madman
Super Moderator
In this episode Dr. Mary Claire Haver is joined by Dr. Rachel Rubin, a board-certified urologist and nationally recognized expert in sexual medicine, fellowship trained in both female and male sexual health. As assistant clinical professor of urology at Georgetown University and former education chair of the International Society for the Study of Women's Sexual Health, she brings unique insight into the stark disparities in how sexual dysfunction is treated across genders. Dr. Rubin founded the Sexual Medicine Research Team, and her advocacy work has been instrumental in changing FDA labeling on hormone therapy and advancing the American Urological Association Guidelines on genital urinary syndrome of menopause.
During the conversation, Dr. Haver and Dr. Rubin explore the intersection of menopause, hormones and women's sexual health, revealing why most doctors, including OB-GYNs, receive virtually no training in sexual health despite sexual dysfunction affecting millions of women. Dr. Rubin explains how men's sexual health benefits from 27 fellowship programs while women's sexual health has only three, and why erectile dysfunction research receives billions while female orgasm research gets nothing from the NIH. She breaks down the complete anatomy of the clitoris that most medical professionals never learned, explaining why understanding this matters for surgical outcomes, pleasure, and treating conditions like vulvar vestibule pain that affects penetration, tampon use, and pelvic exams. Dr. Rubin discusses how the vulvar vestibule, the hormone sensitive tissue surrounding the urethra, becomes a source of pain for many women during perimenopause, on birth control pills, or postpartum due to low estrogen and testosterone.
Chapters
00:00 – Why Women’s Healthcare Is Structurally Broken
00:51 – Meet Dr. Rachel Rubin and the Case for Sexual Medicine
02:58 – The FDA, Estrogen Fear, and a Personal Wake-Up Call
04:02 – Why OB-GYN Training Leaves Sexual Health Out
06:08 – Sexual Medicine Fellowships: Why Almost No Doctors Are Trained
08:23 – The Double Standard Between Men’s and Women’s Sexual Health
11:05 – Risk, Choice, and Why Men Get Options Women Don’t
13:10 – Why Women’s Sexual Health Gets Labeled “Psychological”
15:38 – The Clitoris, Homologs, and Anatomy We Were Never Taught
18:30 – Orgasm Myths, Hollywood Sex, and What Actually Works
20:51 – Surgery, Nerves, and Sexual Harm No One Studies
24:59 – Pelvic Pain, Misdiagnosis, and Finally Being Believed
32:53 – Genitourinary Syndrome, Hormones, and Preventing UTIs
46:05 – Libido, Medications, Hormones, and What Doctors Don’t Explain
1:42:45 – Reclaiming Sexual Health, Dignity, and Feeling Like Yourself Again
