Urologist and sexual-medicine specialist Dr. Rachel Rubin joins Steven Bartlett to argue that women's hormonal and sexual health is systematically neglected because doctors are never trained in it. She walks through how testosterone, estrogen, and progesterone change across the menstrual cycle, perimenopause, and menopause, defends hormone replacement therapy as widely misunderstood since the misinterpreted Women's Health Initiative study, and makes the case for vaginal estrogen/DHEA as a safe, cheap way to prevent UTIs and treat painful sex. She explains the anatomy of the clitoris and the 'orgasm gap,' arguing most women orgasm from the clitoris rather than penetration and that conditions like clitoral adhesion go undiagnosed. The conversation closes on pain during sex, the distorting effects of pornography, scheduling sex, body image, and the role of communication and conflict resolution in lasting relationships.
Rubin explains why she is 'filled with rage': doctors are not trained in hormones or sexual health, so even affluent women (Melinda Gates, Oprah, Halle Berry) are let down, and women's health gets less research and manpower than men's.
Rubin reframes testosterone as a hormone women make that drops in their 30s (not at menopause), walks through the menstrual cycle, and explains the hormonal shifts of perimenopause and menopause.
How combined birth control suppresses the ovaries and lowers testosterone, the principle of informed consent about sexual side effects, and a survey finding sexual side effects from GLP-1 weight-loss drugs.
Rubin recounts how the early-2000s Women's Health Initiative was misinterpreted, stigmatizing hormone therapy overnight, and frames hormone therapy as four buckets (estrogen, progesterone, testosterone, vaginal hormones) that women should be able to access.
Rubin demonstrates vaginal estrogen cream, DHEA, tablets and rings, explaining genitourinary syndrome of menopause and how vaginal hormones prevent UTIs by more than half and are safe for everyone, including cancer patients.
Up to 75% of women report painful sex at some point; Rubin lays out skin, muscle, nerve, and endometriosis causes and urges seeing a specialist rather than accepting pain.
Rubin describes the 'orgasm gap,' argues most women orgasm from the clitoris rather than penetration, and explains clitoral adhesion, which is undiagnosed but treatable.
Discussion of how pornography distorts expectations, spontaneous vs responsive arousal, vibrators, and Rubin's view that porn is not inherently bad but problematic when it involves deception or desensitization.
Rubin and Bartlett discuss the 'sex recession,' the spontaneity myth, scheduling sex and quarterly partner dates, body image, and communication as the foundation of good sex.
Rubin's core message that biology is minimized in women's health and that education and communication, plus seeing conflict as 'no bad guy,' are what make relationships and sex work.
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