Interview, Fireside Chat
Dr Rachel Rubin: "I'm Filled With Rage!" Your Doctor Was Never Taught About Women's Bodies!
- Critical Access Gap in Generic Medications: Over 75% of people in large database collections are not receiving prescriptions for generic testosterone and vaginal hormone therapies, limiting women's access to treatments that prevent death from urinary tract infections (UTIs) and improve quality of life.
- Educational Deficits in Medical Training: The word "clitoris" does not exist on the checklist for what an OBGYN must learn in their training; consequently, most doctors lack the knowledge to examine clitoral anatomy or treat sexual pain and dysfunction.
- Testosterone Decline Timeline: Women's testosterone levels begin a precipitous drop in their 30s, not at menopause, often leading to reduced libido, arousal, and orgasmic satisfaction, a factor largely ignored in standard medical education.
- Birth Control Side Effects: Combined oral contraceptives suppress ovarian function and stop natural testosterone production; studies indicate up to 27% of users report decreased libido, and removing the medication can resolve these symptoms.
- GLP-1 Medication Risks: A recent survey of 1,000 women taking GLP-1 weight loss drugs (e.g., Ozempic, Mounjaro) found that approximately 25% experienced sexual side effects, with half of those reporting lowered sexual function.
- Vaginal Hormone Therapy Safety: Vaginal estrogen creams, tablets, and rings (micro-dosing) are safe for all ages, including postmenopausal women, cancer survivors, and those breastfeeding; they prevent UTIs by more than 50% and treat Genitourinary Syndrome of Menopause (GSM).
- Misinterpretation of Hormone Safety Data: The 1990s Women's Health Initiative study concluded hormone therapy caused cardiovascular disease, leading to a cessation of prescriptions; however, subsequent data confirms that for women under 70, the specific regimen studied posed no increased risk, yet only 1.7% of eligible women currently receive prescriptions.
- Anatomy of the Clitoris: The clitoris is a large internal structure with 10,000 nerve endings, analogous to a penis under a microscope; approximately 23% of women suffer from "clitoral adhesion" where the hood sticks to the head, preventing stimulation and orgasm.
- Orgasm Gap Statistics: About 20% of women report an inability to orgasm, compared to nearly 0% of men; the primary barrier is the misconception that penetration alone triggers orgasm, whereas most women require clitoral stimulation.
- Arousal Types: Men are predominantly spontaneous arousal types (70%), while women are more frequently responsive arousal types (40-50%), meaning many women only become aroused after sexual contact and foreplay have begun.
- Pelvic Floor Dysfunction: Tight or uncoordinated pelvic floor muscles can cause pain during penetration, weak orgasms, and reduced blood flow for engorgement; treatment often requires physical therapy rather than general gym exercises.
- Pornography and Relationship Expectations: Pornography caters to male demand (65% of traffic is men), often depicting penetration as the primary pleasure source; this creates unrealistic expectations that cause women to feel "broken" when penetration does not result in orgasm.
- Spontaneous vs. Responsive Arousal: The "spontaneous desire myth" (the idea that desire should always precede sex) is inaccurate for many women; scheduling intimacy or "partner days" is recommended to create space for responsive arousal in busy, stressful lives.
- Body Image and Self-Esteem: Women often withhold sexual pleasure due to body image insecurities, believing they do not deserve sex until they lose weight, despite the fact that all bodies deserve intimacy and pleasure.
- Doctor-Patient Interaction Barriers: Doctors often dismiss symptoms like "Not Feeling Like Myself" (NFLM) in under 10-minute visits due to a lack of training and a fear of giving nuanced advice, preferring to say "no" to treatments they do not understand rather than explain risks and benefits.
- Case Study Outcomes: A patient in her 60s reversed osteopenia, eliminated hot flashes, and restored libido through a combination of vaginal, systemic, and testosterone hormones, eventually enrolling in and toppling a law school class she previously would have deemed impossible.
- Recommendation for Patients: Women should seek specialized providers (urologists or gynecologists with a focus on pelvic pain/hormones) and bring partners to appointments to educate them on the biological causes of sexual dysfunction to remove blame from the relationship.
- Forward-Looking Goal: Dr. Rubin aims to increase the percentage of women receiving appropriate hormone therapy prescriptions, which currently stands at a mere 1.7% of the eligible population, to reverse the decline in women's sexual and urologic health.