Jun 22, 2026 · 1h 50m
Systemic medical failures leave women without essential hormone and sexual healthcare
Medical Whistleblower: What Your Doctor Doesn’t Know Is Hurting You | Dr Rachel Rubin
The widespread lack of medical training in female anatomy and hormone therapy leaves millions of women suffering from treatable physical pain and sexual dysfunction.
- 1Systemic gaps in medical education leave doctors unprepared to treat female anatomical and hormonal health issues.
- 2Hormone therapies and localized estrogen are highly effective treatments for painful intercourse and recurring infections.
- 3Dismantling sexual taboos and understanding clitoral biology are essential for closing the orgasm gap and improving intimacy.
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The breakdown of how localized vaginal estrogen cream can prevent urinary tract infections and treat Genitourinary Syndrome of Menopause.
The brief
Despite its critical role in well-being, women's sexual health remains severely neglected by modern medicine, leaving even affluent patients struggling to access basic care due to systemic gaps in medical education.
The biological drivers of female libido and comfort, such as testosterone and estrogen, are frequently misunderstood, leading to untreated pain during intercourse and misdiagnosed hormonal deficiencies.
From the physiological changes of menopause to the hidden side effects of birth control pills, hormonal transitions are routinely dismissed, leaving women to suffer through preventable infections and intimacy issues.
Addressing the orgasm gap and pelvic floor dysfunction requires couples to dismantle sexual taboos, prioritize clitoral anatomy over performance myths, and replace spontaneous expectations with scheduled intimacy.
True progress in female wellness relies on educating both medical professionals and partners, transforming clinical facts into shared empathy that can salvage relationships and restore physical connection.
What was said on this episode
35 statements · 15 positive · 16 negative · 2 mixed · 2 neutral
Twice-weekly vaginal cream improves sexual function and is better than Viagra
“if you do that twice a week, it makes sex not painful and dry. It helps with arousal and orgasm. It's literally better than Viagra”
Listen at 1:05
Vaginal cream can prevent deaths from urinary tract infections
“this scream can also help prevent death from urinary tract infections”
Listen at 1:15
Clitoris education is absent from the OB-GYN training checklist
“the word clitoris, Clitoris today in 2026 does not exist in the checklist for what an OB GYN has to learn in their training”
Listen at 2:03
Limited medical information reduces people’s sexual health, relationships, and general health
“people are limiting their ability to have great sex, great relationships, and great health because they aren't having access to all the information that they could”
Listen at 3:50
Women’s hormone and sexual healthcare is worsening rather than improving
“we are actually getting worse at this, not better at this”
Listen at 5:06
Fear and misinformation made hormone-therapy prescribing a lost medical skill
“There was so much fear and misinformation 20 years ago about hormone therapy that it is a lost art. Doctors don't know how to write the prescriptions.”
Listen at 6:19
Research funding does not ensure clinicians know hormone prescriptions, risks, and benefits
“it doesn't translate into them Knowing how to actually write the prescription, knowing the difference between the type of hormones, knowing the safety risk, the benefits, because they never had the class”
Listen at 6:36
Beliefs that menopausal hormones are dangerous reflect politics and poor science interpretation
“that Is all politics and bad interpretation of science”
Listen at 12:58
Women’s estrogen declines to nearly zero after age 50
“Every woman over the age of 50, her estrogen goes to essentially zero”
Listen at 13:53
Women’s testosterone begins a sharp decline during their thirties
“testosterone starts to precipitously drop in your 30s”
Listen at 14:16
Birth-control pills can lower testosterone and cause low libido or painful sex
“one of the side effects is it lowers testosterone. And so that can cause low libido pain with sex in a small subset of people who take it.”
Listen at 15:26
Combined birth control suppresses ovarian hormone production
“birth control causes your ovaries to just stay quiet. They shut down for a bit.”
Listen at 16:47
A survey found roughly one-quarter of women on GLP-1 drugs reported sexual side effects
“about 25% report sexual side effects from these medications”
Listen at 19:10
Testosterone improves libido in postmenopausal women
“we have global consensus, actually, that testosterone helps for libido in postmenopausal Women”
Listen at 19:41
Women seeking testosterone should access knowledgeable prescribing physicians
“if you want it and you want to try it and you're curious about it, then you should have access to physicians who understand how this works”
Listen at 20:22
Some women may receive testosterone during perimenopause because levels decline in their thirties
“Sometimes people just get testosterone because remember, that falls in your 30s”
Listen at 25:48
Unopposed estrogen can thicken the uterine lining and raise endometrial cancer concerns
“if it gets thicker, thicker, thicker, there is worry over years that leads to endometrial or uterine cancer”
Listen at 27:20
Older hormone therapy showed no increased cardiovascular or stroke risk below age seventy
“below age 70, that type of hormone therapy, which we don't really use anymore, has no increased risk of cardiovascular disease or stroke”
Listen at 29:52
Low-dose vaginal estrogen or DHEA supports vaginal and bladder health
“vaginal hormones are micro doses of estrogen, or what we call dhea, vaginally, that supports the bladder and the vagina”
Listen at 30:55
Vaginal hormone microdosing is safe for everyone at every age
“there is a magical solution that is safe for everybody on earth that is microdosing these hormones vaginally at any age”
Listen at 31:28
Vaginal hormones reduce urinary tract infections by more than half
“research has been clear since the 1990s that using vaginal hormones prevent UTIs urinary tract infections by more than half”
Listen at 34:15
Vaginal estrogen or DHEA cuts urinary tract infections by more than half
“vaginal estrogen or vaginal DHEA, which we just showed a bunch, prevent UTIs by more than half”
Listen at 39:04
Hormone therapy decisions should depend on symptoms rather than age alone
“she may not need anything at all. But what if she starts getting a lot of urinary tract infections or having dry, scratchy, painful sex, or her libido just doesn't feel. It sort of feels like back when it did on birth control pills. That may be an indication where she may benefit from, whether it's testosterone or vaginal hormones or some kind of combination combination.”
Listen at 41:13
Up to 75% of women experience painful sex at some point
“pain with sex is actually not rare at all. There are some published reports that up to 75 of women will say at some point in their life sex is painful.”
Listen at 47:59
Women with painful sex should consult clinicians specializing in pelvic pain
“I would really try to see someone who has an exercise active interest in this. See a specialized gynecologist or a specialized urologist who has an interest in pelvic pain.”
Listen at 49:34
Overly tight pelvic-floor muscles can cause pain and impede penetration
“if they're too tight, tight muscles are painful, they're sore, they're, they're, they burn. And so penetration can happen if you're relaxed.”
Listen at 54:34
Pelvic-floor treatment often requires learning muscle coordination rather than strengthening
“for many people, it's just learned the coordination.”
Listen at 56:18
Clitoral adhesions occur in approximately 23% of cases
“about 23% of the time, the hood can get stuck to the head”
Listen at 58:42
Removing clitoral adhesions can improve orgasm, arousal, and satisfaction by up to 70%
“if you remove these adhesions in an office based, very simple procedure, we saw improvements in orgasm, arousal and satisfaction, up to 60 to 70%”
Listen at 59:13
Pornography itself is not inherently harmful and can increase arousal
“I don't think porn in and of itself is bad. I think porn we, you know, watching, watching people have sex, watching people fall in love, watching people in romance, people like that, it gets them excited, it gets them aroused.”
Listen at 1:08:48
Highly specific solo sexual conditioning may not transfer to partnered sex
“if you're only able to do something in one way, in one position, with one watching one specific thing, that may not translate into integrate intimate sex with a partner.”
Listen at 1:11:04
Female orgasm before penetration may relax pelvic muscles and improve penetration
“I think orgasm first will allow for pelvic floor release and relaxation, which will make penetration more pleasurable, enjoyable.”
Listen at 1:28:13
Couples should consider scheduling sex to create time for intimacy
“there's a big opportunity for people in our modern society, which is over scheduled, to schedule sex”
Listen at 1:29:48
Women’s sexual health requires greater attention to biological factors
“biology matters in women. And we often spend so much time talking about psychosocial issues, about emotions, and all of that is true, that is important to sexual health. But we minimize biology when it comes to women.”
Listen at 1:34:13
Understanding both partners’ biology is important for sexual relationships
“understanding your partner's biology and your own biology is quite important”
Listen at 1:36:04
Statements are attributed to the speaker as said on the episode and reflect their view at the time, not PodLume's. They are not advice.
Books & mentions
The Diary Of A CEO with Steven Bartlett
For more deep dives into modern healthcare, biology, and relationship dynamics.