Health & Medicine
Sexual medicine specialist Dr. Rachel Rubin reveals why women's sex lives are being quietly destroyed, the impact of prescription drugs on libido, and the treatments most doctors aren't prescribing.
Dr. Rachel Rubin identifies a hidden hormone crisis where women's sexual health is often neglected by doctors. She highlights that menopause is a whole-body hormone event and that treatments like Hormone Replacement Therapy (HRT) are underutilized. She also notes that physical barriers, such as tight pelvic floors or clitoral adhesions, and medications like GLP-1s and antidepressants significantly impact sexual function.
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Key takeaways
Women's sex lives are being quietly destroyed, and many doctors are unaware of the extent of the issue. Dr. Rubin highlights that sexual pain and low libido are often physical problems that are frequently missed by healthcare providers.
15Prescription drugs, including birth control, GLP-1s, and antidepressants, can significantly affect sex drive. Understanding these impacts is crucial for managing expectations and treatment plans.
157Dr. Rubin played a pivotal role in removing the FDA's boxed warning on menopausal hormone therapy. She explains that HRT is a significant healthcare policy change affecting midlife women and details the different types of HRT available.
37Physical issues such as tight pelvic floors and clitoral adhesions can block orgasm in up to one in four women. Addressing these physical barriers is essential for improving sexual health.
57Even gynecologists often misunderstand aspects of women's bodies, such as the clitoris. Dr. Rubin argues that women's healthcare is still neglected and that building a knowledgeable medical team is vital.
57Ask GenPod next
“What are the different types of Hormone Replacement Therapy (HRT) available?”
“How can women identify if they have pelvic floor problems?”
“What are the signs that a woman's sexual pain is a physical problem?”
Background reading
Expert Profile
Dr. Rachel Rubin is a board-certified urologist and sexual medicine specialist. She is one of only 80 doctors in the US trained to treat both male and female sexual health. She is the Founder of Rachel Rubin MD and Director-at-Large of the International Society for the Study of Women's Sexual Health.
24Questions
Dr. Rubin explains that doctors often miss physical problems causing sexual pain and low libido. She suggests building a team of specialists who understand these issues to ensure better care.
5Medications such as birth control, GLP-1s, and antidepressants can significantly affect sex drive. Understanding these effects is key to managing sexual health.
157Dr. Rubin played a pivotal role in removing the FDA's boxed warning on menopausal hormone therapy, which is one of the most significant healthcare policy changes affecting midlife women in decades.
3Experts
Sources and disclosure
This guide is based on the episode 'Dr Rachel Rubin: "I'm Filled With Rage!" Your Doctor Was Never Taught About Women's Bodies!' from The Diary Of A CEO with Steven Bartlett, published on 2026-06-22.
Women’s sex lives are being quietly destroyed, and their doctors don’t even know it… Sexual medicine specialist Dr Rachel Rubin reveals the hidden hormone crisis, how prescription drugs can impact sex, and the treatments most doctors aren't prescribing like Hormone Replacement Therapy.
Dr Rachel Rubin is a board-certified urologist and sexual medicine specialist, and one of only 80 doctors in the US trained to treat both male and female sexual health.
She recently played a pivotal role in the removal of the FDA's boxed warning on menopausal hormone therapy - one of the most significant healthcare policy changes affecting midlife women in decades.
She is also the Founder of Rachel Rubin MD and Director-at-Large of the International Society for the Study of Women's Sexual Health.
She explains: ◼️ Why most doctors fail women on sexual health, and how to build a team that won't ◼️ Why menopause is a whole-body hormone event, and the treatments that actually help ◼️ The physical barrier blocking orgasm in 1 in 4 women, and how to fix it ◼️ How a tight pelvic floor could be ruining your sex life ◼️ Why your sexual pain and low libido are physical problems your doctor keeps missing
Chapters
• 00:00:00 Why Women's Healthcare Is Still Neglected • 00:04:17 If Men Had These Symptoms, Would Medicine Be Better? • 00:07:02 Why Even Gynaecologists Misunderstand The Clitoris • 00:08:03 What You'll Learn From This Conversation • 00:11:07 The Question Women Ask Most • 00:11:32 Why Testosterone Matters For Women • 00:13:41 How Birth Control Can Kill Libido • 00:16:25 How GLP-1s And Antidepressants Affect Sex Drive • 00:18:26 Should Women Take Testosterone? • 00:19:30 Understanding The Menstrual Cycle • 00:23:11 Why Perimenopause Starts Earlier Than You Think • 00:25:19 What Is HRT And How Does It Work? • 00:26:01 Does Estrogen Increase Cancer Risk? • 00:27:27 Why HRT Got A Bad Reputation • 00:29:24 The 4 Types Of HRT Explained • 00:31:19 What Really Causes UTIs? • 00:33:22 Vaginal Hormones Explained • 00:37:19 Does Cranberry Juice Actually Help UTIs? • 00:38:31 When Should You Start HRT? • 00:40:36 A HRT Success Story • 00:44:43 Ads • 00:46:47 Is Pain During Sex Normal? • 00:49:28 How To Have Better Sex • 00:51:54 What Your Pelvic Floor Actually Does • 00:53:48 Signs You Have Pelvic Floor Problems • 00:55:24 Is It Normal Not To Orgasm? • 00:57:30 What Is A Clitoral Adhesion? • 00:58:55 How Sex Toys Can Improve Intimacy • 01:00:07 What Men Get Wrong About Arousal • 01:01:57 What Happens To Women After Orgasm? • 01:02:55 Do Women Get Anything From Penetrative Sex? • 01:04:40 How Porn Changed Our Expectations • 01:06:58 What Healthy Porn Looks Like • 01:08:12 How Porn Can Damage Relationships • 01:10:12 Ads • 01:12:21 Why You Should Change Up Your Sex Life • 01:13:35 Why We Hide Our Sexual Struggles • 01:17:17 Responsive Vs Spontaneous Desire Explained • 01:19:58 The Question Every Couple Should Ask • 01:20:51 What If You Want Different Things In Bed? • 01:23:10 How To Tell Your Partner About Kinks • 01:24:28 The Secrets People Hide From Their Partners • 01:25:42 How To Tell If She's Faking Orgasms • 01:27:46 How Stress And Dopamine Influence Libido • 01:29:33 Should Sex Be Scheduled Or Spontaneous? • 01:31:24 How Self-Esteem Affects Sex • 01:33:04 The Most Important Thing We Missed • 01:35:06 Better Communication, Better Sex • 01:42:51 Why This Work Matters So Much • 01:43:57 What Needs To Change In Your Own Life?
Independent Research: https://stevenbartlett.com/wp-content/uploads/2026/06/DOAC-Rachel-Rubin-Independent-Research-Further-Reading.pdf
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