The Diary of a CEODr Rachel Rubin: The Truth About HRT & Menopause Doctors Won't Tell Women | Dr Rachel Rubin
At a glance
WHAT IT’S REALLY ABOUT
Women’s sexual health, hormones, and pleasure: medical myths, practical fixes
- Rubin says women’s sexual health is neglected because clinicians are undertrained on basics like the clitoris, menopause care, and sexual pain, leading to widespread misinformation and poor access to effective treatments.
- She reframes menopause as a whole-body hormonal event and explains how estrogen, progesterone, and testosterone change across life stages—often starting earlier than people think in perimenopause.
- She highlights vaginal estrogen/DHEA as a low-dose, high-impact intervention for dryness, painful sex, urinary symptoms, and UTI prevention, claiming it is underprescribed despite strong safety and efficacy data.
- She attributes much of the “orgasm gap” to anatomy and education (clitoral stimulation vs. penetration myths), plus overlooked issues like clitoral adhesions and pelvic floor dysfunction.
- Beyond biology, she stresses that better sex is driven by communication, curiosity, and realistic expectations—challenging porn-shaped scripts, addressing responsive desire, and making intentional time for intimacy.
IDEAS WORTH REMEMBERING
5 ideasWomen’s sexual health is often dismissed because clinicians weren’t trained to treat it.
Rubin claims even OB/GYN training can omit core sexual anatomy and function (e.g., clitoris), so patients seeking help for libido, orgasm, or pain may need specialists and multiple opinions.
Testosterone matters for women, and declines can start in the 30s.
She describes testosterone as a human hormone (not “male-only”) that supports libido, arousal, orgasm, and satisfaction, and notes some women experience noticeable changes well before menopause.
Hormone-altering drugs can meaningfully change sexual function—plan for informed consent, not surprises.
She links libido/orgasm changes to combined birth control (ovaries suppressed without testosterone replacement), antidepressants (sexual side effects), and reports early survey findings of sexual effects with GLP-1 weight-loss drugs.
Vaginal estrogen (or vaginal DHEA) is positioned as a cornerstone therapy for dryness, painful sex, urinary symptoms, and recurrent UTIs.
Rubin describes microdosed local therapy (cream/tablet/ring) as improving tissue health and vaginal acidity/microbiome, cutting UTIs by more than half, and being broadly safe across ages and many medical histories.
Menopause care was derailed by miscommunication about the Women’s Health Initiative, creating a lasting access and skills gap.
She argues the WHI messaging scared clinicians and patients away from hormone therapy, leaving doctors unsure how to prescribe modern regimens and contributing to very low utilization among eligible women.
WORDS WORTH SAVING
5 quotesAnd if you do that twice a week, you can prevent death from urinary tract infections. You can help with urinary frequency, urinary urgency, leakage. You make sex not painful and dry. It helps with arousal and orgasm. It's literally better than Viagra, and this is over the counter in the UK.
— Dr. Rachel Rubin
The word clitoris today, in 2026, does not exist in the checklist for what an OBGYN has to learn in their training. The word doesn't exist.
— Dr. Rachel Rubin
We put a sheet over you like we are mechanics looking under the hood.
— Dr. Rachel Rubin
Sex is not supposed to be painful. If sex is painful, you need to figure out why. It's-- You deserve a diagnosis. You deserve an answer. You deserve to understand exactly why sex is painful.
— Dr. Rachel Rubin
Many times nothing.
— Dr. Rachel Rubin
High quality AI-generated summary created from speaker-labeled transcript.
