Chapter: Why Women's Healthcare Is Still Neglected
Summary
Dr. Rachel Rubin argues that a systemic failure in medical education and practice has left women's sexual health neglected, with profound consequences for their well-being and relationships. She highlights that simple, cheap interventions like vaginal estrogen cream—which can reduce pain, dryness, and UTIs while improving arousal—are not prescribed to over 75% of women who could benefit. A key educational gap is the omission of the clitoris from OBGYN training checklists as of 2026, despite most women requiring clitoral stimulation to orgasm. The episode explores how misunderstanding arousal styles (spontaneous vs. responsive) can damage relationships, with data showing men have roughly 70% spontaneous arousal versus 10-15% in women. Verified claims include that up to 27% of birth control users report decreased libido, no published studies exist on GLP-1 sexual side effects in women, and global consensus supports testosterone therapy for postmenopausal libido. Vaginal hormones are proven to prevent UTIs and are safe for all ages. The discussion also covers the prevalence of painful sex (up to 75% of women at some point, with 10-20% suffering chronic pain), the myth that sex should be spontaneous, and how body image issues block pleasure. Dr. Rubin calls for better doctor training, self-advocacy, and open communication, noting that even high-profile women like Melinda Gates, Oprah, and Halle Berry were misdiagnosed. The episode frames the current "sex recession" as a crisis of education and connection that can be reversed.
Key Points
Vaginal cream benefits
Clitoral education gap
Systemic neglect of women's health
Birth control pills suppress ovarian testosterone production
GLP-1 weight loss drugs lack sexual health research for women
Testosterone therapy improves libido and more in postmenopausal women
Vaginal hormones prevent UTIs and treat GSM
GSM explained and link between hormones and UTIs
Vaginal hormone application methods and cost
75% of women not receiving life-saving generic medications
Pain during sex is common but not normal
Causes of painful sex include tissue, muscle, nerve, and scar tissue issues
Recommendation to see a specialist for pelvic pain
Prevalence of chronic pain during sex and hormonal role
Misunderstanding arousal destroys relationships
Spontaneous vs. responsive arousal data
Education and communication as solutions
Spontaneity myth and scheduling sex
Body image and self-esteem as blockers
Sex recession and need for education
Biology matters in women's sexual health
Vaginal cream is better than Viagra for women and cheap.
UnverifiedMore than 75% of women in large databases are not getting prescriptions for this cream.
UnverifiedThe word clitoris does not exist in OBGYN training checklists in 2026.
UnverifiedMelinda Gates saw three doctors before getting proper hormone therapy.
UnverifiedOprah saw five doctors and still her heart palpitations were not linked to perimenopause.
UnverifiedHalle Berry was misdiagnosed with genital herpes when she had genitourinary syndrome of menopause.
UnverifiedUp to 27% of people on birth control report decreased libido.
UnverifiedNo published paper exists on sexual health side effects of GLP-1s for women.
UnverifiedTestosterone helps with libido in postmenopausal women (global consensus).
Partially supportedVaginal hormones prevent UTIs by more than half, research clear since the 1990s.
UnverifiedVaginal hormones are safe for your great grandmother in the nursing home and for a breastfeeding wife.
UnverifiedVaginal hormones are literally better than Viagra for arousal and orgasm.
UnverifiedMore than 75% of people in large database collections are not getting prescriptions for generic medications that could save their lives.
UnverifiedUp to 75% of women will say at some point in their life sex is painful.
UnverifiedBetween 10 and 20% of US women suffer from persistent chronic pain during sex.
UnverifiedDuring menopause, estimates range from 20 to almost half of women having pain during sex.
UnverifiedMen have about 70% spontaneous arousal rate, women about 10-15%.
UnverifiedWomen have about 40-50% responsive arousal rate, men about 10-15%.
UnverifiedMixed arousal style is about 15-20% in men and 35% in women.
UnverifiedWe are in a sex recession; people are having less sex than ever.
Partially supportedScheduling quarterly partner days can improve sex life.
UnverifiedBody image issues are a huge problem for women's sexual pleasure.
Partially supportedWhy Women's Healthcare Is Still Neglected
0:00
If Men Had These Symptoms, Would Medicine Be Better?
4:39
Why Even Gynaecologists Misunderstand The Clitoris
7:24
What You'll Learn From This Conversation
8:25
The Question Women Ask Most
11:29
Why Testosterone Matters For Women
11:54
How Birth Control Can Kill Libido
14:03
How GLP-1s And Antidepressants Affect Sex Drive
16:47
Should Women Take Testosterone?
18:48
Understanding The Menstrual Cycle
19:52
Why Perimenopause Starts Earlier Than You Think
23:33
What Is HRT And How Does It Work?
25:41
Does Estrogen Increase Cancer Risk?
26:23
Why HRT Got A Bad Reputation
27:49
The 4 Types Of HRT Explained
29:46
What Really Causes UTIs?
31:41
Vaginal Hormones Explained
33:44
Does Cranberry Juice Actually Help UTIs?
37:41
When Should You Start HRT?
39:11
A HRT Success Story
41:16
Ads
45:23
Is Pain During Sex Normal?
47:27
How To Have Better Sex
50:08
What Your Pelvic Floor Actually Does
52:34
Signs You Have Pelvic Floor Problems
54:28
Is It Normal Not To Orgasm?
56:04
What Is A Clitoral Adhesion?
58:10
How Sex Toys Can Improve Intimacy
59:35
What Men Get Wrong About Arousal
1:00:47
What Happens To Women After Orgasm?
1:02:37
Do Women Get Anything From Penetrative Sex?
1:03:35
How Porn Changed Our Expectations
1:05:20
What Healthy Porn Looks Like
1:07:38
How Porn Can Damage Relationships
1:08:52
Ads
1:10:52
Why You Should Change Up Your Sex Life
1:13:01
Why We Hide Our Sexual Struggles
1:14:15
Responsive Vs Spontaneous Desire Explained
1:17:56
The Question Every Couple Should Ask
1:20:38
What If You Want Different Things In Bed?
1:21:31
How To Tell Your Partner About Kinks
1:23:50
The Secrets People Hide From Their Partners
1:25:07
How To Tell If She's Faking Orgasms
1:26:21
How Stress And Dopamine Influence Libido
1:28:26
Should Sex Be Scheduled Or Spontaneous?
1:30:12
How Self-Esteem Affects Sex
1:32:04
The Most Important Thing We Missed
1:33:43
Better Communication, Better Sex
1:35:46
Why This Work Matters So Much
1:43:30
What Needs To Change In Your Own Life?
1:44:37