that they could. For
0:41example, women are not orgasming as much
0:43as men. The data is very clear there.
0:45And women come to see me all the time as
0:46I'm a sex doctor. And they say, "I'm
0:48broken and you have to fix me. I'm not
0:49orgasming during sex." And I think the
0:51majority of problem is education. Women
0:54think that orgasm comes from
0:55penetration. But the clitoris is how
0:57most women orgasm. And yet most women do
1:01not know where their clitoris is. And in
1:03fact, the word clitoris today in 2026
1:06does not exist in the checklist for what
1:09an OBGYN has to learn in their training.
1:11>> And as men, what are we getting wrong in
1:14heterosexual relationships when we're
1:16trying to arouse our partners?
1:18>> Well, men are constantly asking about
1:20they want their penises bigger, harder,
1:22straighter, girthier, lasting longer.
1:25But none of that has anything to do with
1:27how women experience pleasure [music]
1:28and satisfaction in the bedroom. So
1:30that's why I'm so loud about these
1:31things because no one is getting good
1:33sex ed. Because the basic information is
1:35not being shared. And we fundamentally
1:37don't give a crap about women's sexual
1:39health, about their menstrual cycles,
1:40pregnancy, menopause, hormones, pain
1:42with sex, libido. [music]
1:44But we actually do have a lot of
1:45information that we are not using
1:47because everyone forgot to teach your
1:48doctor.
1:49>> And I want to focus today's conversation
1:50on women's health cuz I have so many
1:52questions and curiosities.
1:53>> Right.
1:54>> So let's start with the subject of
1:55hormones.
1:56>> This is going to be so [ __ ] good.
2:00>> This is super interesting to me. My team
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2:13if you are regular viewer of the show
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2:33Do we have a deal?
2:34If you do it, I'll tell you what I'll
2:35do. I'll make sure
2:37every single week, every single month,
2:39we fight harder and harder and harder
2:40and harder to bring you the guests and
2:41conversations that you want to hear. I
2:43stayed true to that promise since the
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2:45and I will not let you down. Please help
2:48us. Really appreciate it. Let's get on
2:50with the show.
2:52>> [music]
2:54>> Dr. Rachel Rubin.
2:57Before we started recording, you said a
2:58line to me, which I found to be very
3:01interesting. You said, "I'm filled with
3:04rage."
3:06Why are you filled with rage?
3:08>> I am filled with rage because I do think
3:10that people are limiting their ability
3:12to have great sex, great relationships,
3:15and great health because they aren't
3:17having access to all the information
3:18that they could, and they're going to
3:20see doctors who actually don't know how
3:23to help them with these problems.
3:25>> And on the subject of women's health,
3:27sexual health, hormones, etc., can you
3:29give me the background context of the
3:32disservice that's been done? I remember
3:33you you were talking previously about
3:35how even the most affluent women in the
3:37world are being let down.
3:39>> Yeah, I think this is the great
3:40equalizer in the fact that no one is
3:43getting good medical care here when it
3:45comes to hormone therapy, menopause, and
3:47sexual health. Melinda Gates just came
3:49out and said she had to see three
3:50doctors before she got proper hormone
3:52therapy prescriptions. Oprah had to see
3:55five doctors and still they didn't
3:57understand that her heart palpitations
3:59was from perimenopause and menopause.
4:01How about Halle Berry, right, who has
4:03access to all the doctors in the world
4:05and she publicly came out and said she
4:07was diagnosed with genital herpes when
4:09she really just had the genitourinary
4:12syndrome of menopause. The rich people
4:14are not getting good information about
4:16their bodies, about their hormonal
4:18health, about their sexual health. So,
4:20what are the rest of us doing? We don't
4:21teach it in medical schools, we don't
4:23teach it in residencies. I didn't learn
4:25anything about it and so we are actually
4:27getting worse at this, not better at
4:29this. And so I'm full of rage because we
4:32actually do have a lot of data and we do
4:34have a lot of information that we are
4:35not using because everyone forgot to
4:37teach your doctor.
4:39>> It's staggering to me that, you know,
4:42those very affluent women that you've
4:44mentioned still are being let down by a
4:46medical system. Um, it also sort of begs
4:49the question that if men were in that
4:51situation, this probably wouldn't be the
4:53case. And that's says something about
4:55the research and the investment that's
4:57gone into understanding women's health
4:58relative to men's health.
5:00>> It's a huge problem. We don't have
5:01enough specialties of medicine that
5:03focus on women's health and we don't
5:06have enough like manpower behind us. We
5:08can throw money at the situation, but
5:09you need physical human beings to roll
5:12up their sleeves and do this work. Like
5:14doing research is challenging and you
5:16need people to actually disseminate the
5:18research and talk about the research and
5:20you need the training to happen so it
5:21has to trickle down. So, just because
5:23someone wrote a paper doesn't mean it
5:25automatically gets downloaded into every
5:27doctor's brains. So, someone has to
5:29teach someone how to do something. So, I
5:31I lecture all the time. I do a lot of
5:33trying to teach clinicians how to do
5:35this. I travel all over to say, "Here's
5:37how to write prescriptions." because
5:38that's what it's going to take. There
5:40was so much fear and misinformation 20
5:43years ago about hormone therapy that it
5:45is a lost art. Doctors don't know how to
5:47write the prescriptions. Nobody taught
5:49them how. So, even if they see headlines
5:51and Melinda Gates giving $10 million to
5:53the Menopause Society, that's wonderful,
5:56but it doesn't translate into them
5:58knowing how to actually write the
5:59prescription, knowing the difference
6:01between the type of hormones, knowing
6:02the safety, the risk, the benefits,
6:04because they never had the class. For
6:06example, I'm a urologist. If someone
6:08comes in to me asking about their blood
6:10pressure, I'm not going to pretend like
6:12I know everything about their blood
6:13pressure. I'm going to be very honest
6:14that I have the limitations in my
6:16training. But, for some reason with
6:18hormone therapy and women's health,
6:20every doctor you go see has strong
6:22opinions and will tell women what they
6:24can and cannot have with their bodies
6:26even when they don't know the data. I
6:28come from the men's health world. We
6:30don't tell men you can't have this. You
6:32can't do this. We we talk about shared
6:34decision-making. We talk about risks. We
6:36talk about benefits. For some reason we
6:37don't do that enough in women's health.
6:39>> Why?
6:39>> I think part of it I don't think your
6:41doctor is evil. I actually have a
6:43thought about this. So, I think your
6:44doctor wasn't trained. I think they're
6:46trying to save face. And I think 10
6:48minutes is impossible to give good
6:50medical care. I could never get to know
6:52you fully in 10 minutes and really give
6:55you great advice on your life that's
6:56customized for you. It's almost like the
6:58difference between a viral clip that
7:02you're going to try to do from this
7:03episode and the long-form nuanced
7:05conversation that you're going to have.
7:07You love the nuanced conversation. You
7:09love spending those those 2 hours. And I
7:11think patients want that, too. But, when
7:13they go to the doctor, they're getting
7:14the 10-minute version. And instead of
7:16doctors saying I don't know, they're
7:18sort of saying no no you can't have this
7:20cuz it's easier than than sort of going
7:22into that nuance, which can take time. I
7:24also think that people are going to
7:26their doctor, say say you want to talk
7:29about your orgasm or your libido. Okay?
7:31You go to your gynecologist. Of course,
7:33my gynecologist should know everything
7:35there is to know about the clitoris,
7:37about orgasm, about hormones, about
7:38That's what they do. And the truth is
7:40it's not what they do. And it's they
7:41were never taught that. And they
7:43>> taught about the clitoris.
7:44>> They were The word clitoris today in
7:452026 does not exist in the checklist for
7:50what an OB/GYN has to learn in their
7:51training. The word doesn't exist.
7:53>> What is an OB/GYN for anyone that
7:54doesn't know?
7:55>> An OB/GYN is a doctor who specializes in
7:58obstetrics, so delivering babies, and
7:59gynecology. So, your gynecologist has
8:02never been taught about the clitoris,
8:05about the vulva, about sexual health,
8:06about sexual pain, about libido,
8:08arousal, and orgasm. And so, the ones
8:10who have taken it on their themselves to
8:12get extra training, they're very few and
8:14far between. And so, every day women,
8:17and men too, are going to a doctor
8:19expecting answers on a topic that their
8:23doctor probably has never gotten
8:25training on.
8:25>> And I do want to focus today's
8:26conversation on women's health. And I
8:28want to preface all of this by saying
8:29that I'm going to be as dumb as I am on
8:32this subject. If you say something about
8:34the vagina and I don't know what it
8:35means, I'm not going to pretend to know.
8:37I'm going to ask you what it means. And
8:38I say that because I sometimes think
8:40with these conversations
8:42um the host
8:44often
8:45is too shy to admit their ignorance. And
8:48I have lots of ignorance on this. But I
8:50also have lots of curiosity, and I want
8:51to fill those gaps. And that's going to
8:52require me to be very, very
8:55dumb. And also, my second reason why is
8:58because I have so many women in my life.
9:00Um if you just look at my company, my
9:01entire executive team in my company are
9:03all women. And also, I've got my fiance,
9:05my mom, my sister. And understanding the
9:09women in my life um one element of
9:11understanding them is understanding
9:12their health. Women's health isn't
9:14something that I was ever taught in
9:15school. It's not like a lesson I had.
9:16So, I also think this conversation
9:19is for men. Every man has um four
9:21important women in their lives. So, my
9:23question to you is if if a woman has
9:25clicked on this conversation right now,
9:27what are they going to get from it?
9:28Let's start with that first question.
9:30>> So, I think it's really important
9:32because as men, we expect the women to
9:34know. Surely the woman knows about their
9:36menstrual cycle, about pregnancy, about
9:38postpartum, about menopause, about
9:40hormones. Surely my partner knows, you
9:42know, or the woman in my life, my mom,
9:44my sister, my my daughter, they know all
9:46of that, so I don't have to. And the
9:48truth is, they don't know. When the
9:51women in your life go to their doctor
9:53and they're getting a pelvic exam, say
9:54they're getting a Pap smear, a doctor is
9:56looking at their their genitalia,
9:58putting a speculum in, going inside the
10:01canal and looking around. We put a sheet
10:03over you like we are me chanics looking
10:05under the hood. So, we put a sheet to
10:07keep you comfortable, to keep you
10:09modest, but we we hide your genitalia
10:12from you and we don't teach as we go.
10:15So, I became famous again because I I I
10:18when I started my practice, I didn't buy
10:20any fancy equipment, I bought two
10:22mirrors on Amazon and I give women a
10:24mirror and as I'm examining them, I say
10:27to them, "This is your labia majora.
10:29This is your labia minora. This is your
10:30clitoris. This is your your urethra, the
10:32tube that you pee through." Because
10:34women can't see it. You've got skin,
10:36you've got bones, you've got muscles,
10:38you've got nerves, you've got, you know,
10:40all the organs that are on the inside
10:43and women don't have access to this
10:45language. Certainly men don't have
10:47access to this language. And so, it's
10:49that basic ability to give women
10:51language, you can learn about your body
10:53parts, you can learn how hormones work
10:56in your body, and you can learn basic
10:59medicine for you that becomes important
11:01for how you advocate for what you want,
11:03what you care about, and who you bring
11:05into your medical life. You may have a
11:07physical therapist, you may have a
11:08mental health person, you may have a
11:10primary care, a gynecologist, you may go
11:12on Instagram and get great information
11:14from people on Instagram. And so, that
11:16doctor that makes you feel like crap
11:18because they they tell you something
11:19that you don't agree with, find a
11:21different one, right? You have to
11:23advocate for yourself and I find we are
11:25starting to empower women to do that, um
11:28which is very challenging.
11:29>> What is the most popular question you
11:31get asked now that you've been on these
11:33podcasts and you know you're out there
11:35and you've done millions and millions of
11:36views all over the place and on clips
11:38and so forth. What is the number one
11:39most popular question you get asked?
11:41>> I'm asked a lot about hormones. Like
11:44people want to know about hormones.
11:46People want to know about pain with sex.
11:49And I think people want to know about
11:50libido. I think those are the three I
11:52would say most common things that we
11:54talk about.
11:54>> go in that order then. So let's start
11:56with the subject of hormones. What is it
11:58about hormones that people are so
12:00desperate to understand?
12:01>> So hormones are fascinating because we
12:03forgot to teach doctors anything about
12:05hormones.
12:07And what we have taught about them, they
12:09think it's dangerous, they think they're
12:10harmful, they think that you know it's
12:12it's almost like this thing that is
12:14natural in your body is somehow
12:16dangerous once you get over a certain
12:18age. And that is all politics and bad
12:22interpretation of science.
12:24>> I've got this graph here which um
12:26shows female testosterone levels by age.
12:30And again, as someone that has started
12:32to understand more about female
12:33hormones, I was quite surprised because
12:35you think of testosterone as a male
12:37hormone.
12:38>> Yeah, so that's the biggest
12:39misconception is that women don't make
12:40testosterone. Testosterone is just a
12:42hormone. It's not a male hormone, a
12:44female, it's just a hormone. It's also
12:45not a menopausal hormone. We think of
12:47menopause as estrogen starts to drop,
12:50right? So menopause is a castration
12:52event. If I cut your testicles off right
12:54now, you would have hot flashes, night
12:56sweats, osteoporosis, depression, low
12:58libido, erectile dysfunction, metabolic
13:01syndrome, your weight would go up and
13:03you would be generally pretty unhappy.
13:05It's a big deal when we castrate people.
13:07And yet, we don't do it for men
13:09regularly unless there's a very
13:10significant medical reason to do so. And
13:13yet, every woman over the age of 50,
13:16her estrogen goes to essentially zero.
13:18And that affects bone health, it affects
13:20the brain, it affects the heart, it
13:22affects sexual health, it affects UTIs
13:24start to go up. And so it's a whole body
13:26event that happens. Now, testosterone's
13:28really interesting cuz it actually isn't
13:30at menopause that you lose testosterone.
13:33It happens in your 30s. So, if you look
13:35at this graph, right? You can see
13:37testosterone starts to precipitously
13:39drop in your 30s. So, what do we see
13:41clinically? Sometimes nothing, but we
13:43have a lot of people who will start in
13:45their 30s, mid-30s, late 30s start to
13:47say, "Ooh, my libido's not as high as it
13:49used to be. Huh, my orgasm takes a
13:51little bit longer. I don't feel as
13:53aroused. My engorgement is not the same.
13:55My lubrication
13:56>> Engorgement.
13:57>> Engorgement of the clitoris. It's the
13:58same as an erection, right? So, the
14:00clitoris and the penis are the same.
14:01They get hard with blood flow. And so,
14:03this happens in your 30s and no one's
14:05paying attention because if you look at
14:07the graphs that we are taught in med
14:09school, they look more like this. So,
14:11the books all talk about estrogen and
14:13progesterone. They don't talk about
14:15testosterone very often. And there's
14:17also a lot of things we do to worsen
14:20this problem. When you play with
14:21hormones, there are consequences,
14:23sometimes good and sometimes bad because
14:25we do so much to mess with our hormone
14:27levels. Again, birth control pills, the
14:29way that they work is changing hormone
14:31levels. Medications for acne,
14:34medications for hair loss that people
14:36are using can affect your testosterone
14:38levels. So, birth control is wonderful,
14:41but there are side effects to birth
14:43control just like there's side effects
14:44to any medication. And so, one of the
14:46side effects is it lowers testosterone.
14:49And so,
14:50that can cause low libido, pain with sex
14:53in a small subset of people who take it.
14:55So, if you're someone who does have side
14:57effects, then it's worth having
14:58conversations of different forms of
15:00birth control which may not lower your
15:01testosterone as much. Does that Does
15:03that make sense?
15:04>> It does make sense and it's
15:06it's interesting. My My partner's talked
15:07about this before. My fiance, she was on
15:10birth control for a long time
15:12and she also had concurrently libido
15:14problems.
15:16Now, we don't know whether it was the
15:18birth control, whether it was something
15:19else, but when she came off the birth
15:22control pills, her libido
15:25challenges also evaporated.
15:27>> So, can explain cuz I think again,
15:29knowing the basics and the fundamentals
15:31give women and men access to the
15:33information so they can make choices
15:35with what they want to do with it. Okay,
15:36so how do birth control pills work? Um
15:39when you take a combined birth control
15:41pill, it has a fake amount of estrogen
15:43and a fake amount of progestin in it so
15:46high that it tricks your body into not
15:48ovulating. So, when you have so much
15:50hormone around, your body says, "Oh, I
15:51don't need to make my own cuz there's
15:53plenty around." And so, the ovaries shut
15:55down. So, your ovaries are no longer
15:57making their own hormones because this
15:59happens to men, too. When you take high
16:01doses of testosterone, you become
16:02infertile because your testicles say,
16:04"Oh, I don't need to produce sperm right
16:05now cuz there's plenty of testosterone
16:07around." And so, birth control causes
16:09your ovaries to just stay quiet. They
16:10shut down for a bit. But, your ovary
16:12does three things. It does estrogen,
16:14progesterone, and testosterone. It
16:16doesn't add back testosterone. So, her
16:18experience possibly was because she
16:21wasn't making her own testosterone. And
16:24when she went off that birth control,
16:25her ovaries woke back up and make
16:27estrogen, progesterone, and
16:28testosterone, which to you equaled more
16:31pleasure. Now, because we focus on the
16:33psychosocial, I'll have a lot of people
16:35saying, "No, no, no, it's all
16:36communication." And all of that is
16:38important. Don't get me wrong. But, the
16:40biology matters too. And we know there
16:43is a biological basis to sexual health
16:45for everybody.
16:47>> I was just looking at some data and it
16:48said that in some studies, up to 27% of
16:51people on birth control report a
16:54decrease in their libido/sex drive.
16:57>> Yeah.
16:57>> Which is shocking cuz, you know, it
16:58varies in these studies from one to
17:00seven people to one to that's almost
17:02like one one in three people
17:04are experiencing it. How does one
17:05navigate that, you know, cuz birth
17:07control has tremendous um upsides?
17:10So, how do you navigate that?
17:11>> I think that everything that we do,
17:13there's the risk of doing something and
17:15the risk of not doing something. No drug
17:17is going to be without possible side
17:19effects and so that's where becomes
17:21important to know what are the
17:22non-negotiables. Antidepressants is a
17:25perfect example. We know that they can
17:28help people, right? A lot of people, but
17:30we know there are sexual side effects
17:31like low libido, delayed orgasm. And so
17:34it has to do with informed consent,
17:36which means I Stephen, if I'm going to
17:38give you a medicine, I want you to know
17:40that there is the common side effects,
17:43the less common side effects, and then
17:45the disastrous side effects. That's why
17:46on the commercials they talk about all
17:48the disastrous side effects. But often
17:50they don't even research the sexual side
17:52effects. So for example, GLP-1s, okay?
17:56>> What's a GLP-1?
17:56>> Yep, the GLP-1s are the weight loss
17:58drugs that everybody's talking about.
17:59Ozempic, Mounjaro, all the all the
18:02celebrities are on these injections that
18:04are making them lose tons of weight. We
18:06are starting to look at these drugs in
18:08women, but they're not nobody's looking
18:10at it for sexual health. Everyone's
18:12looking at it for can you get pregnant?
18:14Reproductive health. There is not a
18:15single published paper on sexual health
18:18side effects for women. So we did a
18:20survey, it's not published yet, but we
18:22presented it at a conference at a
18:24medical conference. We surveyed a
18:26thousand women online who have taken
18:28these medications and about 25% report
18:32sexual side effects from these
18:34medications. Again, that's not to say
18:35the medicines are good or bad, right or
18:37wrong, but there are side effects. Now
18:39of those 25% about 50% of those people
18:42said it lowered their sexual function
18:44whether it's libido, arousal, and
18:46orgasm. And about 25% said it made it
18:48better.
18:48>> So carrying on in this track about
18:51women's hormone levels through time and
18:53through age and through life phases,
18:55what else do I need to know or
18:56understand about how important
18:58testosterone is?
19:00>> So we know we have global consensus
19:02actually that testosterone helps for
19:04libido in postmenopausal women, okay?
19:07Now there is also data in perimenopausal
19:10women as well and that is clear data. It
19:13helps with libido, but it also helps
19:15with arousal, it helps with orgasm, and
19:17satisfaction. It can also help with body
19:20image, which is like a cool a really
19:22cool thing. In my clinic, I use FDA
19:24approved testosterone for men, and I
19:26give it to them in doses appropriate
19:28like 1/10 the dose for a man, I give it
19:30to my female patients. And I see that
19:33over the 3 to 6 months of taking it,
19:36they get this
19:38it clicks. Now, does that mean every
19:39woman on Earth needs it? No, we're not
19:42there yet, but if you want it and you
19:44want to try it and you're curious about
19:45it, then you should have access to
19:47physicians who understand how this works
19:49and they know how to write the damn
19:51prescription.
19:52>> There's five life stages on here. We
19:53have puberty, your fertile years,
19:55perimenopause, menopause, and then post
19:58menopause.
19:59When you think about a woman's hormonal
20:01journey through these different life
20:03stages,
20:05what is the sort of advice you would
20:06give them to make sure they're
20:07hormonally healthy across every life
20:09stage? What are like the basics? What
20:11are the tactics, strategies, medications
20:14that they should be thinking about? And
20:16I say this because I've got women women
20:17in my life for every stage in this life
20:20phase at the moment. I've got you know,
20:21I've got my nieces in the sort of
20:23puberty era. I've got my my fiance in
20:26the fertile years. I've got my mom and
20:28grandparents etc. in the peri- and
20:30post-menopause years as well.
20:31>> Yeah. So, if you look at your nieces for
20:34example, when they were babies compared
20:36to now, there are changes happening.
20:38Their bodies are transforming because
20:40they're getting a surge of hormones in
20:41their body and that's estrogen,
20:43progesterone, and testosterone. They're
20:44cycling, which means they're getting
20:46periods. So, let's talk about the
20:48menstrual cycle for a second. I think
20:49it's helpful.
20:50>> Okay.
20:51>> So, [clears throat] when women have
20:51their period,
20:53they bleed for a few days, right? And
20:56that's when their hormones, their
20:57estrogen and their progesterone is at
20:59its lowest, okay? So, hormones are at
21:01their lowest. And then
21:04the hormones start to increase. Your
21:05estrogen starts to go up. You don't make
21:07progesterone yet in the beginning. Your
21:08estrogen starts to go up and it make
21:11there's a a follicle in your ovary which
21:13has an egg, right? It's going to pop out
21:14an egg.
21:16Ovulation is when the egg pops out. So,
21:18you get this big surge of estrogen and
21:20then when the egg pops out of the ovary,
21:22right? That's what's going to make a
21:23baby if it gets fertilized, there is a
21:25shell of the egg, right? The egg has a
21:27shell which makes progesterone. So, the
21:30second half of the cycle there's
21:31progesterone around, okay? First half of
21:33the cycle no progesterone.
21:35>> Mhm.
21:35>> And so, that [clears throat] second half
21:36of the cycle the shell has making
21:38progesterone and then when you don't
21:40have fertilization, the shell starts to
21:43break down.
21:43>> Okay.
21:44>> And that natural breakdown is a drop in
21:46progesterone which causes the lining of
21:48the uterus to shed and you get a period
21:50again. And so, it's estrogen goes high
21:53in the beginning and then pops out an
21:55egg, progesterone gets high in the
21:56second half and then they both fall and
21:58you have a period. And so, the hormones
22:00being low in the beginning, estrogen is
22:02not zero. It's about 50, okay? So, when
22:04we talk about numbers, if you get your
22:06your hormones checked, if they're at
22:07their low it's like 50, but when you
22:09ovulate, your estrogen may be 150, 200,
22:12300. And then when you're pregnant, your
22:15estrogen may be as high as 3,000 or
22:17higher, right? It's very many thousands.
22:19And so, these hormones have actions in
22:21our bodies. And so, the reason it's
22:23important is cuz when we give back
22:24hormone therapy, well, are we giving
22:26back 10,000 like pregnancy? No, we're
22:28giving back to be like 50, 60, 70, the
22:31way that you are early in your cycle
22:33kind of a thing. Now, testosterone's not
22:35even on this graph that everybody gets
22:37taught of estrogen then progesterone,
22:39but we do know testosterone is pretty
22:41stable through the cycle, although we do
22:43believe it peaks during ovulation which
22:45makes sense cuz you want to have a baby,
22:47right? So, evolution says, "Okay, you
22:49need to be horny around the time that
22:50you are going to ovulate." And so, your
22:53testosterone starts to go up. Now, it's
22:55really important cuz you're probably not
22:56having a conversation with your nieces
22:57about their menstrual cycles, but it's a
22:59problem because no one's talking about
23:00it if they're painful, if they're
23:02abnormal, if they're um uh uh uh we
23:05don't have a lot of conversations around
23:07what is a normal amount of bleeding. We
23:09have so many people who have problems,
23:11whether it's PCOS, which is now called
23:13PMOS, which is a metabolic issue that
23:16causes you to have irregular periods.
23:18There's endometriosis where you have
23:19painful periods. There are so many
23:21medications we give to people that can
23:23alter their hormonal health and and
23:25sexual health for that matter. And then
23:27it all starts to get even more chaotic
23:29in perimenopause, which is again age 35
23:32to 45. If menopause we say is 45 to 55,
23:35right, is normal menopausal age. Average
23:37age is 52, and we think perimenopause is
23:40when things start to change for people
23:41about 10 and it can be about 10 years.
23:44That means 35 to 45. So, how old are
23:46you? I don't remember.
23:47>> 33.
23:48>> 33. And my partner's 33.
23:49>> All right, so 33. So, this idea that I'm
23:51too young or it's too early or I'm not
23:54there yet, the truth is things do start
23:57to change.
23:58>> What changes for a woman?
23:59>> So, there are so many symptoms to
24:01hormonal fluctuations. So, for some
24:03people it's temperature changes, for
24:04some people it's fatigue, for some
24:06people it's remembering things, for some
24:07people it's low libido. Some people get
24:09dry eyes, itchy ears, burning mouth,
24:12joint pain. Some people get irregular
24:14periods. Some people get pain with sex.
24:17Some people get UTIs. I would love to
24:19talk about what why hormones are so
24:21important for the bladder and UTI
24:23prevention. And so, there are so many
24:25symptoms and everyone says, "Oh, we're
24:27blaming everything on hormones." And the
24:30truth is, we haven't talked about
24:31hormones enough to actually start
24:33looking at this to figure out what is
24:35important and what is hormonally
24:36important.
24:37>> So, when you start to lose progesterone,
24:39when you arrive at perimenopause, what
24:41are the symptoms you feel? Are they
24:42different symptoms to decline in
24:44estrogen?
24:45>> So, it's hard to know for sure, but some
24:47people think that as the progesterone,
24:49so your sleep starts to get a little
24:50crazy, anxiety starts to go up. And so,
24:53some people will start with progesterone
24:55as a support for
24:57you know sort of perimenopausal hormone
24:59therapy but estrogen can also help with
25:01many of those symptoms. So it's not a
25:03one size fits all of whether we give
25:05people everybody gets progesterone or
25:06everybody gets estrogen. Sometimes
25:08people just get testosterone because
25:09remember that falls in your 30s you know
25:12so there's sometimes where we
25:14do all three and there's sometimes where
25:15we do just one or two. Now it's a very
25:18evolving conversation because most of
25:20the book answers most of the guidelines
25:23really talk about menopause and how we
25:25treat people in this menopause when
25:26you're flatlined. Remember that
25:28castration event where everything's zero
25:30and then we add back hormones. So now
25:32we're starting to talk about
25:33perimenopause as a place to to start
25:36giving women hormones and that's a a
25:38very important and evolving conversation
25:41that is happening.
25:41>> And so this conversation that's
25:44sort of raging on about HRT
25:47about safety about what age you should
25:50take it who should take it what form you
25:51should take it in. What's your
25:53perspective on that and what do women
25:54need to know about that?
25:55>> Yeah so so it's important because
25:58>> is HRT?
25:59>> Yeah it's a great question. So hormone
26:00replacement therapy which is a term that
26:03we used to use for hormones in
26:05menopause. It has a bunch of different
26:07names and everyone tries to change the
26:08marketing around it but hormone therapy
26:10in general is this idea of giving back
26:13hormones when you have hot flashes night
26:15sweats osteoporosis you know sort of
26:18this over 50 crowd that has this
26:20declining estrogen and progesterone
26:23levels. And so typically classic hormone
26:25therapy is estrogen and progesterone.
26:28Now again taking just estrogen estrogen
26:31grows things it helps your bone health
26:33it helps your hair skin and nails it
26:35helps you not have hot flashes it helps
26:36you sleep. It can also grow the lining
26:39of the uterus and so if it gets thicker
26:41thicker thicker there is worry over
26:43years that leads to endometrial or
26:45uterine cancer. So endometrium is the
26:48lining of the uterus so here I can okay
26:50so this is a this is a vagina and then
26:54at the the vagina's like a socket. The
26:56very end of the socket is a tiny hole
26:58and that hole is the the pinpoint
27:00opening of the cervix and that hole if
27:03you go through that tiny tiny hole, it
27:06gets to the uterus and the uterus is a
27:08cavity where we hold babies
27:11where the lining comes out. That's what
27:12period blood is is the lining of the
27:15uterus here which we'll call the
27:16endometrial lining. So progesterone is
27:18very important for this lining here. If
27:21the the lining of the uterus gets too
27:23thick with just estrogen, that can lead
27:25to problems, but if you match it with
27:27progesterone, those problems go away.
27:29>> Right. So so if you just gave someone
27:31estrogen, then the linings of the uterus
27:33would get so thick that that would cause
27:34a problem, but if you give it to both
27:36hormones together, it sort of balances
27:38itself.
27:39>> them out and so that's why you'll hear
27:41hormone therapy talked about estrogen
27:42and progesterone just like the birth
27:43control pill your partner was on was an
27:45estrogen and a progestin. There was a
27:47combination.
27:48>> Okay, got you.
27:49>> And also the history is kind of
27:50important here of why your mothers and
27:52grandmothers weren't given access to
27:54this medication and the stigma behind
27:57it. In the late 90s, a lot of people
28:00were on hormone replacement therapies
28:02and they were seeing benefits. They
28:04actually were all these observational
28:06studies that showed wow, the heart
28:07disease is less and like
28:09>> During menopause.
28:10>> during menopause and a billion dollars
28:12went into the NIH to study this in women
28:15and they did they that was called the
28:16Women's Health Initiative. It was
28:18thousands and thousands of people age 50
28:20to 79. They gave a hormone pill like a
28:23birth control pill almost to all of
28:25these women and they followed them and
28:27they stopped the study early in the
28:29early 2000s and they did a press
28:31conference and at this press conference
28:32they said we're shutting down the the
28:34study early. Hormone therapy causes
28:36cardiovascular disease and breast
28:38cancer. And overnight, a multi-billion
28:41dollar industry went to nothing.
28:43Everyone was told throw your hormones in
28:45the garbage. This is dangerous. What was
28:47crazy is those people who were
28:49prescribing hormone therapy were looking
28:51around saying, "I don't understand. My
28:53patients aren't dying of heart disease.
28:55They're not getting extra breast
28:56cancers. Like, this doesn't make any
28:58sense." And when people actually looked
29:00at the study, it didn't say any of those
29:02things. It was wild how misinterpreted
29:04this study was. In fact, the same
29:07authors of this study back in the early
29:082000s published this year, in 2025
29:11actually, that below age 70 that type of
29:15hormone therapy, which we don't really
29:16use anymore, has no increased risk of
29:19cardiovascular disease or stroke. And
29:21yet now you have a generation of doctors
29:23who weren't taught how to do this. Only
29:251.7% of women have are getting
29:28prescriptions for hormone therapy who
29:30who should be offered prescriptions. So,
29:32it is a disaster.
29:34>> Only 1.7%?
29:35>> Only 1.7%.
29:36>> Oh, really? Hmm. Wow.
29:38>> And so, hormone therapy is not something
29:41that I'm saying every woman must have,
29:43but every woman should have access to
29:45the toolbox. I like to think about
29:47hormone therapy is really four buckets
29:49that we talk about. Hormone therapy is
29:51whole body estrogen, which helps with
29:52hot flashes, night sweats,
29:54uh bone loss, progesterone, whole body
29:57progesterone therapy, which protects the
29:59uterus and is this yin yang, especially
30:00if you have a uterus, but it helps with
30:02sleep, and it can help with anxiety
30:03reduction in many of our patients, not
30:05everybody, but a lot of them. The third
30:07thing is testosterone, which we talked
30:09about, which can help with libido. Um
30:11that's what we have the most evidence
30:13for. And then the fourth thing is
30:14vaginal hormones. Now, vaginal hormones
30:17are microdoses of estrogen or what we
30:20call DHEA vaginally, that supports the
30:23bladder and the vagina. So, it helps
30:24with pain with sex, dryness, urinary
30:27frequency, urinary urgency, leakage, and
30:30it prevents urinary tract infections
30:32massively. It is safe for your great
30:34grandmother in the nursing home. It is
30:36safe for your wife who's breastfeeding.
30:39So, if you know anyone in your life who
30:41is a woman, who's having urinary
30:43frequency, urgency, leakage, urinary
30:46tract infections, pain with sex,
30:48dryness, there is a magical solution
30:51that is safe for everybody on Earth um
30:54that is microdosing these hormones
30:56vaginally.
30:57>> At any age?
30:57>> At any age at all. In fact, even more
30:59important for people who are older
31:02because they are dying of urinary tract
31:03infections. So, it's it's it's one thing
31:06when a young person gets a urinary tract
31:08infection and they go to the urgent care
31:09and they get an antibiotic. Even they
31:11deserve prevention and this is prevents
31:14uh those problems in those people, too.
31:15>> Again, what is this?
31:17>> So, vaginal hormones. So, this is a
31:18really important topic. It's called
31:20genitourinary syndrome of menopause or
31:22GSM. Say GSM loudly for your listeners.
31:25>> GSM.
31:26>> GSM, genitourinary syndrome of
31:28menopause. Genital, urinary, syndrome of
31:32menopause. But, really, it's kind of a
31:35dumb name because it's any hormonal
31:37changes in your body can affect the
31:40bladder and the genitals.
31:41>> So, UTI. What is a UTI? And what's
31:44what's causing a UTI? U- urinary tract
31:47infection.
31:48>> Yeah, very good. So, urinary tract
31:49infections are when there is bacteria in
31:52the bladder and it can be a lot of uh of
31:55bad bacteria that can grow and create uh
31:57inflammation. It causes bladder pain,
32:00pain with urination. It feels like razor
32:02blades. Um but, it can also go into your
32:04bloodstream and cause fevers and chills
32:06and cause kidney infections. It can
32:08cause something called urosepsis where
32:10you have to go to the intensive care
32:12unit and need uh antibiotics through an
32:14IV and it can kill you if you have an
32:17infection go through your whole body.
32:18And this gets worse and worse as you get
32:20older.
32:21>> Why is there a link between hormones and
32:22UTIs?
32:23>> Yeah, because what happens is the vagina
32:26is supposed to be acidic and healthy and
32:29hormones help keep it. It is the
32:31hormones, the estrogen and the
32:32testosterone, that keep healthy bacteria
32:34growing in the vagina and suppress or
32:37lower the bad bacteria.
32:39>> So, there really is a vagina microbiome.
32:42>> There is and There's There's no
32:43probiotic on Earth that is proven to do
32:46what the vagina needs quite like
32:48hormones. Hormones make the tissue go
32:50from uh not acidic to quite acidic, and
32:53it is that acidic environment that
32:55protects it from infection. And so,
32:57perimenopause and menopause or other
32:59situations happen, and it changes that
33:02microbiome, so the good bacteria are are
33:05lower and the bad bacteria start to
33:07grow, which can increase your risk of
33:09infections. And sex Right, sex is a
33:12contact sport. So, uh you're bringing
33:14the outside environment into the inside
33:16environment. Uh ejaculate is also not
33:18acidic, and that can change the
33:20microbiome as well. And so, we know
33:21women who are sexually active also have
33:23an increased risk of urinary tract
33:25infections. So again, like a plant
33:28needing water, vaginal hormones help
33:30support the vagina and the bladder to
33:33maintain that acidic environment. And
33:35research has been clear since the 1990s
33:39that using vaginal hormones prevent
33:41UTIs, urinary tract infections, by more
33:43than half.
33:44>> So, what have we got here in front of
33:45me?
33:46>> All right. So, there's a bunch of
33:47different ways you can give yourself
33:49vaginal hormones. The most common way is
33:51a cream. Now, this cream is uh $14 on
33:55Mark Cuban's pharmacy, and it lasts
33:57about 2 and 1/2 months. Now, this cream
34:00that comes with an applicator, which you
34:02don't ever have to use if you don't want
34:03to, but what you can do is you want to
34:06use 1 g of this cream. So, this amount
34:09is 1 g of this cream. We'll put it on
34:11this paper here to show you. 1 g of this
34:15cream rubbed into the vagina. So, you
34:18take it You can take it on your fingers
34:20and rub it into the walls like you If
34:21you put sunscreen on your face, you
34:23don't glob it on and walk out the door.
34:24You rub it in, so it doesn't look all
34:26white and filmy. So, you put it in You
34:28take it with your finger and you put it
34:31in the vagina and you rub it into the
34:33walls of the vagina you can rub it on
34:35the outer this area as well at the
34:37opening.
34:37>> Let me try it. I don't have a vagina but
34:40So you take the this what what is this
34:43cream called?
34:43>> It's estradiol cream.
34:45>> Estradiol take it on your finger you rub
34:47it inside the walls of the vagina like
34:49this.
34:49>> rub it in like you would rub sunscreen
34:51on your face and if you do that twice a
34:53week you can prevent death from urinary
34:56tract infections. You can help with
34:58urinary frequency, urinary urgency,
35:00leakage, you make sex not painful and
35:02dry, it helps with arousal and orgasm.
35:04It's literally better than Viagra and
35:07this is over the counter in the UK. In
35:09the United States you need a
35:10prescription um but it's as little as
35:12$14 if you use Mark Cuban's online
35:15website it should be covered by your
35:16insurance. Now some women hate creams
35:18and so we have things that are not as
35:20messy as what you're showing right there
35:22and we have little tablet inserts. So
35:24here is a it comes with an applicator
35:27and so what a woman does is put this in
35:28her vagina and press a button
35:32and this little tablet so instead of a
35:34cream you could just put this little
35:35tablet in twice a week and that does the
35:38same thing as the cream.
35:40>> Ah okay.
35:40>> Okay so it's a little less messy so
35:42people tend to like the creams better.
35:44Now if you really don't want to do
35:45anything twice a week this is a ring
35:47that goes in the vagina and it can stay
35:49in there for 3 months. Now this it's
35:52sort of like a tampon you can kind of
35:54put it in the vagina and the vagina does
35:55not feel it. By the way the vagina is
35:57not very sensitive in terms of
35:59nerve endings and so when women put
36:01tampons in they don't feel them. When
36:03you put this ring in that you wouldn't
36:05feel it either and it would stay in for
36:063 months at a time.
36:07>> It's quite it's quite quite a big ring.
36:09>> Vagina can hold like a bowling ball of a
36:12baby can come out of a vagina so it can
36:13actually withstand quite a lot of
36:16volume.
36:16>> And there's a chemical inside this ring
36:18that's going to diffuse
36:19>> Estradiol that slowly diffuses estrogen
36:21for the ring. So that's nice for women
36:23who have dementia, who have very bad
36:25dexterity with their fingers, they're in
36:27a nursing home, uh for someone who's on
36:29the go and they can't remember something
36:31twice a week. So, our ADHD patients like
36:33things like that. And so, there's just
36:34different It's all the same stuff. It's
36:37just in different formulations. Now, the
36:38one different one, this is something
36:40called DHEA. Now, DHEA is the precursor
36:44hormone to estrogen and testosterone.
36:47And remember I said the vulva, the
36:48vagina, the bladder need testosterone,
36:51too. It So, this is a a chemical that
36:54converts into estrogen and testosterone.
36:57And so, DHEA is a supplement you can
36:59buy, you know, sort of in the in the
37:01supplement aisle, but if you put it
37:03locally in the vagina, this is an
37:04FDA-approved product. It's called
37:05Intrarosa. And if you just put this in
37:07the vagina, uh uh it's meant for every
37:10night, but you can do it twice a week.
37:12Um it it melts at bedtime. When you wake
37:14up, and it prevents UTIs. It helps with
37:17pain with sex.
37:18>> And just to be clear again, so you think
37:20a lot of people should be taking these
37:22these things?
37:23>> believe it's preventative. So, I think
37:25And we wrote guidelines by the American
37:27Urological Association uh why this is so
37:29important, how to do it. So many women
37:32have symptoms of urinary frequency,
37:33urgency, leakage, uh urinary tract
37:36infections, pain with sex, dryness. And
37:38this is a safe option for all of those
37:41women. Does that make sense?
37:42>> It does make sense. And one of the
37:43things that doctors sometimes tell their
37:45patients to take to help with the UTI
37:48situation is that?
37:51>> Okay, this is a disaster. So,
37:53women get urinary tract infections a
37:55lot. And so, what do we tell women? Pee
37:57after sex. Wipe from front to back.
38:00Like, that's not data-driven, by the
38:02way. That's all a folk folk tale. Like,
38:04that's that's folklore. There is some
38:05data that cranberry pills can help uh
38:08with preventing UTIs, but the uh amount
38:11that you'd have to drink is uh very
38:14sugary and diabetes-inducing and won't
38:16taste that good. And so, there they do
38:18make pills, but it's a small These
38:20things are small things that help.
38:22Drinking lots of water can help, but
38:24vaginal hormones, vaginal estrogen or
38:26vaginal DHEA, which we just showed a
38:28bunch of, prevent UTIs by more than
38:31half. They don't just prevent UTIs, they
38:33help with urinary frequency, urgency,
38:36leakage, pain with sex. They help your
38:38arousal, they help your orgasm, and
38:40they're safe for every age with every
38:43medical problem. If you've had cancer,
38:45blood clot, stroke, any problems at all,
38:47vaginal hormones are safe and could save
38:50your life. And so this is such an
38:52important topic.
38:53>> There should be a button just down below
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39:10Thank you so much.
39:11My my partner's 33 years old now. She's
39:13not yet in the perimenopause stage. At
39:16what point does someone start taking
39:18HRT? Is it when they're in
39:21the menopause stage, which is defined as
39:2312 consecutive months without your
39:25period? Is it when they're
39:26postmenopausal? Is it in perimenopause?
39:29>> Yeah, this is a very important question
39:31cuz it's not a one-size-fits-all. At
39:32this age, start this medicine. It's
39:34really when people start having
39:35symptoms. And so I'll give you an
39:37example. So say your partner um
39:40gets pregnant, okay? You decide to have
39:42a baby. Her estrogen is going to go to
39:4410,000 uh for 9 months. It's going to be
39:46super super high. And the day she gives
39:49birth, it's going to crash to zero. So
39:51you go from super high hormones down to
39:54zero. And if she chooses to breastfeed
39:56or pump or or do any of that, they stay
39:59extremely low in the menopausal range
40:02for the entire time you're
40:03breastfeeding. So when you are
40:04breastfeeding or pumping or doing
40:06anything uh and your periods don't come
40:09back, you're basically menopausal.
40:10>> And what are the symptoms then? So if
40:12you just had a baby, you're
40:13breastfeeding.
40:14>> have hot flashes, she may have night
40:15sweats, she may, you have urinary
40:17frequency, urgency, leakage. There's all
40:19sorts of symptoms that come come with
40:21that.
40:21>> Libido changes as well.
40:22>> Libido definitely changes, pain with sex
40:23goes up. And so we call this the
40:25genitourinary syndrome of lactation. And
40:28so there's all sorts of hormonal changes
40:30that can happen at that time. So we see
40:31a big need for vaginal hormones in this
40:34patient population. It's safe for the
40:35breast milk, it's safe for the baby, it
40:37doesn't cause any problems, but it can
40:38really help with all of those symptoms.
40:41Now say she is done having babies and
40:43now she's 30 8 39 40 and she is doing
40:48fine and she has regular periods and she
40:50has no symptoms and no problem. She may
40:51not need anything at all. But what if
40:53she starts getting a lot of urinary
40:54tract infections or having dry scratchy
40:56painful sex or her libido just doesn't
40:58feel it sort of feels like back it when
41:00it did on birth control pills. That may
41:03be an indication where she may benefit
41:05from whether it's testosterone or
41:08vaginal hormones or some kind of
41:09combination. What if she's 43 and her
41:12sleep starts to get really bad and that
41:14may be an indication for progesterone. I
41:17have a patient who was
41:19having hot flashes and night sweats and
41:21brain fog and fatigue. I see her and she
41:24says I will not take hormone therapy.
41:26It's not safe. My mother told me it
41:27causes cancer. At no point am I going to
41:30do this. I said, okay. We had a long
41:32conversation. I shared data and papers
41:34and we did a shared we just worked with
41:36each other and I wasn't pushing anything
41:38on her, but ultimately she started with
41:40vaginal hormones. Her orgasms come back.
41:43Her arousal gets back and she comes back
41:45to see me and says, "Rubin, what are you
41:46doing here? I'm feeling much better.
41:48Like this is you've given me my life
41:50again. I'm not peeing in the middle of
41:52the night so I'm sleeping better. I
41:54don't have as much dryness. Sex is no
41:55longer painful. I haven't had a UTI in
41:57months. What else do you got?" Well, she
41:59was still suffering with hot flashes and
42:01night sweats. She had a bone density
42:03scan which showed osteopenia and she was
42:06worried about osteoporosis cuz her
42:07mother died of osteoporosis fractures.
42:10Well, if she did whole body estrogen,
42:12she would prevent her risk of a of a
42:14fracture. She would make her hot flashes
42:15and night sweats go away, which would
42:17have benefit on how she sleeps, and
42:20ultimately probably benefit on her whole
42:21vascular system. And so, she started
42:24estrogen, and cuz she had a uterus, she
42:25took progesterone at night, and she
42:27said, "Well, my libido is still a bit
42:29low." We looked at her testosterone. We
42:31said, "Testosterone will likely help
42:33with your libido, but it's going to take
42:344 to 6 months." So, 4 to 6 months, she
42:36comes back to see me. Not only is her
42:39libido so much better, but she feels
42:41that she has the cognitive ability to
42:43enroll in law school. Like, this woman
42:46literally decides that she wants to
42:47change the trajectory of her career and
42:50enrolls in law school, and her brain is
42:53working in like ways she hasn't seen it
42:55in so long, and she is competing against
42:5822-year-olds in law school. And when I
43:00tell you she finished at the top of her
43:02class, she finished at the top of her
43:03class, whereas she said, "I would have
43:05never even considered this opportunity
43:08uh if I hadn't been doing all of these
43:10things." So, in
43:11>> And what age is she?
43:11>> She's in Now, she's in her 60s.
43:14And so, that's why I'm so loud about
43:16these things, because what other organ
43:18in medicine do we let fail completely
43:21before we like do something about it. We
43:23don't make you go blind completely
43:25before we give you eyeglasses. We don't
43:27let your kidneys run out completely
43:29before we give you dialysis or
43:30medications to help your kidneys along.
43:32We don't let you go into full liver
43:34failure before you get the transplant.
43:36Like, this idea of your ovaries have to
43:38fail, and you have to suffer for 12
43:40months before someone intervenes is
43:43insanity.
43:44>> But for some women, they do start HRT
43:46during the perimenopausal phase.
43:48>> Yeah.
43:49>> And for some, they start it during
43:50menopausal postmenopausal stage.
43:51>> Correct.
43:52>> And it's all depending on you how you're
43:53feeling.
43:53>> It's all depending on how you're feeling
43:55and what you want, what your objectives
43:56are.
43:57>> Okay. But it's never too early to start
44:00necessarily.
44:00>> not necessarily. Like, so again, we give
44:02birth control all the time to people in
44:04their reproductive years. Birth control
44:05is just high-dose fake hormone therapy,
44:08right? So, we're giving women hormone
44:09therapy as young as in their teens,
44:12right? To help with different things in
44:14birth control. But, so if you think of
44:15it as all of it is some form of hormone
44:18therapy, it just depends are we using
44:19the natural form of hormone therapy or
44:21we using the synthetic hormone hormone
44:23therapy? We have to get comfortable with
44:25hormones at all ages. And the thing that
44:27we see most commonly, Steven, is sort of
44:29what we call NFLM, not feeling like
44:32myself. I love that statement because
44:34women are coming to the doctor every day
44:36saying NFLM, I'm not feeling like
44:39myself, and they're getting dismissed.
44:40And the truth is there are often
44:42hormonal reasons why you may not be
44:45feeling like yourself. So, for some
44:46people it might be musculoskeletal pain,
44:48so we see plantar fasciitis and frozen
44:51shoulder, and we think of as those
44:53having underlying hormonal causes as
44:55well. So, there's published data that
44:57less than 9% of Medicare patients are
44:59getting prescriptions for this.
45:01More than 75% of people in large
45:04database collections are not getting
45:06prescriptions for this. And so, women
45:08are not getting access to generic
45:10medications that could save their lives
45:13and also really improve quality of life.
45:15I don't know about you, but dryness
45:17People are not having sex anymore
45:19because of the pain, the dryness, the
45:20irritation when it's fixable.
45:26>> I don't speak Vietnamese, but this show
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47:27You said um earlier that one of the
47:29questions people come to you about is
47:30pain during sex. Why are are women
47:33experiencing pain during sex? What is
47:35What is What is going on there
47:36physiologically?
47:37>> Yeah, pain with sex is actually not rare
47:39at all. There are some published reports
47:41that up to 75% of women will say at some
47:43point in their life sex is painful.
47:46>> So, a really dumb question here.
47:48Sex is not supposed to be painful.
47:50>> Sex is not supposed to be painful. If
47:52sex is painful, you need to figure out
47:54why it's You deserve a diagnosis. You
47:56deserve an answer. You deserve to
47:57understand exactly why sex is painful.
48:00You could have a problem with the
48:02tissue. So, you could have a skin
48:04problem, which as we know the tissue of
48:06the vulva is very hormonally sensitive.
48:08So, that tissue could be impacted by
48:10hormones. It's skin. So, people can get
48:12eczema. They can get autoimmune skin
48:15conditions. So, you may have a skin
48:16condition. You may have problem with
48:18your muscles. So, remember the vagina
48:20and the vulva are surrounded by these
48:22big pelvic floor muscles. And just like
48:25you can get tight muscles in your neck
48:27and in your back, you can get tight
48:29muscles in your pelvis. We also know
48:31there's nerves that are involved in this
48:33area. So, if you have a back problem and
48:35you feel it running down your leg,
48:36right? That's called sciatica or sciatic
48:38pain, you can have a back problem that
48:41actually causes you to have pelvic pain.
48:43So, we see people with penis pain or
48:45vulva pain because of problems in their
48:47spines. If you have scar tissue inside
48:50your body from endometriosis, that's
48:52pushing and scarring this tissue from
48:54the inside, you may have pain with sex.
48:57And so, there are many different things
48:59that can cause pain with sex. But
49:01remember I said your OBGYN got almost no
49:04training in this.
49:05>> So, if if I'm currently experiencing
49:07pain during sex as a woman,
49:09what advice would you give them? What
49:11should they do?
49:12>> Yeah, so I would really try to see
49:15someone who has an active interest in
49:17this. See a specialized gynecologist or
49:20a specialized urologist who has an
49:22interest in pelvic pain. And you may
49:24need a couple of opinions. Just like if
49:26you go to the first plumber, you want to
49:27get a couple quotes on well, who's going
49:29to do the best job? It's okay to see a
49:31few different people for this problem.
49:33>> And in terms of prevalence, up to 75% of
49:35women as you say will experience painful
49:37intercourse at some point in their
49:38lives. Between 10 and 20% of US women
49:41suffer from persistent chronic pain
49:43during sex. And during menopause, it
49:45climbs drastically
49:47with estimates ranging to 20 to almost
49:50half of women
49:52having pain during sex.
49:54>> And that probably doesn't even add to
49:55the people who stopped having sex
49:57because either they don't have a partner
49:58or because they it's too painful to even
49:59consider it. And I think it's important
50:02to know that hormones play a fundamental
50:04role here. Not a like a not it's not the
50:06whole story, but it's a huge part of it.
50:08>> In different seasons of life, if
50:11if a woman wanted to have the best sex
50:13of her life, what are the fundamental
50:14things you'd aim at to make sure she can
50:16have the best sex of her life?
50:17>> Yeah, so as you know, this is Diary of a
50:19CEO. So I love how you you love the
50:22health topics, but obviously financial
50:24literacy is really important to for you
50:26to help people because for some reason
50:28people stink about talking about money
50:30and talking about sex, and yet we all
50:32want to be really great at both, right?
50:33We all want a lot of money and we all
50:35want to have great sex, and yet people
50:37stink at talking about it. They they
50:38don't know the fundamentals, they don't
50:40know the basics. And so I actually use
50:42financial literacy sort of as a as a
50:44framework in how we talk about good sex.
50:47And so you've got your savings account
50:49and your you know, your your checking
50:51account. Those are the those are the
50:52basics. Everyone needs money in their
50:53checking and savings account, right?
50:55That's what everybody needs. So that's
50:56going to be your education, your
50:58nutrition, your exercise, your sleep,
51:01your your your communication, uh safety.
51:04Like are you safe in your relationship?
51:05Like the basics. Are you doing the basic
51:07things you need to have great sex? You
51:09know, communication is probably the most
51:11important thing. Can you talk about it?
51:12Can you use words? Um can you explore?
51:15Can you ask questions? So so that's
51:16really important for great sex. Then
51:18there's the 401k, right? The 401k is
51:20something that we all want and should
51:23have access to, right? It's important
51:25for compounding growth and long-term
51:27support of your financial life. Think
51:29about hormones. Think about going to a
51:31doctor who's going to make sure that
51:34everything is optimized the way that it
51:36should be. Your your pelvic muscles are
51:38in good condition. Your mental health is
51:39in good Do you know do you have Do you
51:41need a sex therapist? Do you want to
51:43bring toys into the bedroom and devices
51:45to have even more fun? That's kind of
51:46like the really important. Not everybody
51:48has access to it. Not everyone's going
51:50to do it, but I think it's really,
51:51really important for everyone to talk
51:52about. Then there's like crypto. Okay,
51:55so crypto, that's not to say don't do
51:58crypto. Like don't put all your money in
52:00crypto. Don't do everything and don't
52:02start with crypto. So that's going to be
52:04when you're watching, you're scrolling
52:06Instagram and you see these ads for do
52:09this injection, do this, you know,
52:11cosmetic procedure, do this supplement
52:15that's going to make sex great again. Uh
52:17the truth is if it looks too good to be
52:19true on TV and in the ads like it
52:21probably isn't going to fix what if if
52:24other things are are are struggling. So
52:26I think great sex is within everybody's
52:29reach, but I think your great sex is
52:32different than other people's great sex.
52:34>> So let's go through these slowly and one
52:36one at a time. I kind of broke it down
52:37into three categories, which is there's
52:40biological and physical blockers to
52:41great sex, which are some of the things
52:43we talked about, um hormone crashes,
52:45etc. You mentioned the pelvic floor.
52:49How is an issue with your pelvic floor
52:51going to impact your sex? And what is
52:53the pelvic floor? Why would you have an
52:54issue with it? What do you see in
52:56patients?
52:56>> Yeah, so everyone has a pelvis has a
52:58pelvic floor. So men have a pelvic
52:59floor, women have a pelvic floor. It
53:01just means the bones of your pelvis, so
53:03your hips, right? And your pelvis bone,
53:06your butt bones, all of this is this big
53:08bony structure that holds all of your
53:10organs in place. And your genitals are
53:13attached to this pelvic floor. And the
53:16pelvic floor is surrounded by thick big
53:19muscles. So if we look at the inside of
53:22the pelvic floor, it's these big thick
53:24muscles. And muscles are just like your
53:27biceps, right? Like muscles are
53:28something that contract and relax and
53:31there can be problems with muscles,
53:33right? just like if you work out too
53:35much and you've got a sore trap and you
53:37got to go get it massaged and and or you
53:39got to do physical therapy cuz your
53:40shoulder is hurting. A lot can go wrong
53:43with the pelvic floor. And so, sex is a
53:45contact sport. So, if you're going to
53:47get erections, if you're going to have
53:48an orgasm, if you're going to allow for
53:50penetration to happen, you have to have
53:53healthy muscles because you're asking
53:55your muscles to contract and relax in a
53:57sexual way. And so, as blood is flowing
54:00through the area, blood is going to
54:02engorge the clitoris and it's going to
54:04get bigger and erect, it's going to
54:05engorge the penis, it's going to get
54:07bigger and erect. These muscles are
54:09going to have to relax so that you can
54:10have penetration cuz if they're too
54:12tight, tight muscles are painful,
54:14they're sore, they're they're they burn.
54:16And so, penetration can happen if you're
54:18relaxed, but then orgasm is a series of
54:21muscle contractions which equates to
54:23pleasure and release, which is all has
54:25to do with the nerves and the muscles.
54:27Does Does that make sense?
54:28>> I'm trying to understand how the pelvic
54:30floor would would give me bad sex and
54:33how I would know if the pelvic floor is
54:35the reason I'm currently having bad sex.
54:37>> Yeah, so if if sex hurts, so if the
54:39muscles are too tight and you can't have
54:41penetration but you want it, yeah, that
54:42can be bad sex. If orgasm is painful,
54:46weak, or impossible, it could have to do
54:49with the muscles. It's not always the
54:50muscles, but it could have to do with
54:52the muscles of the pelvic floor. If
54:54arousal, your ability to engorge and
54:56lubricate are diminished or less, that
54:59could be due to pelvic floor cuz you're
55:00not getting enough blood flow to the
55:02area. And so, there are multiple
55:04different ways and if you're not feeling
55:06your genitals, you watch something sexy
55:08on TV and then you feel it in your
55:10genitals or you see someone attractive
55:12walking down the street and you feel it
55:13in your genitals, there's this brain
55:15genital connection. And sometimes that
55:18you So, you have to have perfect wiring
55:20and of your nerves, your hormones, and
55:22your muscles, and so that could have be
55:24affected by your pelvic floor. Now, we
55:26do a lot to mess up our pelvic floor, by
55:28the way. People do surgery, people have
55:30babies, uh people um muscle uh health
55:33changes for many reasons, and so when
55:35you have problems, there may be
55:37biological reasons to these problems.
55:40>> Should we be going to the gym and like
55:41doing pelvic floor exercises to improve
55:43our sex lives?
55:43>> You typically don't do them at the gym.
55:45There are typically trained physical
55:47therapists who help you know what's
55:49going on with your pelvic floor. So for
55:51some people it's to strengthen it and to
55:53do like almost contractions, we call
55:55them Kegel exercises, but for many
55:57people it's just learn the coordination.
55:59>> And you can go and get an exam.
56:00>> You can go get an exam and work with a
56:02pelvic floor physical therapist.
56:03>> So some women, uh cuz we sometimes have
56:06them writing with questions, talk about
56:08the fact that they're they're not having
56:09orgasms. Is that normal or is that not
56:12normal as it relates to um sexual
56:14contact?
56:15>> So about 20% of women will say that they
56:18can't have an orgasm. And the real
56:21question, I'm I'm fascinated by this
56:23data because not 20 20% of men do not
56:25have orgasm problems. And so again, if
56:28we go back to the financial literacy
56:30equation, we have a pay gap in this
56:32country, right? Women are not paid as
56:34much as men. Well, women are not
56:35orgasming as much as men. And so the
56:37data's very clear there. And I think the
56:40majority of problem is education. Women
56:43think that orgasm comes from
56:44penetration. Surely if the in and out
56:47penetration is happening, I should be
56:48able to have an orgasm. And the truth is
56:51that's not how most women orgasm. Some
56:53can, but the reason why women don't
56:56orgasm from penetration is cuz the
56:58clitoris is up here. So the clitoris is
57:00how women orgasm, right? Penetration is
57:03not how most women orgasm. Just like if
57:05you rub your thigh over and over again,
57:07you're not going to have an orgasm. Now
57:09you could keep rubbing your thigh for
57:10the whole duration of this podcast, you
57:12still won't have an orgasm cuz it's
57:14close to your penis, but it's not
57:15actually your penis, which is where men
57:17have orgasms from. And so the clitoris,
57:20if you follow those labia minora, those
57:22inner wings, you get to the hood of the
57:24clitoris or a foreskin, we call it a
57:26prepuce, and that, if you pull it back,
57:29you see what is the tip of the head of
57:31the clitoris, but that's just the tip of
57:33the iceberg. The clitoris is this huge
57:36structure.
57:37My necklace is, of course, like a gold
57:39clitoris. Um the this a huge structure
57:42that goes all the way down to your butt
57:44bones. It's a penis. Under the
57:46microscope, it looks like a penis. It is
57:47made up of the same tissue as a penis.
57:49It works exactly the way a penis does.
57:51It's just that we have a whole field of
57:53medicine devoted to the male penis. I'm
57:55a urologist. And no one is even taught
57:58how to examine a clitoris or where it
58:00is. So, if the penis is going in here or
58:03a toy or a finger or a device, that is
58:05not activating the the clitoris, which
58:08is a mostly internal structure.
58:10>> There's something called a clitoral
58:11adhesion, which people don't know about
58:13as well, which I've heard you talk about
58:14before.
58:15>> Yeah.
58:15>> What is that? And how many people suffer
58:16with that?
58:17>> Yeah, so the clitoris has this hood to
58:19it, okay? And about 23% of the time, the
58:22hood can get stuck to the head. So, for
58:25example, I'm wearing a sleeve here. So,
58:28you should be able to pull back the hood
58:30of the clitoris to see the whole head.
58:32It looks like a mushroom. You know how
58:34penises have like that almost like a
58:35mushroom rim rim around it. So, the
58:38clitoris should have that, too. But
58:39about 23% of the time it gets stuck. So,
58:42you actually cannot see the full head of
58:44the clitoris. It's called a clitoral
58:45adhesion. And so, you should be able to
58:47pull it back, but in about a quarter of
58:49the time you cannot. And we published
58:51data that if you remove these adhesions
58:53in an office-based very simple
58:55procedure, we saw improvements in
58:57orgasm, arousal, and satisfaction up to
59:0060 to 70%.
59:01>> Wait. So, so one
59:03five women
59:04>> Yeah.
59:04>> have a clitoral adhesion. And when
59:06solved, it improves their sexual
59:08satisfaction by up to 60%.
59:10>> Yes, but no one's examined any woman in
59:12your life. No one has ever examined
59:13their clitoris, ever. In any exam, in
59:16any doctor's visit, and nobody's asking
59:19women about their orgasm, about their
59:21satisfaction. Where like they come in
59:23with pain or they come in with libido
59:25issues, but no one is examining this
59:27part of the body. And so, it's this
59:29question of is it cuz we haven't or cuz
59:31we shouldn't? It's cuz we haven't. We
59:33haven't We have never done this before.
59:35>> You pulled up the sex toys though. I
59:37think we were talking about orgasm gaps.
59:39>> So, again, when you were talking about
59:42orgasm and how women experience
59:44pleasure, it's all buried inside the
59:47body. So, if your penis was entirely
59:50inside your body, say you gained 500 lb,
59:52okay? And your your belly was so big you
59:55couldn't hold on to your penis to to do
59:57what it takes to have an How would you
59:58orgasm?
1:00:00>> Uh probably I don't know.
1:00:02>> The vibrator industry would be a
1:00:03gazillion dollar industry instead of
1:00:05just a billion dollar industry because
1:00:06vibration can help activate this blood
1:00:09flow. And so, for women, vibration on
1:00:12the outside can be extremely helpful cuz
1:00:15remember the clitoris is kind of around
1:00:17this area. And so, by putting vibrators
1:00:20on the outside Now, inside, you can also
1:00:22have pleasure, but not everyone
1:00:23experiences pleasure the same way. And
1:00:26so, understanding devices and trying
1:00:28different things is really really
1:00:30important.
1:00:30>> I don't know. Oh, here we go. Okay, so
1:00:32this is vibrating now.
1:00:33>> So, this one This kind of device is
1:00:34interesting because it is a wand that
1:00:37can help just like with trigger points.
1:00:39So, if you have pain in in these
1:00:41muscles, this can go inside, vibrate to
1:00:43help with engorgement, but can also get
1:00:45rid of some of the tension in some of
1:00:47those muscles.
1:00:48>> As men, what are we getting wrong in
1:00:51heterosexual relationships when we're
1:00:52trying to arouse our partners um both of
1:00:56the context of using sex toys, but also
1:00:58without sex toys? What is it that we
1:00:59just don't understand?
1:01:00>> I think that men
1:01:03are constantly asking about they want
1:01:05their penises bigger, harder,
1:01:07straighter, girthier, uh lasting longer,
1:01:12and none of that has anything to do with
1:01:13how women experience pleasure and and
1:01:16satisfaction in the bedroom. And so, the
1:01:17question needs to be how do women
1:01:19experience pleasure? What is their
1:01:21anatomy like? How can we activate the
1:01:24clitoris, the arousal response? What are
1:01:26the brain things that we need to do to
1:01:28make women interested, right? What what
1:01:30gets women excited cuz it's different
1:01:32than what gets men excited. And your
1:01:33part every partner's different in terms
1:01:35of what gets them excited. And I would
1:01:37love to see more curiosity. I wish
1:01:40everyone was were as curious as you
1:01:41about what do we need to learn about
1:01:44women and how they behave and how they
1:01:45act and what they want.
1:01:47>> Yeah, so you need
1:01:48>> I'd like to implement it tonight.
1:01:49>> Communication, right? It's that question
1:01:51and also understanding that your partner
1:01:54never got told any of these things. And
1:01:57so this is where watching this podcast
1:01:59together could be really helpful to say,
1:02:00"Did you know that? Was it What do you
1:02:02like? Do you know? Like can we look at
1:02:04your clitoris together? Like do you know
1:02:06what these body parts are called? Where
1:02:07is it that you experience pleasure?" Cuz
1:02:09some people find direct stimulation of
1:02:11their clitoris is too sensitive. Cuz we
1:02:13know the clitoris has like 10,000 nerve
1:02:15endings. So going directly over the
1:02:16clitoris can sometimes be too much. Some
1:02:18partners love it. Some partners want
1:02:20more stimulation on just the outside
1:02:22here. Some people need vibration. So
1:02:24that's another big problem.
1:02:25>> I can So she's going to orgasm at some
1:02:27point if this is sufficiently
1:02:28stimulated.
1:02:29>> there's sort of a build-up and release
1:02:31of pleasure, right? That's orgasm. And
1:02:33again, that is often not happening
1:02:36during penetration.
1:02:37>> And once she experiences that, what
1:02:39happens immediately after for her? Cuz I
1:02:41know from a man's perspective, if I
1:02:42orgasm, there's some kind of like
1:02:44decline in arousal and I don't want you
1:02:46to touch it again.
1:02:47>> That's very similar in women.
1:02:49>> Okay, so it's the same thing.
1:02:50>> Except women can bounce back faster. Not
1:02:51all of them, but but but women can have
1:02:53multiple orgasms.
1:02:54>> So she orgasms, it's very very
1:02:56sensitive, she doesn't want me to touch
1:02:57it for a while.
1:02:58>> Yeah.
1:02:59>> And then she could she potentially could
1:03:01bounce back faster.
1:03:02>> She could potentially. Some people do,
1:03:04some people don't, but that's the
1:03:05conversation of is this something that
1:03:07is pleasurable? Is this something to try
1:03:08again? Is multiple orgasms something
1:03:10that you want to have or try to have?
1:03:12When does penetration happen during the
1:03:14dance? Because often times men orgasm
1:03:16and then they're done, they all over, go
1:03:17to sleep, whatever it is. Is the orgasm
1:03:19happening after your orgasm, before your
1:03:21orgasm? Is it happening before and after
1:03:23your orgasm? Like are there cuz that
1:03:25could be a nice way to sandwich it of
1:03:27like there is, you know, giving the the
1:03:29sensitive tissue some time to rest, then
1:03:32your orgasm happens and then you
1:03:33potentially go for round two.
1:03:35>> So, if the
1:03:36sensitive pleasurable part is on the
1:03:39outside here on the clitoris, then what
1:03:41do they get from penetrative sex if the
1:03:44this one of main event is here in the
1:03:46clitoris?
1:03:46>> Many times nothing. Many times
1:03:48[clears throat] connection. Many times
1:03:50uh sort of this need for closeness and
1:03:52pleasure. Many times there are women who
1:03:55have extra nerve endings sort of inside
1:03:57the vagina on the top of the vagina and
1:03:59the cervix. So, there are women who love
1:04:01penetration, but many women get the main
1:04:04event from the clitoris and so it's part
1:04:06of the whole menu as opposed to
1:04:09penetration is the whole story. And I
1:04:11think every woman's body is different
1:04:14and so kind of making these broad
1:04:15statements of every partner likes this,
1:04:18but many women are asking for
1:04:19penetration mainly because they're like,
1:04:22"Okay, that's when you have your orgasm
1:04:24it's done and then I can go to bed, I
1:04:26can read my book, I can do all these
1:04:27other things." But the pleasure often
1:04:30comes from that clitoral stimulation.
1:04:31Now, some women can orgasm from penetra-
1:04:34I have a theory. It's a really
1:04:35interesting theory that maybe your
1:04:36listeners can prove with science or help
1:04:38me prove with science.
1:04:39So, you know how there's men who
1:04:41prematurely ejaculate? Like who
1:04:43ejaculate very quickly?
1:04:44>> Yeah.
1:04:45>> There are men who orgasm in a minute or
1:04:46less.
1:04:47That's probably [clears throat] 8% of
1:04:49men, okay? So, if we think men and
1:04:50women's bodies are very similar, could
1:04:52we argue that 8% of women will orgasm
1:04:56within a minute or less?
1:04:58Theoretically, it makes sense, right? I
1:05:00think those are the women who orgasm
1:05:02with penetration. They're so sensitive,
1:05:04their nerves are so sensitive that
1:05:06penetration's very pleasurable and then
1:05:08they have this magical orgasm and they
1:05:10do it very quickly. So, it's good in a
1:05:12way, it's often seen as like great in a
1:05:13woman and not great in men. And so, I
1:05:16just have this theory that like there
1:05:17are women who have extra sensitive body
1:05:20parts.
1:05:20>> So,
1:05:21I mean, one of the things I've learned
1:05:22from everything you've said is just like
1:05:24how much porn has messed up
1:05:27our perception of sex.
1:05:30>> I mean, WWF has messed up our perception
1:05:33of
1:05:34I don't know.
1:05:35Like what people's bodies are like
1:05:37exercise fighting like like it's all
1:05:39manufactured. And it's all manufactured
1:05:41because that's the algorithm that has
1:05:43been working to get men excited. And it
1:05:46doesn't like again, it's that question
1:05:47of that curiosity of who's watching
1:05:50porn, what do people want from porn,
1:05:52what are they getting from porn because
1:05:53it's not what women want typically. And
1:05:56it has really messed up people's
1:05:58perceptions of what is actually fun and
1:06:00pleasurable for the partner. So, seeing
1:06:01that curiosity of like what does my
1:06:03partner actually want? You know, you can
1:06:05have great sex without penetration. And
1:06:07so, the question is is what does great
1:06:09sex look like?
1:06:10>> For you and your partner. When I look at
1:06:11a website, got some data here on a
1:06:12website like Pornhub, which is one of
1:06:14the leading porn websites, it says that
1:06:16roughly 65% of their traffic
1:06:19is men. Independent surveys tracking any
1:06:23regular pornography use find a similar
1:06:25gap, but note that women's consumption
1:06:26is highly age dependent. Men between the
1:06:28age of 18 and 35,
1:06:3175 to 95% of them report viewing porn
1:06:34regularly, whereas women age 18 to 35,
1:06:39only 34% roughly,
1:06:41report viewing porn regularly. And if we
1:06:44think about these systems as catering to
1:06:46demand, it means that porn websites are
1:06:48catering to
1:06:50predominantly male
1:06:53demand. And that explains why for most
1:06:55young men, we learn about sex from porn
1:06:57websites.
1:06:58>> Right.
1:06:59>> And then we assume that's the the woman
1:07:01looked like she was having fun, and the
1:07:03man was doing this particular thing, and
1:07:04then And take that into our
1:07:05relationships, and I think this is where
1:07:07the misunderstanding begins.
1:07:08>> And the women think they're broken
1:07:10because they're not having magical
1:07:11orgasms from penetration. They come to
1:07:13see me all the time and say, "I'm
1:07:14broken. You have to fix me. I'm not
1:07:16orgasming during sex." They have wildly
1:07:18good orgasms with a vibrator, with a
1:07:19hand, with
1:07:21a shower head, with whatever it is from
1:07:24on their clitoris, and that's totally
1:07:25normal, right? And then you show them
1:07:27the body parts. You say, "This is right,
1:07:29the clitoris and the penis are the same
1:07:30thing. You activate a penis for a man to
1:07:32orgasm. You activate a clitoris for a
1:07:33woman to orgasm." And once you teach
1:07:35them that, it makes perfect sense to
1:07:37them. Like they were normal the whole
1:07:38time.
1:07:38>> What do you think of pornography?
1:07:40>> I actually think pornography is great.
1:07:42>> For relationships? For connection?
1:07:44>> the right porn. Like look at Okay, let's
1:07:45look at something like Heated Rivalry.
1:07:47Have you heard of it?
1:07:47>> No.
1:07:48>> Okay, Heated Rivalry is an HBO show that
1:07:50came out this year that is about two gay
1:07:54male hockey players. Okay, it's based on
1:07:56a romance novel book in came from
1:07:58Canada, and HBO put it out there, and it
1:08:01went viral in levels that the world has
1:08:03never seen before. And it is about two
1:08:05young men
1:08:06who fall in love, but there's a very
1:08:08sexual relationship between them. And
1:08:10heterosexual women have watched this 10
1:08:13times over. Like they are addicted to
1:08:15this show. It's all over social media.
1:08:16It's this huge thing. It's essentially
1:08:18porn for women, right? It is women who
1:08:20are watching these pornographic
1:08:22episodes, and it's really important.
1:08:23They love it. It's supported. Everyone's
1:08:25talking about it. So, I don't think porn
1:08:27in and of itself is bad. I think porn,
1:08:30we, you know, watching people have sex,
1:08:32watching people fall in love, watching
1:08:34people with in romance. People like
1:08:35that. It gets them excited. It gets them
1:08:37aroused. But I think too much, if you
1:08:39are watching porn because and not
1:08:41interacting with humans, if you are
1:08:43watching porn all the time, if you need
1:08:45to if you can only watch porn to have
1:08:47good sex, like then
1:08:49that may not be the best, you know, and
1:08:51healthiest thing to do.
1:08:52>> I guess the question I was asking is, if
1:08:54you're in a relationship and one partner
1:08:55is using a lot of porn, won't that kill
1:08:58the sexual desire to be intimate with
1:09:01your partner?
1:09:02>> It depends. It depends on the
1:09:03relationship and it depends on what each
1:09:05person needs in order to feel supported
1:09:07and connected, right? I don't think we
1:09:09can say blanketly it's good or bad,
1:09:11right or wrong. I think if it is good or
1:09:14bad, right or wrong for that couple,
1:09:16then it's a problem. Cuz there are
1:09:17couples who like to watch porn together.
1:09:19There are couples where oh, that maybe
1:09:21someone has a much higher libido than
1:09:22the other person. So they said, "Okay,
1:09:24the high libido person can use porn and
1:09:26then once a week we'll circle together
1:09:28and we'll have a great experience
1:09:29together." Because it's not everyone's
1:09:31job to meet each other on the libido.
1:09:34>> The study that I was looking at was a
1:09:35couple dozen studies including a major
1:09:36meta-analysis show a consistent link
1:09:38between solo porn consumption and lower
1:09:40relationship and sexual satisfaction.
1:09:43The erosion of intimacy is usually
1:09:44driven by deception. Finding a partner
1:09:47is hiding porn use is usually triggers
1:09:49intense feelings of betrayal, rejection,
1:09:50and insecurity.
1:09:52And heavy solo use can desensitize
1:09:55the brain's reward system leading to
1:09:57performance anxiety and erectile issues
1:09:59during real-life partner sex. It can
1:10:01also create highly unrealistic
1:10:03expectations regarding body types,
1:10:05stamina, and performance making real sex
1:10:08feel less stimulating.
1:10:10>> Again, it was that deception. It's the
1:10:12hiding. If your that that ex of yours
1:10:14didn't tell you what was really going on
1:10:15and so you felt disconnected from that
1:10:18person because you didn't get that
1:10:19honest truth of what was going on.
1:10:21>> But also the desensitization of it. Like
1:10:23it's never going to you know
1:10:25I guess it depends on how you're using
1:10:26pornography.
1:10:27>> It depends on how you use it. So again,
1:10:29that's the truth.
1:10:29>> Like you can like train your brain to
1:10:31get pleasure in a certain way.
1:10:34And then when you're with your partner,
1:10:35one could argue that it's going to be
1:10:36quite difficult for them to replicate
1:10:38that particular way that you've pleasure
1:10:39you've learned to pleasure yourself.
1:10:41>> Right. And that's a that's a problem,
1:10:43right? If you're only able to do
1:10:44something in one way, in one position,
1:10:46with one watching one specific thing,
1:10:49that may not translate into great
1:10:51intimate sex with a partner.
1:10:53>> For the last couple years I've been
1:10:54working on something that I realized
1:10:55every podcaster listening to this, but
1:10:57actually probably every creator
1:10:58listening to this might just need.
1:11:00Podcasting is difficult for many
1:11:01reasons, and one of them is that these
1:11:03hosting platforms don't give you much
1:11:04information, and also because they're so
1:11:06fragmented, you kind of have to go
1:11:08through every single platform uploading
1:11:10it to YouTube and then taking the same
1:11:11big old video file and uploading it to
1:11:13Spotify's platform. It takes huge
1:11:15amounts of time, and that friction means
1:11:17most of us don't do it. That is the
1:11:19problem we set out to solve, and so we
1:11:20built something called Flight School,
1:11:21which you can find at flightcast.com.
1:11:23And today Flight School is also one of
1:11:26our show sponsors, and some of the
1:11:27world's biggest podcasters are now using
1:11:29our platform to run their shows because
1:11:31it gives you an edge. It saves you time.
1:11:34It gives you analytics most people won't
1:11:36typically get. It allows you to use AI
1:11:38to be more informed on your show, and it
1:11:41has growth tools that other hosting
1:11:43platforms don't have. So, podcasters
1:11:44that are using Flight School have this
1:11:46unfair advantage. So, go to
1:11:47flightcast.com/doac
1:11:50now.
1:11:51I've done almost 700 interviews with
1:11:54some of the most interesting people in
1:11:55the world, and one of the things you
1:11:56learn, which is unexpected, is that
1:11:58vulnerability is the doorway to
1:12:00connection. And after sitting here for 2
1:12:023 hours with a guest, I feel a deep
1:12:04sense of connection to them. And as they
1:12:06leave, what I get them to do is to write
1:12:09a question in the Diary of a CEO. We've
1:12:12taken all of the questions from the
1:12:14Diary of a CEO. We have put the question
1:12:17here on this card with the name of the
1:12:20person that wrote it. So, you can sit at
1:12:21home, as I do with my fiance, and my
1:12:23colleagues at work, and other people in
1:12:25my life, whenever we get a minute, we
1:12:27play the Diary of a CEO conversation
1:12:29cards, and it is incredible what
1:12:32happens. These are great if you're in a
1:12:33romantic relationship and you want to
1:12:35connect your partner more. These are
1:12:36also great if you're in a team and you
1:12:38want to bond your team together. And I
1:12:40have to say they're also great for
1:12:41families that want to learn more about
1:12:42each other and that need a good excuse
1:12:44to spend some time in a digital world in
1:12:47the analog environment connecting human
1:12:50to human. It is remarkable what the
1:12:52right question at the right time can do.
1:12:55Go to the diary.com
1:12:57and you can get these conversation cards
1:12:59right now.
1:13:01And there's different types of arousal,
1:13:02right? I was I heard from a sex expert I
1:13:05spoke to that men and women often have
1:13:07different types of arousal, spontaneous
1:13:09and like reactive. Is it?
1:13:11>> Yep. Yep. So there again, this idea of
1:13:13like I want to have sex, I'm ready to go
1:13:15versus I want to have sex because we've
1:13:17started having sex and we've started
1:13:19that process and now I can get into it.
1:13:21Sort of like exercise. Some people are
1:13:22like ready to go to the gym and exercise
1:13:25and other people like I don't want to I
1:13:26never want to exercise, but once they
1:13:28start getting going, oh I know this is
1:13:29good for me, I should do this. This
1:13:31feels really good and that's sex for a
1:13:33lot of people. But again, it's also a
1:13:36question of what kind of sex are you
1:13:37having? If you have sex the same way
1:13:39every single time and it's not that fun
1:13:42and it's not that interesting to your
1:13:43partner, are they going to look forward
1:13:45to it? Are they going to Are they going
1:13:46to want it? Are they going to seek it
1:13:47out? And is that really low libido at
1:13:49all or is that sort of the product of
1:13:51like we just aren't talking about it
1:13:53improving. If you had the same podcast
1:13:55guest on every single week and it was
1:13:57the same conversation every single week,
1:13:59it's not going to last you very long,
1:14:01right? You do different things. You try
1:14:02different things. Oh, what worked? What
1:14:04didn't work? How could we do this
1:14:05better? What does the algorithm want us
1:14:07to do now? No one's doing that in their
1:14:09sex lives. Like Like no one's even
1:14:10talking about it. Like honey, what's
1:14:12working? What do we like? What's going
1:14:13on? I saw this thing like
1:14:14>> Why? Why don't we talk about it?
1:14:16>> Because we don't talk about money
1:14:17either. We don't talk about sex. Because
1:14:18we're trying to be a pro I don't know.
1:14:19What do you think?
1:14:20>> I think that's a little bit of it, but I
1:14:21think the subjects are like deeply
1:14:24personal, emasculating
1:14:26and so intrinsically linked to like
1:14:29self-esteem.
1:14:30>> It's vulnerable.
1:14:31>> Yeah, it's like super vulnerable. So And
1:14:33if someone I remember I had a
1:14:36partner turn around to me who
1:14:38interestingly was going through some of
1:14:39the issues that were undiagnosed, turn
1:14:41around once upon a time and expressed
1:14:43that she didn't like having sex and I
1:14:44didn't understand that at like a 20 as a
1:14:4523 22-year-old guy.
1:14:48>> Yeah.
1:14:48>> And so you kind of look yourself in the
1:14:49mirror and go, "Oh shit." Like it's
1:14:51super emasculating.
1:14:53It turned out that there was actually a
1:14:54physiological challenge she'd had.
1:14:56>> Yeah.
1:14:56>> But we'd been in a relationship for a
1:14:59long time and she wasn't enjoying sex
1:15:01for because there was a physiological
1:15:02issue.
1:15:03>> Mhm.
1:15:03>> She didn't say anything to me.
1:15:04>> Yeah.
1:15:05>> I didn't know. And then the day she said
1:15:07something to me, my I didn't know
1:15:09anything about sex. So I just
1:15:10interpreted it as like, "Damn, I'm not
1:15:12good in the you know I might I must not
1:15:13be good in the bedroom or something."
1:15:15Um which is super like hurtful. Yeah.
1:15:17And then that kind of breaks the
1:15:17relationship down and it's all
1:15:19predicated on this like
1:15:21highly emotional, highly self-esteem
1:15:23linked, poorly educated subject which
1:15:26destroys relationships.
1:15:27>> Destroys it. I
1:15:28And that's such an important story,
1:15:31right? Because if you had had access to
1:15:34the information, she thought she was
1:15:36protecting you by not telling you that
1:15:38information.
1:15:38>> interesting? I went to one of my friends
1:15:40and one of my best friends and said,
1:15:41like, "My partner's just said this to
1:15:42me. Like what does that mean?" And he
1:15:43went to me, he goes, "Mine too." I was
1:15:46like, "What?" I was like, "So you're not
1:15:47having sex with your partner?" He goes,
1:15:48"No." And we And by the way, I'm talking
1:15:49about 30 year olds. He was like, "No, we
1:15:51haven't had sex in 3 months." And I was
1:15:53like, "What What's the reason?" And he
1:15:54said to me, "She said she just doesn't
1:15:56like having sex." And I'm like, "Oh,
1:15:58okay. So that's
1:16:00that's the same in my relationship. My
1:16:01my former ex-girlfriend said she just
1:16:02doesn't like having sex."
1:16:04And
1:16:05I can't tell you how ignorant and poor
1:16:10and insufficient the conclusions in such
1:16:14a situation we arrive at are. We're
1:16:16like, "Well, maybe maybe there's
1:16:18something wrong with me. Maybe it's a
1:16:20sexuality challenge. Maybe it's a
1:16:22genetic thing. Maybe they were just but
1:16:23they were born in didn't want to have
1:16:25sex like we don't we just don't know
1:16:26what it is."
1:16:28From doing this podcast and speaking to
1:16:30people like you, I like, "Oh my god. I
1:16:33just wish like 5 10 years ago when I had
1:16:35these conversations with my guy friends
1:16:37and also with my the ex-partner that I'm
1:16:38referencing, I just wish I knew that it
1:16:42wasn't any of those things.
1:16:44>> Mhm.
1:16:44>> It was something that um
1:16:46could have been helped.
1:16:47>> Yeah.
1:16:48What's so important is that you were
1:16:51able to learn and see and grow in this,
1:16:54right? A little bit of information gave
1:16:56you empathy for this partner where you
1:16:58took it on as a you problem, it became a
1:17:01you problem cuz it was both of you
1:17:02together, but it started with biology.
1:17:05And so, if we actually taught people the
1:17:07biology or to think about biology or to
1:17:10like be able to talk about sex, to talk
1:17:12about sexual health, to talk about
1:17:14genitals, to make them not private
1:17:15parts, how much better would your sexual
1:17:18upbringing really have been? How much
1:17:20less hurt and shame and guilt would you
1:17:22have felt because it actually wasn't you
1:17:24at all, right?
1:17:25>> It's the horrible conclusions you arrive
1:17:26at and the the conclusions you arrive at
1:17:29are often seen as both unchangeable and
1:17:32therefore, in my situation back then,
1:17:34the conclusion was, well, this
1:17:35relationship's never going to work.
1:17:37Because the false conclusion we'd
1:17:38arrived at was not something we could we
1:17:41could change.
1:17:42>> Mhm.
1:17:43>> Uh whereas, when I hear about all of
1:17:44these different things we've talked
1:17:45about today, I go, "Oh my god, there's
1:17:47so many other conclusions I could have
1:17:48arrived at or my friends could have
1:17:49arrived at that would have been fixable
1:17:51and therefore, the relationship, which
1:17:53is a perfectly great relationship with a
1:17:54person, was therefore savable." One of
1:17:56them is the thing we just talked about,
1:17:58which is this idea that men and women
1:18:00have different types of arousal,
1:18:01spontaneous and responsive. And I was
1:18:03looking at some of the data on the
1:18:05variance, which I think is very
1:18:06important for people to know.
1:18:08And it says that men are highly
1:18:10spontaneous in their arousal, which kind
1:18:12of means, from my interpretation, and
1:18:13please correct me if I'm wrong, that as
1:18:15a man, I can literally be I can
1:18:17literally think about something
1:18:20and get aroused. And it's not to say
1:18:22that women can't, but it the data
1:18:24suggests that men are more that way
1:18:26inclined. The data here says that their
1:18:28spontaneous rate in a man is about 70%,
1:18:30whereas in women, it's about 10 to 15%.
1:18:33It says the responsive rate, which I
1:18:34guess is like I get aroused once the
1:18:36ship starts moving, once we start
1:18:38foreplay, once contact starts, is 10 to
1:18:4115% in men, and in women in this
1:18:44particular report is 40 to 50%.
1:18:47>> Mhm.
1:18:47>> So, that would suggest to me that women
1:18:49are much more likely to be aroused once,
1:18:52you know,
1:18:53foreplay or contact or the sexual
1:18:55actions have taken place, I'm guessing.
1:18:57>> Mhm.
1:18:58>> And then the mixed style
1:19:01is 15 to 20% in men and 35% in women.
1:19:05Um is that all accurate?
1:19:06>> It's accurate, and I think it really
1:19:08comes to this idea of your path to
1:19:11having a better understanding of that
1:19:13prior relationship was actually
1:19:15education and communication.
1:19:17>> Yes.
1:19:18>> Right?
1:19:18>> If you had a better understanding of the
1:19:20biology, if she had a better
1:19:22understanding of the biology, if she
1:19:24were vulnerable enough to be real with
1:19:26you and honest with you up front as
1:19:28opposed to kind of a bombshell that
1:19:30happened too late, um all of that pain,
1:19:32all of that hurt probably would have
1:19:34looked different.
1:19:35>> Right? It would have looked like the
1:19:36world would have looked very different.
1:19:37Now, that's what I'm fighting against
1:19:40because I think that to your point, I
1:19:42think men are suffering. They're feeling
1:19:45disconnected from their partners.
1:19:46They're feeling a difficulty of even
1:19:48finding a partner, and part of that is
1:19:50cuz they lack that curiosity of like,
1:19:52what like, what do they want? What do
1:19:55they need? What kind of communication
1:19:57helps me get to where I want to go with
1:19:58this person? And a lot of that is
1:20:00vulnerability and curiosity and
1:20:03interest, and I think that's what women
1:20:05often are looking for in partners. Is
1:20:07they're looking for someone who's going
1:20:09to give a crap about them enough to care
1:20:11what they specifically need and want,
1:20:14not what gen What do women want, and
1:20:16what is it like like, what specifically
1:20:19about this person in front of me? What
1:20:21does she need to feel that erotic love,
1:20:25support, connection, lust? And for the
1:20:27man, too. Like, what do you need to feel
1:20:30all of those things? And what a good
1:20:32relationship is is when people work
1:20:35together to try to optimize that for
1:20:37everybody.
1:20:38>> are the questions that you would ask
1:20:40your patients to ask their partner
1:20:43to start to tease out some of these
1:20:44things? Couples will come up to me when
1:20:46I'm in a restaurant or something, and
1:20:48they'll come up together, and they'll
1:20:49always they'll often say to me that the
1:20:52episode they watched together was about
1:20:54sex.
1:20:55So, I I literally have this image of
1:20:57this particular couple that came up to
1:20:58me when I was abroad, and they said, "We
1:21:01were just listening on the plane about
1:21:02your sex episode." So, I'm like they're
1:21:05listening now.
1:21:06>> Like again, I think it's that basic
1:21:08thing of like what does great sex mean
1:21:09for you?
1:21:10>> Okay.
1:21:11>> [clears throat]
1:21:11>> What what do you want? Like what what is
1:21:13a great time? What's it something fun?
1:21:15Like what is it about sex that you
1:21:17enjoy? When you ask people what do they
1:21:19get out of sex, it's like 200 different
1:21:21reasons. Everyone wants something
1:21:23different, and everyone doesn't always
1:21:25know what they want. And then having
1:21:26that ability, if you don't know what you
1:21:27want, is having that curiosity to
1:21:30explore together.
1:21:31>> So, with that said, 200 different
1:21:33opinions on what good sex is. And this
1:21:36is kind of what I think you find in
1:21:37couples. And when I've sat with my
1:21:38partner before and said like what do you
1:21:39what arouses you during sex? What do you
1:21:41like?
1:21:42The two things can often be different.
1:21:44>> Totally.
1:21:44>> And so, is this not a problem that one
1:21:47partner might say, "I really want you to
1:21:50tie me up and da da da da da." And then
1:21:52the other partner might say, "I really
1:21:54want you to not tie me up and be really
1:21:57soft and gentle." And there's a bit of a
1:21:59dichotomy between sorts of sex
1:22:01preferences,
1:22:02>> Mhm.
1:22:03>> which means no one's really ever getting
1:22:04what they want. Like how do you navigate
1:22:06that?
1:22:06>> When you go to buy a house, you don't
1:22:08always get to choose what house you get
1:22:09unless you you know you build it
1:22:11yourself. Like there are compromises in
1:22:13life, and and there is no all good or
1:22:15all bad. You're never going to find this
1:22:16is actually the problem with pornography
1:22:18is you figure out the exact porn in the
1:22:20exact situation or even worse with AI.
1:22:22Like you're going to have a sex robot
1:22:24who's going to be able to do exactly
1:22:25what you want in the way that you want
1:22:26to do it and people are afraid about
1:22:29what that means for intimacy and
1:22:30relationships and great sex going
1:22:32forward because the truth is sex is
1:22:34messy, it's awkward, it's smelly,
1:22:36there's fluids, there's funny noises,
1:22:39there's like it's it's vulnerable, it's
1:22:41like really uncomfortable sometimes for
1:22:44to like have these deep conversations,
1:22:46but isn't that why life exists? Like
1:22:48isn't that like the most fun part is
1:22:50when you can kind of have that with
1:22:52somebody else where they know all of you
1:22:54and they want to explore that with you.
1:22:55Now, if it's not the right relationship,
1:22:58it's not the right relationship, right?
1:22:59Like and and figuring out if that is an
1:23:01important part of your life and it's a
1:23:02non-negotiable, then find the rooms
1:23:05where there are other people who do that
1:23:06those things too. I mean, what you will
1:23:08find is that people have all sorts of
1:23:10agreements and relationship setups and
1:23:13as a sex doctor, like the things I hear
1:23:15in a room like would, you know, are
1:23:17quite wild and you you wouldn't even
1:23:18believe. Like people are doing Well, I
1:23:21think people have multiple like there
1:23:23are there are people who have open
1:23:24relationships. So, they have multiple
1:23:26partners or they have certain kinks,
1:23:29right? So, there are things that they
1:23:30really enjoy that maybe somebody would
1:23:32look at that and be like, oh, that's
1:23:33very strange, but there are other
1:23:34consenting people who also are
1:23:36comfortable and want to do those things.
1:23:37There are websites that deal with
1:23:39different erotica and different kinks
1:23:41and things like that. And there's also
1:23:42this idea of fantasy. It's also okay to
1:23:44have things that you think about but
1:23:46that you don't actually want to partake
1:23:48in and and that you use.
1:23:50>> On this point of fantasy, what if you
1:23:51have a you probably have experience
1:23:53where someone's come to you and they
1:23:54have a fantasy
1:23:56but they don't want to tell or a kink
1:23:58and they don't want to tell their
1:23:59partner because they're worried about
1:24:01the reaction.
1:24:02>> Yeah, this is where things like sex
1:24:03therapy become really helpful of how do
1:24:05you have a third party? Cuz again, when
1:24:07your doctor's telling you to do
1:24:08something or bringing something out,
1:24:09it's it's so much less
1:24:11scary than if you're doing it on your
1:24:13own. There are also different like apps
1:24:15and things like that where you can sort
1:24:17of dip a toe where you you you have
1:24:20There's one called Spicer, I believe,
1:24:21where you can sext each other in ways
1:24:23and they'll push questions. If you both
1:24:25agree, it'll tell each other that you
1:24:26both agree with things. So, there's ways
1:24:29to dip a toe here and sort of be curious
1:24:31about it, but again, that's where
1:24:32watching things together or asking the
1:24:34questions. This should happen not when
1:24:35you're naked in the bedroom actively
1:24:37having sex. Like it's okay to have
1:24:39conversations about sex when you're not
1:24:41having sex, right? Like you plan these
1:24:43podcasts before you actually sit down to
1:24:45record. Afterwards, you talk with your
1:24:47team, "Hey, this is what I liked about
1:24:49it. Here's what I didn't like. Let's
1:24:50change this in the future. Let's never
1:24:52have Dr. Ruth Westheimer on again,
1:24:53right?" Like these are the conversations
1:24:55you're going to have with your team.
1:24:56People don't do that about sex very
1:24:57often, right? They don't actually do
1:24:59after action. What went well? What
1:25:01didn't go well? Do you ever want to try
1:25:02this? Like what would be fun here? Like
1:25:05there there is often a a lack of
1:25:06curiosity.
1:25:08>> And to be you are sex doctor, but people
1:25:10come to you and sort of offload their
1:25:11sex lives to you.
1:25:12>> My job is so fun. I love my job. It's so
1:25:15fun because people will talk to me about
1:25:17their most Like we do 2 hours and we
1:25:20talk about their lives in the context of
1:25:22their sexual health for 2 hours and
1:25:25people never have those types of
1:25:27conversations even with their partners.
1:25:29And it is incredibly vulnerable. It's
1:25:31incredibly important for people to see
1:25:33that and see, "Oh, that was actually
1:25:35really nice to talk about. I didn't know
1:25:37this, that, and the other thing about my
1:25:38body."
1:25:39>> And what you find that men and women
1:25:41typically are hiding from their partners
1:25:45when they do confide in you?
1:25:47>> I think they don't tell their partners
1:25:48just about anything. Like they don't
1:25:50There's a lot they don't tell their
1:25:51partners, right?
1:25:52>> Is there a difference between men and
1:25:52women what they are not saying?
1:25:55>> That's a great question. I would say
1:25:57that no one is talking about sex at all.
1:26:00Women are hiding their pain from their
1:26:02partners. Men are hiding their um
1:26:06insecurities and their frustrations and
1:26:08there's a lot of shame around erectile
1:26:10dysfunction and sexual problems in men
1:26:12and so they a lot of people just either
1:26:14stop having sex or stop talking about it
1:26:17or sort of have a mediocre sex because
1:26:20they are not that great at talking about
1:26:21these things.
1:26:22>> And I imagine your I mean my first
1:26:23reaction would be like, "Oh, you should
1:26:24tell them."
1:26:26But I imagine that doesn't necessarily
1:26:27work.
1:26:27>> I think it's a challenge. Like if you
1:26:29have had if you have been faking an
1:26:31orgasm for your entire relationship
1:26:34>> And women have been.
1:26:35>> Yeah, many. The statistics are quite
1:26:36clear. Like if you're only having
1:26:38penetration and your partner orgasms
1:26:40every time and it's a perfect orgasm
1:26:42every time, I would say there's a high
1:26:43percentage that that's not real. Because
1:26:46the truth is is orgasm often takes a lot
1:26:49of arousal and a like like again,
1:26:51stopwatch. Every header if a penis
1:26:53enters a vagina and they orgasm about 5
1:26:57and 1/2 minutes is on average how long
1:26:58men last, right? Like that's science.
1:27:00It's about 5 and 1/2 minutes. Now, if
1:27:02you're longer, great job. If it's
1:27:03shorter, it's okay. It's all within the
1:27:04range of normal. Women, if penetration
1:27:07is happening, almost nobody orgasms in 5
1:27:10and 1/2 minutes. It's usually well over
1:27:1213, 14, 15 minutes and penetration is
1:27:15usually not how that happens. Cuz again,
1:27:17if you're distracted while you're trying
1:27:19to stimulate your penis, it's going to
1:27:20take longer. Women need focus on the
1:27:22clitoris. So again, if your partner is
1:27:24orgasming every time within that 5 and
1:27:261/2 minutes and it's like clockwork, I
1:27:29would call [ __ ] on
1:27:30a high percentage of it. So but but a
1:27:33partner doesn't want to tell you, right?
1:27:34Like they're afraid to tell you cuz
1:27:36they're they want to make you happy,
1:27:37right? It's not that they're having bad
1:27:38sex. They just know that that's not
1:27:40what's going to get them to orgasm and
1:27:42they want you to be happy and to feel
1:27:44supported.
1:27:45>> So
1:27:46that presents a pretty good case that
1:27:48the woman should orgasm first.
1:27:50>> I think so because I think orgasm first
1:27:53will allow for pelvic floor release and
1:27:55relaxation, which will make penetration
1:27:57more pleasurable, enjoyable. I think
1:27:59women can have multiple orgasms, so
1:28:01there's a case to be made for before and
1:28:03after. Why are women having zero
1:28:05orgasms, men having one orgasm when
1:28:06women could be having three orgasms and
1:28:08men have one orgasm? So I think we
1:28:10should be actively trying to change the
1:28:13orgasm gap and focus on the pleasure and
1:28:16I think making penetration the main
1:28:17event is where the challenge I think
1:28:20penetration can be part of the whole
1:28:22story but doesn't necessarily always
1:28:23need to be the main event.
1:28:26>> On the physical blockers you talked
1:28:27about some of them like anxiety. One of
1:28:29them that I think isn't talked about
1:28:30enough especially in the modern world is
1:28:32what they call like the dopamine drain
1:28:33where you've got mental burnout or
1:28:35chronic stress or we talked a little bit
1:28:37about depression but I did notice that
1:28:40through my life when I'm very very
1:28:42overworked shall I say
1:28:46my libido is not the same.
1:28:48>> Yeah.
1:28:49>> And this is also the case for for women
1:28:51as well. Do you have a lot of women come
1:28:53to you or couples come to you where this
1:28:55is quite clearly the problem this sort
1:28:56of like dopamine drain it's actually
1:28:58their stress and lifestyle it could be
1:28:59the kids it could be
1:29:01>> Oh it's a huge problem right? It makes
1:29:02logical sense again if we go back to the
1:29:04fundamentals of if you're not sleeping
1:29:06if you're overworked if you're burned
1:29:08out if you have no white space for
1:29:09yourself why are why are you going to
1:29:11have all this excitement for your
1:29:12partner and all of these things like if
1:29:14we're scrolling all the time at bedtime
1:29:16or if we're watching porn all the time
1:29:18or we're watching reading romance novels
1:29:20all the time but we're not talking to
1:29:22the partner with that we're with or
1:29:24we're not creating that time and space I
1:29:26think there's a big opportunity for
1:29:28people in our modern society which is
1:29:30over scheduled to schedule sex. I mean
1:29:33they do this quite well. So when you
1:29:35were dating right and you would ask your
1:29:37your date you know let's go out Saturday
1:29:39night you were literally scheduling
1:29:41potential sex. You're like I could get
1:29:43lucky I'm going to plan for it all week
1:29:45I'm going to get excited I'm taking this
1:29:46person out I'm like it's going to be
1:29:48really fun and I'm going to do whatever
1:29:49it takes to sort of cross that finish
1:29:51line. So we were always scheduling sex
1:29:53and it was very erotic and fun when
1:29:55you're in your dating life and now you
1:29:57live with a person and you sort of they
1:29:59see you at your best they see you at
1:30:01your worst they see you at your
1:30:02crankiest and your most tired and so
1:30:04it's really hard to get that level of
1:30:07excitement when you're dealing with
1:30:10those, you know, sort of life
1:30:12circumstances.
1:30:13>> People will say that, you know, there's
1:30:14a spontaneity myth around sex that it
1:30:16should be spontaneous and that's kind of
1:30:17how we see it in films. Like they grab
1:30:19you in the hallway and you start kissing
1:30:20and whatever else.
1:30:21>> not real. It's just the same as WWF.
1:30:23Like it's not real. And so that's the
1:30:25truth is like you If you see your
1:30:27partner every day and you see your
1:30:28partner your high and your low and the
1:30:30crankiest and all of these things and
1:30:31you're all working like crazy, where is
1:30:33the space for that? Like that's not how
1:30:35humans work. So creating That's why
1:30:36vacation sex is always fun for people or
1:30:39they find time, you know, so again, if
1:30:41you've got kids and your kids are
1:30:42staying up later than you are and you
1:30:44don't have a lock on your door and
1:30:45you're worried about making noises and
1:30:46you don't want to be too loud. Like how
1:30:48are you going to have great sex in that
1:30:49situation?
1:30:50>> One of the I guess the challenges people
1:30:51might also bring up is that if you're
1:30:53scheduling sex, it puts a lot of
1:30:55performance pressure on you. If I know
1:30:57tonight at 8:00 p.m. I have to have sex
1:31:00because that's the time we scheduled
1:31:01this week,
1:31:03then like, gosh, I'm going to be
1:31:04finishing my work at 5:00, 6:00, 7:00. I
1:31:06don't know. I need to get home. [snorts]
1:31:07I need to have I need to have sex as
1:31:08well. Gosh.
1:31:09>> So So this is where you schedule it
1:31:10around a time that you know is going to
1:31:12work for you. So I do I tell people to
1:31:13do things like
1:31:15quarterly dates. So I get I Listen, I'm
1:31:17working in DC. Everyone is very
1:31:18high-powered with very busy jobs. I say
1:31:21one Friday a quarter, you and your
1:31:23spouse can literally block your
1:31:24calendars. One a quarter cuz quarter.
1:31:27Okay, that means you might have sex
1:31:28every week. You might have your your
1:31:29your eight late night sex whenever. You
1:31:31could might have sex whenever you have
1:31:32sex. But once a quarter, have a day
1:31:35where you just block it out and you have
1:31:37a spouse day or a partner day or
1:31:39whatever it looks like and maybe do an
1:31:41act It doesn't necessarily have to be a
1:31:42sex day, but you actually take time of
1:31:45your little mini Maybe you go on a walk.
1:31:47Maybe you go on a hike. Maybe take a
1:31:48bath. Maybe get a massage. You kind of
1:31:50create space for you to actually say,
1:31:52"Oh, wait, we like each other. Oh, we
1:31:54like talking to each other. We don't
1:31:55have to just talk about the kids all the
1:31:56time." So again, the more you invest in
1:31:59each other and in a joyful way, the
1:32:02better sex you're going to have.
1:32:03>> What about self-esteem issues? You
1:32:05mentioned that as well. Body image
1:32:07issues. How often do you see that being
1:32:09the blocker to great sex?
1:32:11>> It's a huge problem. Again, I wish that
1:32:14the energy that my female patients put
1:32:17into wanting to be skinny
1:32:19is is enormous and I wish that energy
1:32:22was put into wanting to be strong, but
1:32:24it's kind of funny because
1:32:27what people think about themselves
1:32:28versus what they think for their friends
1:32:30are very different. Your best friend,
1:32:32say they're overweight. Do they deserve
1:32:33great sex?
1:32:34>> Of course.
1:32:35>> Of course they do, right? Your best
1:32:37friend deserves great orgasms, great
1:32:38sex, no matter what they look like, no
1:32:40matter what they weigh. Everybody
1:32:41deserves intimacy, pleasure, and
1:32:43connection with someone that they can
1:32:44have intimacy, pleasure, and connection
1:32:45with. But for some reason when we think
1:32:47of ourselves, "Oh, I can't be naked with
1:32:50this person. Oh, I can't be happy until
1:32:52I lose this much weight. I don't deserve
1:32:54an orgasm unless I am, you know,
1:32:57skinny." And that's a huge problem.
1:32:58>> So, what do we do about it?
1:33:00>> I think it's empowerment, it's
1:33:01communication, it's explaining to
1:33:03people. I think that all of the mindset
1:33:04stuff that you do and you talk about is
1:33:06so important cuz look, you changed your
1:33:08mind around your own situation with this
1:33:11ex of yours because you got education,
1:33:13right? You were able to see that it was
1:33:14more complicated than that. And I do
1:33:17think by educating people on bodies, on
1:33:21pleasure, on joy, on connection, on
1:33:24intimacy, I actually think it changes
1:33:25the narrative. I think people we're in a
1:33:27sex recession, okay? People are having
1:33:29less sex than ever. People are not
1:33:31connecting, people are scrolling and
1:33:33they're on their AI chatbots instead of
1:33:35like human connection. We're getting
1:33:36worse at this, not better. I I I just
1:33:39think that like we have to reach humans
1:33:41and we have to be able to talk about it
1:33:42to change the narrative.
1:33:44>> What is the the most important thing we
1:33:45haven't talked about that we should have
1:33:46talked about as it relates to all the
1:33:47work that you do?
1:33:49>> I think the most important thing is that
1:33:51biology matters in women and we often
1:33:54spend so much time talking about
1:33:56psychosocial issues, about emotions, and
1:33:59all of that is true. That is important
1:34:01to sexual health, but we minimize
1:34:02biology when it comes to women, and we
1:34:05have to let women advocate for
1:34:07themselves about the biology, and we
1:34:08need to train doctors to care about the
1:34:10biology. I would love to find out from
1:34:11all the women in your life and the women
1:34:13on your team, like what experience Like
1:34:16I would love for you to ask them their
1:34:17experiences with medical providers, cuz
1:34:21I don't think we have that curiosity of
1:34:22like what are you experiencing that's
1:34:24different.
1:34:25>> Yeah, I think that I Yeah, I think
1:34:26that's probably going to have to If for
1:34:27me to have like a healthy relationship
1:34:29with my partner, I think that's going to
1:34:30have to be
1:34:31uh practice or like part of our You
1:34:34know, we check in on our relationship,
1:34:36etc. But we don't really check in on the
1:34:38physiology.
1:34:39>> So, super interesting. So, I spend 2
1:34:41hours with people, and there are times
1:34:42when the partner comes to that talk. And
1:34:45so, they get to hear sort of what their
1:34:47partner is describing. They even get to
1:34:49see the exam, and they get sort of a
1:34:51tour of their own partner's body parts.
1:34:53And so, it is helpful sometimes to bring
1:34:55partners into those conversations, the
1:34:57biology conversations, of like she
1:34:59doesn't want to have sex with you not
1:35:01because you're bad at sex. Look how
1:35:03painful it is right here at the opening
1:35:05of her vulva. It's like a sunburn. I
1:35:07touch it with a Q-tip, and she's on
1:35:08fire. Like, what do you think your penis
1:35:10is doing? And it gives that ability to
1:35:12say, "Oh, it's not a me problem. How do
1:35:14I support her best knowing that this is
1:35:16the issue?" So, getting partners to
1:35:18understand the biology is extremely
1:35:20helpful. Or, say you have a man who's
1:35:22taking an antidepressant or a hair loss
1:35:25medication that can cause sexual
1:35:26dysfunction as well. Um say you have a
1:35:28man who takes an antidepressant and it
1:35:30lowers his libido. Is it, "Oh, honey,
1:35:32you're not attracted to me anymore. You
1:35:33must not love me." Or, is it, "I
1:35:35actually understand the biology that
1:35:37your libido is lower because of this
1:35:38antidepressant." And two things can be
1:35:40true. So, so I think understanding your
1:35:42partner's biology and your own biology
1:35:44is quite important.
1:35:46>> Yeah, I guess that's the the crux of the
1:35:47conclusion really is that both education
1:35:50and communication are where it all
1:35:52begins.
1:35:53>> Which is the fundamentals, right?
1:35:54>> Yeah. And I think here gosh, if I had
1:35:56better education on these subjects got
1:35:58at the start of my adult life
1:36:01and also I had like figured out how to
1:36:02communicate with my partner and maybe
1:36:05even also with yourself. And like to be
1:36:07a bit honest with yourself about how
1:36:09you're feeling, not to gaslight
1:36:10yourself, not to gaslight your partner.
1:36:12Just It just goes to show how better
1:36:14relationships would have been, not just
1:36:16with your romantic partner, but really
1:36:17with all the people in your lives. And
1:36:19this is easier said than done. Like
1:36:21especially the communication part.
1:36:23Because these are very, very sensitive
1:36:24subjects.
1:36:25And so we we'd rather just shut up about
1:36:28them and keep them as these sort of like
1:36:29secrets among that we whisper about with
1:36:31the closest people in our lives, maybe
1:36:32our best friend.
1:36:33And I just think generally one of the
1:36:35things I've come to learn from doing
1:36:36this podcast as well is that
1:36:38you know, there was this quote I read.
1:36:39It said you can predict the long-term
1:36:40health of a relationship by whether each
1:36:42challenge heals to 101% or 99%.
1:36:46Does your conflict make you stronger?
1:36:49And what it's essentially saying is like
1:36:51conflict is guaranteed in life, but the
1:36:53thing that's going to turn your conflict
1:36:54into a strengthened relationship or a
1:36:56weakened one is
1:36:58your how you deal with it. Like and
1:37:01that's all predicated on communication.
1:37:03And so
1:37:05if we can just teach people how to
1:37:06communicate, if we can become better
1:37:08communicators, which is both function of
1:37:10speaking and listening
1:37:12and I guess curiosity
1:37:14then all of these downstream challenges
1:37:15and misunderstandings would have a
1:37:17chance of being solved for. And I think
1:37:19about this all often. I think often
1:37:20think, okay, how I'm communicating with
1:37:22my partner currently is really going to
1:37:24determine whether we have an argument in
1:37:25two years time or a year's time or six
1:37:28months time. Our strategy
1:37:30of communication. Does she feel safe
1:37:33expressing a problem? How do I receive
1:37:35the problem even when it feels like I'm
1:37:36being blamed? And vice versa. And then
1:37:40are we open-minded about solutions or do
1:37:42we come with a bias around this is the
1:37:44solution, this is what I think the
1:37:45correct answer will be.
1:37:47I've spent a lot of time, you know, I'm
1:37:48like 7 years into my relationship now,
1:37:49almost.
1:37:51So, I spend a lot of time thinking,
1:37:52okay, like how do people go how do they
1:37:53build a relationship like 50 years? And
1:37:55the crux of it seems to be
1:37:58conflict resolution {slash}
1:37:59communication. That seems to be the crux
1:38:00of it. And actually with finance issues
1:38:02that we talk about with finance experts,
1:38:04always sex issues, the crux of it seems
1:38:07to be
1:38:08conflict resolution {slash}
1:38:09communication.
1:38:11And I also know, cuz I know lots of
1:38:12couples, that we're all living on a
1:38:14different spectrum here. Some couples
1:38:16are like they come home at 6:00 p.m. and
1:38:18all they want to do is talk about the
1:38:20most sensitive subjects. And then you've
1:38:22got this other group of couples
1:38:24who almost don't talk about anything.
1:38:25They're kind of like strangers that are
1:38:27like burying everything in the cut
1:38:28cupboard.
1:38:29And they think burying it in the
1:38:30cupboard means that it's
1:38:33out of sight, out of mind, and it's not
1:38:34impacting anything.
1:38:37But again, you come to learn
1:38:39that any problem buried raise its head
1:38:41in unexpected ways.
1:38:44And you know, I'm thinking of one
1:38:45particular friend of mine who was in a
1:38:46relationship for 14 years, had a baby,
1:38:49they kind of stopped having sex, didn't
1:38:51really talk about it.
1:38:54They become
1:38:56like parallel lines that are drifting
1:38:58apart. And they get, you know, several
1:39:00years later go, "What happened?
1:39:02What happened to our relationship?"
1:39:04Well, they never spoke about it.
1:39:07So,
1:39:08>> I think you understand this perfectly,
1:39:10and for you to
1:39:12see it in this you can help so many
1:39:14people because I think these are the
1:39:16fundamentals. How do we teach young
1:39:18people and old people that conflict
1:39:21resolution is important in intimacy and
1:39:23vulnerability are important and biology
1:39:26is important, science is important, and
1:39:28we can do this. I I just taught you a
1:39:30few things that I know today, and you
1:39:33Not only did you understand it, but you
1:39:35were curious about it to ask further
1:39:36questions, and you can now
1:39:38figure out how it works in your own
1:39:40relationship, in your own life. You're
1:39:41even caring enough about thinking about
1:39:43your friends' lives. And so, if you've
1:39:45shown that this matters and this is
1:39:47important, I just think how many people
1:39:49are going to benefit by your
1:39:50vulnerability and your curiosity and
1:39:52saying, "Oh, I could do that, too."
1:39:54>> Yeah, it's crazy, isn't it? That like if
1:39:55you love this person so much,
1:39:58yet you don't often love them enough
1:40:00just to communicate
1:40:02about some of these like sensitive,
1:40:04tricky subjects, which is like craziness
1:40:06when you articulate it like that. Like
1:40:08I've been in relationships where I just
1:40:09absolutely love this person, but no, I
1:40:11wouldn't I wouldn't raise X, Y, and Z
1:40:13subject. It's just
1:40:15it's just too uncomfortable.
1:40:16>> And the few times, I guess I will ask
1:40:18that you have been vulnerable, has it
1:40:20gone well or not well?
1:40:22>> gosh, it's like the most important
1:40:23thing. I just I always think, "Why
1:40:24didn't I do this sooner?"
1:40:25>> Mhm.
1:40:27>> I I Yeah, okay. So, to be even more
1:40:30honest, I like didn't have conversations
1:40:32with my partner about sex at all. Like I
1:40:34just I assumed she liked it. I think she
1:40:37assumed I liked it.
1:40:39And it wasn't until like a year further
1:40:40into the relationship that you start
1:40:41going like, "Wait, I don't
1:40:43think this is how this person wants to
1:40:45have sex." Or I don't know. I actually
1:40:47have to give her the credit cuz she's
1:40:49the one that started like pushing on the
1:40:50communication. I think sometimes as men
1:40:52we just
1:40:55You know, that that old slightly toxic
1:40:58phrase, "Happy wife, happy life." I
1:40:59think sometimes as men we just kind of
1:41:00assume that if no one's saying anything,
1:41:02then everything's great.
1:41:05But it takes two to tango.
1:41:07>> And I think expecting your partner to
1:41:10have all the words and to know
1:41:11everything is the wrong answer. So,
1:41:13that's where again, that third party,
1:41:15whether people come to see me together
1:41:17as a medical person or a sex therapist
1:41:19or or a third party to help you have
1:41:21that conversation, cuz I think we assume
1:41:23our partners know everything about their
1:41:25own bodies and can communicate about
1:41:27their own bodies, and that's just not
1:41:28true. Even showing that curiosity
1:41:31makes you quite evolved, right? And I
1:41:32think that that's the energy that we
1:41:34need in 2026 is breaking down those
1:41:37barriers because it will lead to
1:41:39stronger relationships, it will lead to
1:41:40stronger partnerships, and it's those
1:41:43hard moments that you grow the most
1:41:45from.
1:41:46>> You need the words though as you say.
1:41:48>> Yeah.
1:41:49>> When you say you need the words, what
1:41:51what what specifically do you mean by
1:41:53that? You need to know how to start the
1:41:54conversation, how to handle the
1:41:56conversation, how to receive a subject
1:41:58that might be a little bit offensive,
1:42:00that might hurt your ego a little bit.
1:42:01Is this what you mean by like have the
1:42:02words?
1:42:03>> hard to do that on your own because
1:42:05people
1:42:06don't want to hurt other people's
1:42:07feelings. And so just saying it as it is
1:42:09may not be the right approach either.
1:42:11That's where again couples therapists
1:42:13are very good at holding space for those
1:42:14different conversations. And I think one
1:42:17of the other problems here Stephen is
1:42:19many times there's no bad guy. Of course
1:42:22when it's obvious someone cheats on
1:42:24someone, someone breaks trust, yes
1:42:25there's a bad guy. But so often, you
1:42:28know, say someone has a higher libido
1:42:29than someone else. There's no bad guy.
1:42:31That person has a high libido and that
1:42:33person has a low libido. There's no evil
1:42:34bad guy, but there is still conflict.
1:42:37And so how do you deal with conflict
1:42:39when it's not a good guy bad guy
1:42:41situation, but you and how do you love
1:42:43someone and evolve with them, right?
1:42:46Like I think it's not easy.
1:42:47>> I think your point there though is
1:42:49actually
1:42:50where it starts often which is this
1:42:52point of empathy. The minute you realize
1:42:53that there is no bad guy. Just as you
1:42:54said it, I thought oh my gosh, yeah.
1:42:56Back when I had those intimacy
1:42:58challenges in that relationship,
1:43:01it was a case of trying to figure out
1:43:03who the bad guy was. I was like, is it
1:43:04me? Is that me problem? Is it a you
1:43:06problem? That's kind of like what the
1:43:07brain jumps to. But actually now that
1:43:10had time passed and we figured out what
1:43:11it was, turns out that it was neither of
1:43:13us. It was really the whole time not me
1:43:16against her or her against me. It was me
1:43:18and her against the problem.
1:43:19>> Mhm.
1:43:21>> And that refrain, I think removes the
1:43:23like shame, the blame, and all that
1:43:25stuff that gets in the way and focuses
1:43:27you as a team
1:43:29on resolution and conflict resolution.
1:43:31Thank you. You've you know, you said
1:43:33that
1:43:34I will help people, but actually you're
1:43:35the one that's helping people. I'm just
1:43:37asking questions
1:43:39and uh
1:43:40>> I disagree. I think it's the simple is
1:43:42the vulnerability of watching others.
1:43:46It's the simple stuff that makes the
1:43:48biggest change.
1:43:49>> Why does this matter so much, Jack? I
1:43:50can see it in your face.
1:43:53>> Because so many people are hurting.
1:43:55Relationships are hurting. People's
1:43:56health is hurting. People aren't having
1:43:58as much pleasure and joy and quality of
1:44:00life that they could be having using
1:44:02what we already know to be true. Simple
1:44:05things, communication, connection,
1:44:07education, basic medical care. These
1:44:09things can bring so much joy, health,
1:44:13great relationships, great living. I see
1:44:16it every day in my clinical practice and
1:44:18I want that. I want that for every
1:44:20person out there and I want them to
1:44:22fight for it and I want them to advocate
1:44:24for it and I want doctors to show up in
1:44:26a big way to help them and I think we
1:44:29can do it. But I I I am so passionate
1:44:31about this because I see all the like I
1:44:34see how much it's not being done.
1:44:37>> Dr. Rachel, we have a closing tradition
1:44:39where the last guest leaves a question
1:44:40for the next not knowing who they're
1:44:41leaving it for. The question left for
1:44:43you is, what would be one thing you
1:44:45would like to do or improve in your life
1:44:49tomorrow?
1:44:54>> I would like to get better about
1:44:56practicing what I preach because we
1:44:59always say the shoemakers kids don't
1:45:01wear shoes. I am addicted and obsessed
1:45:04with what I do. I love my work so much,
1:45:07but I don't necessarily spend as much
1:45:10time
1:45:11lifting weights that I should or not
1:45:14scrolling on my phone and paying
1:45:15attention to my children that I should.
1:45:17I don't spend as much time, you know,
1:45:20scheduling those quarterly spouse dates
1:45:22that I tell other people to do. And so I
1:45:24think practicing what I preach is a huge
1:45:26opportunity for me.
1:45:28>> Well, that's refreshing to hear cuz none
1:45:29of us are perfect in that regard. So,
1:45:31it's good to know that just having all
1:45:33the information doesn't necessarily mean
1:45:35um it's easy to execute upon.
1:45:37>> Easy to do, easy not to do.
1:45:40>> Amen.
1:45:41Um
1:45:42where do people go to find more from
1:45:44you? Do they go to your Instagram, your
1:45:46website, your YouTube channel? Where
1:45:47should you Where should they go?
1:45:49>> Yeah, our website is really fabulous. We
1:45:51are very big into research, education,
1:45:53advocacy, and mentorship. So,
1:45:56rachelrubinmd.com
1:45:58that would lead you to sign up for our
1:45:59newsletter which is really an incredible
1:46:01source of education. We are extending
1:46:04you the the latest and greatest in
1:46:05studies, research that you can be a part
1:46:08of, job opportunities, um and advocacy
1:46:10for clinicians. We have courses in
1:46:13teaching you how to do this both free
1:46:15and uh ones that come with continuing
1:46:17medical education. I would say Instagram
1:46:20is um the most popular for me right now.
1:46:23Uh although we're trying to get louder.
1:46:25If only I had your skills, I I would
1:46:26love to be louder on YouTube and other
1:46:28places. Uh we do have a clinical
1:46:30practice both in Washington D.C. and Los
1:46:32Angeles. And so, if we can help in any
1:46:35way on the sexual health side, please
1:46:36reach out to us because sexual health is
1:46:38just health and your quality of life
1:46:40absolutely matters.
1:46:42>> I'll link all of that below.
1:46:44And I hope people sign up for your
1:46:45newsletter as well. That sounds really
1:46:46interesting.
1:46:46>> Thank you.
1:46:47>> Dr. Rachel Rubin, thank you so much for
1:46:49all of this. Um I think it's it's so
1:46:51so telling that your conversations are
1:46:53often the most shared on the podcast and
1:46:56in generally in podcasting because the
1:46:57subjects are so um so important to so
1:47:01many people's lives and they can relate
1:47:02to feeling not themselves as you say,
1:47:05but there's very few people out there
1:47:06that have the credibility, the
1:47:08experience with patients, but also the
1:47:11the ability to articulate it in a way
1:47:13that's highly accessible like you have.
1:47:14So, I know that you you know, we talked
1:47:16beforehand, you don't necessarily love
1:47:17doing this,
1:47:18but um it's a very very important worthy
1:47:20cause cuz there's very few people that
1:47:21can speak to these subjects with the in
1:47:23the way that you can. So, please keep
1:47:24doing it.
1:47:24>> So kind.
1:47:25>> Anybody who's listening now, I highly
1:47:27recommend if there's somebody in your
1:47:28life that might want to listen to this
1:47:29conversation, I think there's a reason
1:47:31why Dr. Rachel's conversations are
1:47:33always the most shared.
1:47:35Um please do share it with them. Dr.
1:47:39Rachel, thank you so much for your time.
1:47:40>> Thank you.
1:47:41>> YouTube have this new crazy algorithm
1:47:43where they know exactly what video you
1:47:45would like to watch next based on AI and
1:47:47all of your viewing behavior. And the
1:47:49algorithm says that this video is the
1:47:52perfect video for you. It's different
1:47:54for everybody looking right now. Check
1:47:56this video out and I bet you you might
1:47:57love it.

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