00:00:00
You rub it inside the water, the vagina >> and just rub it in like you would rub
00:00:03
sunscreen on your face. And if you do that twice a week, it makes sex not painful and dry. It helps with arousal
00:00:09
and orgasm. It's literally better than Viagra. And it's cheap. And I'm telling you all this as a urologist that this
00:00:15
cream can also help prevent death from urinary tract infections. But more than 75% of people in large database
00:00:22
collections are not getting prescriptions for this. And so women are not getting access to generic
00:00:27
medications that could save their lives and also really improve quality of life.
00:00:32
And so I am filled with rage because people are limiting their ability to have great sex, great health because
00:00:38
they aren't having access to all the information that they could. For example, women are not orgasming as much
00:00:43
as men. The data is very clear there. And women come to see me all the time is I'm a sex doctor and they say I'm broke
00:00:48
and you have to fix me. I'm not orgasming during sex. And I think the majority of problem is education. Women
00:00:54
think that orgasm comes from penetration, but their clitoris is how most women orgasm. And yet, most women
00:01:00
do not know where their clitoris is. And in fact, the word clitoris today in 2026
00:01:06
does not exist in the checklist for what an OBGYn has to learn in their training.
00:01:11
>> And as men, what are we getting wrong in heterosexual relationships when we're
00:01:16
trying to arouse our partners? Well, men are constantly asking about they want their penises bigger, harder,
00:01:22
straighter, girthier, lasting longer, but none of that has anything to do with how women experience pleasure [music]
00:01:28
and satisfaction in the bedroom. So, that's why I'm so loud about these things because no one is getting good
00:01:33
sex ed because the basic information is not being shared. And we fundamentally don't give a crap about women's sexual
00:01:39
health, about their menstrual cycles, pregnancy, menopause, hormones, pain with sex, [music] libido. But we
00:01:44
actually do have a lot of information that we are not using because everyone forgot to teach your doctor.
00:01:49
>> And I want to focus today's conversation on women's health cuz I have so many
00:01:52
questions and curiosities. >> So let's start with the subject of hormones. >> This is going to be so [ __ ] good.
00:02:00
>> This is super interesting to me. My team given me this report to show me how many
00:02:03
of you that watch this show subscribe. And some of you have told us according to this that you are unsubscribed from
00:02:08
the channel randomly. So favor to ask all of you please could you check right now if you've hit the subscribe button.
00:02:13
If you are a regular viewer of the show and you like what we do here, we're approaching quite a significant landmark
00:02:18
on this show in terms of a subscriber number. So, if there was one simple free thing that you could do to help us, my
00:02:24
team, everyone here to keep this show free, to keep it improving year over year and week over week, it is just to
00:02:29
hit that subscribe button and to double check if you've hit it. Only thing I'll ever ask of you, do we have a deal? If
00:02:34
you do it, I'll tell you what I'll do. I'll make sure every single week, every single month, we fight harder and harder
00:02:40
and harder and harder to bring you the guests and conversations that you want to hear. I've stayed true to that
00:02:44
promise since the very beginning of the diio and I will not let you down. Please
00:02:48
help us. Really appreciate it. Let's get on with the show. [music] Dr. Rachel Rubin, before we started
00:02:58
recording, you said a line to me which I found to be very interesting. You said,
00:03:03
"I'm filled with rage." Why are you filled with rage? I am filled with rage because I do think that
00:03:11
people are limiting their ability to have great sex, great relationships, and great health because they aren't having
00:03:17
access to all the information that they could. And they're going to see doctors who actually don't know how to help them
00:03:24
with these problems. >> And on the subject of women's health, sexual health, hormones, etc. Can you
00:03:29
give me the background context of the disservice that's been done? And I remember you were talking previously
00:03:35
about how even the most affluent women in the world are being let down. >> Yeah. I think this is the great
00:03:40
equalizer in the fact that no one is getting good medical care here when it comes to hormone therapy, menopause, and
00:03:47
sexual health. Melinda Gates just came out and said she had to see three doctors before she got proper hormone
00:03:52
therapy prescriptions. Oprah had to see five doctors and still they didn't understand that her heart palpitations
00:03:59
was from pmenopause and menopause. How about Halib Berry, right? who has access to all the doctors in the world and she
00:04:06
publicly came out and said she was diagnosed with genital herpes when she really just had the genital urinary
00:04:12
syndrome of menopause. The rich people are not getting good information about their bodies, about their hormonal
00:04:18
health, about their sexual health. So what are the rest of us doing? We don't teach it in medical schools. We don't
00:04:23
teach it in residencies. I didn't learn anything about it. And so we are actually getting worse at this, not
00:04:29
better at this. And so I am full of rage because we actually do have a lot of data and we do have a lot of information
00:04:35
that we are not using because everyone forgot to teach your doctor. >> It's staggering to me that you know
00:04:42
those very affluent women that you've mentioned still are being let down by a medical system. Um it also sort of
00:04:49
begets the question that if men were in that situation, this probably wouldn't be the case. And that says something
00:04:55
about the research and the investment that's gone into understanding women's health relative to men's health.
00:05:00
>> It's a huge problem. We don't have enough specialties of medicine that focus on women's health and we don't
00:05:06
have enough like manpower behind us. We can throw money at this situation, but you need physical human beings to roll
00:05:12
up their sleeves and do this work. Like doing research is challenging and you need people to actually disseminate the
00:05:18
research and talk about the research and you need the training to happen. So it has to trickle down. So just because
00:05:23
someone wrote a paper doesn't mean it automatically gets downloaded into every doctor's brains. So someone has to teach
00:05:29
someone how to do something. So I I lecture all the time. I do a lot of trying to teach clinicians how to do
00:05:35
this. I travel all over to say here's how to write prescriptions because that's what it's going to take. There
00:05:40
was so much fear and misinformation 20 years ago about hormone therapy that it is a lost art. Doctors don't know how to
00:05:47
write the prescriptions. Nobody taught them how. So, even if they see headlines and Melinda Gates giving $10 million to
00:05:54
the Menopause Society, that's wonderful, but it doesn't translate into them knowing how to actually write the
00:05:59
prescription, knowing the difference between the type of hormones, knowing the safety, the risk, the benefits,
00:06:04
because they never had the class. For example, I'm a urologist. If someone comes into me asking about their blood
00:06:10
pressure, I'm not going to pretend like I know everything about their blood pressure. I'm going to be very honest
00:06:14
that I have the limitations in my training. But for some reason with hormone therapy and women's health,
00:06:20
every doctor you go see has strong opinions and will tell women what they can and cannot have with their bodies
00:06:26
even when they don't know the data. I come from the men's health world. We don't tell men you can't have this, you
00:06:32
can't do this. We we talk about shared decision-making. We talk about risks. We talk about benefits. For some reason, we
00:06:38
don't do that enough in women's health. >> Why? >> I think part of it I don't think your
00:06:41
doctor's evil. I actually have a a thought about this. So, I think your doctor wasn't trained. I think they're
00:06:46
trying to save face and I think 10 minutes is impossible to give good medical care. I could never get to know
00:06:52
you fully in 10 minutes and really give you great advice on your life that's customized for you. It's almost like the
00:06:58
difference between a viral clip that you're going to try to do from this episode and the long form nuanced
00:07:06
conversation that you're going to have. You love the nuanced conversation. You love spending those those two hours and
00:07:11
I think patients want that too. But when they go to the doctor, they're getting the 10-minute version. And instead of
00:07:16
doctors saying, "I don't know," they're sort of saying, "No, no, you can't have this." Because it's easier than than
00:07:22
sort of going into that nuance, which can take time. I also think that people are going to their doctor. Say, say you
00:07:29
want to talk about your orgasm or your libido, okay? You go to your gynecologist. Of course, my gynecologist
00:07:34
should know everything there is to know about the clitoris, about orgasm, about hormones, about that's what they do. And
00:07:40
the truth is, it's not what they do. And it's they were never taught that. And >> they were never taught about the
00:07:43
clitoris. >> They were the word clitoris today in 2026 does not exist in the checklist for
00:07:50
what an OBGYn has to learn in their training. The word doesn't exist. >> What is an OBGYn for anyone that doesn't
00:07:55
know? >> An OBGYn is a doctor who specializes in obstetrics, so delivering babies and
00:07:59
gynecology. So your gynecologist has never been taught about the clitoris, about the vulva, about sexual health,
00:08:07
about sexual pain, about libido, arousal, and orgasm. And so the ones who have taken it on their themselves to get
00:08:12
extra training, they're very few and far between. And so every day, women and men
00:08:18
too are going to a doctor expecting answers on a topic that their doctor probably has never gotten training on.
00:08:25
>> You know, I do want to focus today's conversation on women's health. I want to preface all of this by saying that
00:08:30
I'm going to be as dumb as I am on this subject. If you say something about the vagina and I don't know what it means,
00:08:36
I'm not going to pretend to know. I'm going to ask you what it means. And I say that because I sometimes think with
00:08:40
these conversations um the host often is too shy to admit their ignorance and I have lots of
00:08:49
ignorance on this but I also have lots of curiosity and I want to fill those gaps and that's going to require me to
00:08:53
be very very dumb. And also my second reason why is because I have so many women in my life. Um if you just look at
00:09:00
my company, my entire executive team in my company are all women. And also I've got my fianceé, my mom, my sister and
00:09:08
understanding the women in my life. Um, one element of understanding them is understanding their health. Women's
00:09:13
health isn't something that I was ever taught in school. It's not like a lesson I had. So I also think this conversation
00:09:19
is for men. Every man has very important women in their lives. So my question to
00:09:24
you is if if a woman has clicked on this conversation right now, what are they going to get from it? Let's start with
00:09:29
that first question. So I think it's really important because as men we expect the women to know. Surely the
00:09:35
woman knows about their menstrual cycle, about pregnancy, about postpartum, about
00:09:40
menopause, about hormones. Surely my partner knows, you know, or the woman in my life, my mom, my sister, my my
00:09:45
daughter, they know all of that. So I don't have to. And the truth is they don't know. When the women in your life
00:09:52
go to their doctor and they're getting a pelvic exam, say they're getting a papsmear, a doctor is looking at their
00:09:57
their genitalia, putting a a speculum in, going inside the canal, and looking around. We put a sheet over you like we
00:10:04
are mechanics looking under the hood. So, we put a sheet to keep you comfortable, to keep you modest, but we
00:10:10
we hide your genitalia from you, and we don't teach as we go. So I became famous
00:10:16
again because I I when I started my practice, I didn't buy any fancy uh equipment. I bought two mirrors on
00:10:23
Amazon and I give women a mirror and as I'm examining them, I say to them, "This
00:10:28
is your labia majora. This is your labia manora. This is your clitoris. This is your urethra, the tube that you pee
00:10:33
through, because women can't see it. You've got skin. You've got bones. You've got muscles. You've got nerves.
00:10:40
You've got, you know, all the organs that are on the inside. And women don't have access to this language. Certainly
00:10:46
men don't have access to this language. And so it's that basic ability to give women language. You can learn about your
00:10:53
body parts. You can learn how hormones work in your body. And you can learn basic medicine for you that becomes
00:11:01
important for how you advocate for what you want, what you care about, and who you bring into your medical life. You
00:11:06
may have a physical therapist. You may have a mental health person. You may have a primary care, a gynecologist. You
00:11:12
may go on Instagram and get great information from people on Instagram. And so that doctor that makes you feel
00:11:17
like crap because they they tell you something that you don't agree with. Find a different one, right? You have to
00:11:23
advocate for yourself. And I find we are starting to empower women to do that. Um, which is very challenging.
00:11:30
>> What is the most popular question you get asked now that you've been on these
00:11:33
podcasts and you know you're out there and you've done millions and millions of views all over the place and on clips
00:11:38
and so forth. What is the number one most popular question you get asked? I'm asked a lot about hormones. Like people
00:11:44
want to know about hormones. >> People want to know about pain with sex. >> Yeah.
00:11:49
>> And I think people want to know about libido. I think those are the three I would say most common things that we
00:11:54
talk about. >> So let's go in that order then. So let's start with the subject of hormones. What
00:11:58
is it about hormones that people are so desperate to understand. >> So hormones are fascinating because we
00:12:03
forgot to teach doctors anything about hormones. Uh and what we have taught about them. They think it's dangerous.
00:12:10
They think they're harmful. They think that, you know, it's it's almost like this thing that is natural in your body
00:12:15
is somehow dangerous once you get over a certain age. And that is all politics and bad interpretation of science.
00:12:24
>> I've got this graph here which um shows female testosterone levels by age. And
00:12:30
again, as someone that um has started to understand more about female hormones, I
00:12:34
was quite surprised because you think of testosterone as a male hormone. >> Yeah. So that's the biggest
00:12:39
misconception is that women don't make testosterone. Testosterone is just a hormone. It's not a male hormone, a
00:12:44
female. It's just a hormone. It's also not a menopausal hormone. We think of menopause as estrogen starts to drop,
00:12:50
right? So menopause is a castration event. If I cut your testicles off right now, you would have hot flashes, night
00:12:56
sweats, osteoporosis, depression, low libido, erectile dysfunction, metabolic syndrome. Your weight would go up and
00:13:03
you would be generally pretty unhappy. It's a big deal when we castrate people. And yet we don't do it for men regularly
00:13:10
unless there's a very significant medical reason to do so. And yet every woman over the age of 50, her estrogen
00:13:17
goes to essentially zero. And that affects bone health. It affects the brain. It affects the heart. It affects
00:13:23
sexual health. It affects UTI start to go up. And so it's a whole body event that happens. Now testosterone is really
00:13:29
interesting because it actually isn't at menopause that you lose testosterone. It
00:13:33
happens in your 30s. So if you look at this graph, right, you can see testosterone starts to precipitously
00:13:39
drop in your 30s. So what do we see clinically? Sometimes nothing. But we have a lot of people who will start in
00:13:45
their 30s, mid-30s, late 30s, start to say, "Ooh, my libido is not as high as it used to be. Huh, my orgasm takes a
00:13:52
little bit longer. I don't feel as aroused. My engorgment is not the same. My lubrication engorgment of the
00:13:58
clitoris, it's the same as an erection, right? So the clitoris and the penis are
00:14:01
the same. They get hard with blood flow. And so this happens in your 30s and no one's paying attention because if you
00:14:07
look at the graphs that we are taught in med school, they look more like this. So
00:14:11
the books all talk about estrogen and progesterone. They don't talk about testosterone very often. And there's
00:14:17
also a lot of things we do to worsen this problem. When you play with hormones, there are consequences,
00:14:23
sometimes good and sometimes bad, because we do so much to mess with our hormone levels. Again, birth control
00:14:29
pills, the way that they work is changing hormone levels. uh medications for acne, medications for hair loss that
00:14:36
people are using can affect your testosterone levels. So birth control is wonderful, but there are side effects to
00:14:43
birth controls just like there's side effects to any medication. And so one of the side effects is it lowers
00:14:48
testosterone. And so that can cause low libido pain with sex in a small subset of people who take it. So, if you're
00:14:56
someone who does have side effects, then it's worth having conversations of different forms of birth control, which
00:15:01
may not lower your testosterone as much. Does that does that make sense? >> It does make sense. And it's um it's
00:15:06
interesting. My my partner's talked about this before. Um my fianceé, she was on birth control for a long time,
00:15:12
and she also had concurrently libido problems. Now, we don't know whether it was the birth control, whether it was
00:15:19
something else, but when she came off the birth control pills, her libido challenges also evaporated.
00:15:27
>> So, can I explain? Cuz I think again knowing the basics and the fundamentals give women and men access to the
00:15:33
information so they can make choices with what they want to do with it. Okay. So, how do birth control pills work? um
00:15:39
when you take a combined birth control pill, it has a fake amount of estrogen and a fake amount of progesterine in it
00:15:46
so high that it tricks your body into not ovulating. So when you have so much hormone around, your body says, "Oh, I
00:15:52
don't need to make my own because there's plenty around." And so the ovaries shut down. So your ovaries are
00:15:57
no longer making their own hormones because, and this is happens to men, too. When you take high doses of
00:16:01
testosterone, you become infertile because your testicles say, "Oh, I don't need to produce sperm right now because
00:16:06
there's plenty of testosterone around." And so birth control causes your ovaries
00:16:09
to just stay quiet. They shut down for a bit, but your ovary does three things. It does estrogen, progesterone, and
00:16:15
testosterone. It doesn't add back testosterone. So, her experience possibly was because she wasn't making
00:16:22
her own testosterone. And once she went off that birth control, her ovaries woke
00:16:26
back up and make estrogen, progesterone, and testosterone, which to you equaled more pleasure. Now, because we focus on
00:16:33
the psychosocial, I'll have a lot of people saying, "No, no, no. It's all communication and and all of that is
00:16:38
important, don't get me wrong, but the biology matters, too. And we know there is a biological basis to sexual health
00:16:45
for everybody. >> I was just looking at some data and it said that in some studies up to 27% of
00:16:52
people on birth control report a decrease in their libido/ sex drive. >> Yeah. >> Which is shocking cuz you know it varies
00:16:59
in these studies from 1 to seven people to one to that's almost like one one in three people are experiencing it. How
00:17:05
does one navigate that? You know, cuz birth control has tremendous um upsides. So, how do you navigate that?
00:17:11
>> I think that everything that we do, there's the risk of doing something and the risk of not doing something. No drug
00:17:18
is going to be without possible side effects. And so, that's where it becomes important to know what are the
00:17:23
non-negotiables. Anti-depressants is a perfect example. We know that they can help people, right? a lot of people. But
00:17:30
we know there are sexual side effects like low libido, delayed orgasm. And so it has to do with informed consent,
00:17:36
which means I Stephen, if I'm going to give you a medicine, I want you to know that there is the common side effects,
00:17:43
the less common side effects, and then the disastrous side effects. That's why on the commercials they talk about all
00:17:48
the disastrous side effects, but often they don't even research the sexual side effects. So, for example, GLP1s. Okay.
00:17:56
>> What's a GLP-1? >> Yep. The GLP ones are the weight loss drugs that everybody's talking about.
00:18:00
Ozmpic, Mangaro, all the all the celebrities are on these injections that are making them lose tons of weight. We
00:18:06
are starting to look at these drugs in women, but they're not. Nobody's looking at it for sexual health. Everyone's
00:18:12
looking at it for can you get pregnant, reproductive health. There is not a single published paper on sexual health
00:18:19
side effects for women. So, we did a survey, it's not published yet, but we presented it at a conference, at a
00:18:24
medical conference. We uh surveyed a thousand women on online who have taken these medications and about 25% report
00:18:32
sexual side effects from these medications. Again, that's not to say the medicines are good or bad, right or
00:18:37
wrong, but there are side effects. Now, of those 25%, about 50% of those people said it lowered their sexual function,
00:18:44
whether it's libido, arousal, and orgasm. And about 25% said it made it better. So carrying on this track about
00:18:51
women's um hormone levels through time and through age and through life phases, what else do I need to know or
00:18:57
understand about how important testosterone is? >> So we know we have global consensus
00:19:02
actually that testosterone helps for libido in post-menopausal women. Okay. Now there is also data in pmenopausal
00:19:10
women as well and that is clear data. It helps with libido but it also helps with
00:19:15
arousal. It helps with orgasm and satisfaction. It can also help with body image, which is like a cool a really
00:19:22
cool thing. In my clinic, I use FDA approved testosterone for men, and I give it to them in doses appropriate,
00:19:28
like onetenth the dose for a man. I give it to uh my female patients, and I see that over the 3 to 6 months of taking
00:19:35
it, they get this um it clicks. Now, does that mean every woman on earth needs it? No. We're not there yet. But
00:19:42
if you want it and you want to try it and you're curious about it, then you should have access to physicians who
00:19:48
understand how this works and they know how to write the damn prescription. >> There's five life stages on here. We
00:19:54
have puberty, your fertile years, permenopause, menopause, and then postmenopause.
00:19:59
When you think about a woman's hormonal journey through these different life stages, what is the sort of advice you
00:20:06
would give them to make sure they're hormonally healthy across every life stage? What are like the basics? what
00:20:12
are the tactics, strategies, medications um that they should be thinking about? And I say this because I've got women
00:20:17
women in my life at every stage in this life phase at the moment. I've got, you know, I've got my nieces in the sort of
00:20:23
puberty era. I've got my my fiance in the fertile years. I've got my mom and grandparents, etc. in the per and
00:20:30
postmenopause years as well. >> Yeah. So, if you look at your nieces, for example, when they were babies
00:20:36
compared to now, there are changes happening. their bodies are transforming because they're getting a surge of
00:20:41
hormones in their body and that's estrogen, progesterone, and testosterone. They're cycling, which
00:20:46
means they're getting periods. So, let's talk about the menstrual cycle for a second. I think it's helpful.
00:20:50
>> Okay. [clears throat] >> So, when women have their period, they bleed for a few days, right? And that's
00:20:56
when their hormones, their estrogen and their progesterone is at its lowest. Okay.
00:21:00
>> Okay. >> So, hormones are at their lowest and then the hormones start to increase.
00:21:05
Your estrogen starts to go up. You don't make progesterone yet. In the beginning,
00:21:08
your estrogen starts to go up and it make there there's a a follicle in your ovary which has an egg, right? It's
00:21:14
going to pop out an egg. Ovulation is when the egg pops out. So, you get this big surge of estrogen and then when the
00:21:21
egg pops out of the ovary, right? That's what's going to make a baby if it gets fertilized. There is a shell of the egg,
00:21:27
right? The egg has a shell which makes progesterone. So, the second half of the cycle, there's progesterone around.
00:21:32
Okay? First half of the cycle, no progesterone. M >> and so [clears throat] that second half
00:21:36
of the cycle, the shell has making progesterone. And then when you don't have fertilization, the shell starts to
00:21:43
break down. >> Okay. >> And that natural breakdown is a drop in progesterone which causes the lining of
00:21:48
the uterus to shed and you get a period again. And so it's estrogen goes high in
00:21:53
the beginning and then pops out an egg. Progesterone gets high in the second half. Then they both fall and you have a
00:21:59
period. And so the hormones being low in the beginning, estrogen is not zero. It's about 50. Okay. So, when we talk
00:22:05
about numbers, if you get your your hormones checked, if they're at their low, it's like 50. But when you ovulate,
00:22:10
your estrogen may be 150, 200, 300. And then when you're pregnant, your estrogen
00:22:15
may be as high as 3,000 or higher, right? It's very many thousands. And so, these hormones have actions in our
00:22:21
bodies. And so, the reason it's important is because when we give back hormone therapy, well, are we giving
00:22:26
back 10,000 like pregnancy? No, we're giving back to be like 50, 60, 70, the way that you are early in your cycle
00:22:33
kind of a thing. Now, testosterone is not even on this graph that everybody gets taught of estrogen then
00:22:38
progesterone, but we do know testosterone is pretty stable through the cycle, although we do believe it
00:22:43
peaks during ovulation, which makes sense because you want to have a baby, right? So, evolution says, okay, you
00:22:49
need to be horny around the time that you are going to ovulate and so your testosterone starts to go up. Now, it's
00:22:55
really important because you're probably not having a conversation with your nieces about their menstrual cycles, but
00:22:59
it's a problem because no one's talking about it if they're painful, if they're abnormal, if they're um we don't have a
00:23:05
lot of conversations around what is a normal amount of bleeding. We have so many people who have problems, whether
00:23:12
it's PCOS, which is now called PMOS, which is a metabolic issue that cause you to have irregular periods. There's
00:23:18
endometriosis, where you have painful periods. There are so many medications we give to people that can alter their
00:23:24
hormonal health and and sexual health for that matter. And then it all starts to get even more chaotic in pmenopause
00:23:30
which is again age 35 to 45. If menopause we say is 45 to 55 right is normal menopausal age average age is 52
00:23:38
and we think pmenopause is when things start to change for people about 10 and it can be about 10 years that means 35
00:23:45
to 45. So how old are you? I don't remember. >> 33 my partner is 33. >> All right. So 33. So this idea that I'm
00:23:51
too young or it's too early or I'm not there yet. The truth is things do start to change. So
00:23:58
>> what changes for a woman? >> So it there are so many symptoms to hormonal fluctuations. So for some
00:24:03
people it's temperature changes. For some people it's fatigue. For some people it's remembering things. For some
00:24:08
people it's low libido. Some people get dry eyes, itchy ears, burning mouth, joint pain. Some people get irregular
00:24:14
periods. Some people get pain with sex. Some people get UTI. I would love to talk about what why hormones are so
00:24:21
important for the bladder and UTI prevention. And so there are so many symptoms and everyone says, "Oh, we're
00:24:27
blaming everything on hormones." And the truth is we haven't talked about hormones enough to actually start
00:24:33
looking at this to figure out what is important and what is hormonally important.
00:24:37
>> So when you start to lose progesterone when you arrive at permenopause, what are the symptoms you feel? Are they
00:24:43
different symptoms to decline in estrogen? So, it's hard to know for sure, but some people think that is the
00:24:48
progesterone. So, your sleep starts to get a little crazy, anxiety starts to go up, and so some people will start with
00:24:54
progesterone as a support for um you know, sort of pmenopausal hormone therapy. But estrogen can also help with
00:25:01
many of those symptoms. So, it's not a one-sizefits-all of whether we give people everybody gets progesterone or
00:25:07
everybody gets estrogen. Sometimes people just get testosterone because remember that falls in your 30s. uh you
00:25:12
know so there's sometimes where we uh do all three and there's sometimes where we
00:25:15
do just one or two. Now it's a a very evolving conversation because most of the book answers most of the guidelines
00:25:23
really talk about menopause and how we treat people in this menopause when you're flatlined. Remember it's that
00:25:28
castration event where everything's zero and then we add back hormones. So now we're starting to talk about perry
00:25:34
menopause as a place to to start giving women hormones and that's a a very important and evolving conversation that
00:25:41
is happening. >> And so this conversation that's sort of raging on about HRT, about safety, about what age you should
00:25:50
take it, who should take it, what form you should take it in, what's your perspective on that and what do women
00:25:54
need to know about that? >> Yeah. So so it's important because >> and what is HRT?
00:25:59
>> Yeah, it's a great question. So, hormone replacement therapy, which is a term
00:26:03
that we used to use for hormones in menopause, um, it has a bunch of different names and everyone tries to
00:26:08
change the marketing around it, but hormone therapy in general is this idea of giving back hormones when you have
00:26:15
hot flashes, night sweats, osteoporosis, you know, sort of this over 50 crowd that has this declining estrogen and
00:26:22
progesterone levels. And so, typically, classic hormone therapy is estrogen and progesterone. Now again, taking just
00:26:30
estrogen, estrogen grows things. It helps your bone health. It helps your hair, skin, and nails. It helps you not
00:26:36
have hot flashes. It helps you sleep. It can also grow the lining of the uterus.
00:26:40
And so if it gets thicker, thicker, thicker, there is worry over years that leads to endometrial or uterine cancer.
00:26:46
So the endometrium is the lining of the uterus. So here I can Okay, so this is a
00:26:51
this is a vagina. And then at the the vagina is like a sock. At the very end of the sock is a tiny hole. And that
00:26:59
hole is the the pinpoint opening of the cervix. And that hole, if you go through
00:27:04
that tiny tiny hole, it gets to the uterus. And the uterus is a cavity where we hold babies uh where the lining comes
00:27:12
out. That's what period blood is, is the lining of the uterus here, which we call
00:27:16
the endometrial lining. So progesterone is very important for this lining here. If the the lining of the uterus gets too
00:27:23
thick with just estrogen, that can lead to problems. But if you match it with progesterone, those problems go away. So
00:27:30
when >> So So if you just gave someone estrogen, then the linings of the uterus would get
00:27:34
so thick that that would cause a problem. But if you give it to both hormones together, it sort of balances.
00:27:39
>> It balances them out. And so that's why you'll hear hormone therapy talked about
00:27:42
estrogen and progesterone, just like the birth control pill your partner was on was an estrogen and a progesterine.
00:27:46
There was a combination. >> Okay, got you. And also the history is kind of important here of why your
00:27:52
mothers and grandmothers weren't given access to this medication and the stigma behind it. In the late 90s, uh, a lot of
00:28:00
people were on hormone replacement therapies and they were seeing benefits. They actually were all these
00:28:04
observational uh, studies that showed, wow, the heart disease is less and like this isopause during menopause. And a
00:28:11
billion dollars went into the NIH to study this in women and they they it was called the women's health initiative. It
00:28:18
was thousands and thousands of people aged 50 to 79. They gave a hormone pill, like a birth control pill almost, to all
00:28:25
of these women and they followed them and they stopped the study early in the early 2000s. And they did a press
00:28:31
conference. And at this press conference, they said, "We're shutting down this the study early. Hormone
00:28:35
therapy causes cardiovascular disease and breast cancer." And overnight, a multi-billion dollar industry went to
00:28:42
nothing. Everyone was told, "Throw your hormones in the garbage. This is dangerous." What was crazy is those
00:28:48
people who were prescribing hormone therapy were looking around saying, "I don't understand. My patients aren't
00:28:54
dying of heart disease. They're not getting extra breast cancers. Like, this doesn't make any sense." And when people
00:28:59
actually looked at the study, it didn't say any of those things. It was wild how
00:29:04
misinterpreted this study was. In fact, the same uh authors of this study back in the early 2000s published this year
00:29:10
in 2025 actually that below age 70, that type of hormone therapy, which we don't
00:29:16
really use anymore, has no increased risk of cardiovascular disease or stroke. And yet now you have a
00:29:22
generation of doctors who weren't taught how to do this. Only 1.7% of women have
00:29:28
are getting prescriptions for hormone therapy who who should be offered prescriptions. So it is a disaster. only
00:29:34
1.7% >> only 1.7%. >> Oh, really? Wow. >> And so hormone therapy is not something
00:29:41
that I'm saying every woman must have, but every woman should have access to the toolbox. I like to think about
00:29:47
hormone therapy is really four buckets that we talk about. Hormone therapy is whole body estrogen which helps with hot
00:29:53
flashes, night sweats, uh uh bone loss, progesterone, whole body progesterone therapy, which protects the uterus and
00:29:59
is this yin-yang, especially if you have a uterus, but it helps with sleep and it
00:30:03
can help with anxiety reduction in many of our patients. Not everybody, but a lot of them. The third thing is
00:30:08
testosterone, which we talked about, which can help with libido. Um, that's what we have the most evidence for. And
00:30:14
then the fourth thing is vaginal hormones. Now, vaginal hormones are micro doses of uh estrogen or what we
00:30:20
call DHEA vaginally that supports the bladder and the vagina. So, it helps with pain with sex, dryness, urinary
00:30:27
frequency, urinary urgency, leakage, and it prevents urinary tract infections massively. It is safe for your great-g
00:30:34
grandandmother in the nursing home. It is safe for your uh wife who's breastfeeding. So if you know anyone in
00:30:40
your life who is a woman who's having urinary frequency, urgency, leakage, urinary tract infections, pain with sex,
00:30:48
dryness, there is a magical solution that is safe for everybody on earth um that is micro doing these hormones
00:30:56
vaginally >> at any age >> at any age at all. In fact, even more important for people who are older
00:31:02
because they are dying of urinary tract infection. It's one thing when a young person gets
00:31:07
a urinary tract infection and they go to the urgent care and they get an antibiotic even they deserve prevention
00:31:12
and this is prevents those problems in those people too. >> Again what is this? >> So vaginal hormones. So this is a really
00:31:19
important topic. It's called genital urinary syndrome of menopause or GSM. Say GSM loudly for your listeners.
00:31:25
>> GSM. >> GSM. Genital urinary syndrome of menopause. Genital urinary syndrome of
00:31:32
menopause. But really, it's kind of a dumb name because it's any hormonal changes in your body can affect the
00:31:40
bladder and the genitals. >> So UTI, what is a UTI and what's what's causing a UTI? Urinary tract infection.
00:31:48
>> Yeah, very good. So urinary tract infections are when there is bacteria in the bladder and it can be a lot of of
00:31:55
bad bacteria that can grow and create inflammation. It causes bladder pain, pain with urination. It feels like razor
00:32:02
blades. Um, but it can also go into your bloodstream and cause fevers and chills.
00:32:06
It can cause kidney infections. It can cause something called eurospsis where you have to go to the intensive care
00:32:12
unit and need in antibiotics through an IV and it can kill you if you have an infection go through your whole body.
00:32:18
And this gets worse and worse as you get older. >> Why is there a link between hormones and
00:32:22
UTI? >> Yeah. Because what happens is the vagina is supposed to be acidic and healthy and
00:32:29
hormones help keep it. It is the hormones, the estrogen and the testosterone that keep healthy bacteria
00:32:35
growing in the vagina and suppress or lower the bad bacteria. >> So, there really is a vagina microbiome.
00:32:42
>> There is. And there's there's no probiotic on earth that is proven to do what the vagina needs quite like
00:32:48
hormones. Hormones make the tissue go from uh not acidic to quite acidic. And it is that acidic environment that
00:32:55
protects it from infection. And so pmenopause and menopause or other situations happen and it changes that
00:33:02
microbiome. So the good bacteria are are lower and the bad bacteria start to grow
00:33:07
which can increase your risk of infections. And sex, right? Sex is a contact sport. So uh you're bringing the
00:33:14
outside environment into the inside environment. Uh ejaculate is also not acidic and that can change the
00:33:20
microbiome as well. And so we know women who are sexually active also have an increased risk of urinary tract
00:33:25
infections. So again, like a plant needing water, vaginal hormones help support the vagina and the bladder to
00:33:33
maintain that acidic environment. And research has been clear since the 1990s that using vaginal hormones prevent UTI,
00:33:42
urinary tract infections by more than half. >> So what have we got here in front of me?
00:33:46
>> All right, so there's a bunch of different ways you can give yourself vaginal hormones. The most common way is
00:33:51
a cream. Now, this cream is uh $14 on Mark Cuban's pharmacy, and it lasts about 2 and 1/2 months. Now, this cream
00:34:00
that comes with an applicator, which you don't ever have to use if you don't want
00:34:04
to, but what you can do is you want to use one gram of this cream. So, this amount is 1 gram of this cream. We'll
00:34:11
put it on this paper here to show you. One gram of this cream rubbed into the vagina. So you take it, you can take it
00:34:19
on your fingers and rub it into the walls like you, if you put sunscreen on your face, you don't blob it on and walk
00:34:24
out the door. You rub it in so it doesn't look all white and filmy. So you put it in, you take it with your finger
00:34:30
and you put it in the vagina and you rub it into the walls of the vagina and you
00:34:34
can rub it on the outer this area as well at the opening. >> Let me try. Look, I don't have a vagina,
00:34:39
but I >> Oh my gosh. >> So you take the this what is this cream called? >> It's estradiol cream.
00:34:45
>> Estradile. Take it on your finger. You rub it inside the walls of the vagina.
00:34:49
>> And just rub it in like you would rub sunscreen on your face. And if you do that twice a week, you can prevent death
00:34:55
from urinary tract infections. You can help with urinary frequency, urinary urgency, leakage. You make sex not
00:35:01
painful and dry. It helps with arousal and orgasm. It's literally better than Viagra. And this is over the counter in
00:35:08
the UK. In the United States, you need a prescription. Um, but it's as little as
00:35:12
$14 if you use Mark Cuban's online website. Right. It should be covered by your insurance. Now, some women hate
00:35:18
creams and so we have things that are not as messy as what you're showing right there. And we have little tablet
00:35:23
inserts. So, here is a It comes with an applicator. And so, what a woman does is
00:35:28
put this in her vagina and press a button and this little tablet. So, instead of a cream, you could just put
00:35:35
this little tablet in twice a week and that does the same thing as the cream. >> Oh, okay.
00:35:40
>> Okay. So, it's a little less messy. So, people tend to like the creams better.
00:35:44
Now, if you really don't want to do anything twice a week, this is a ring that goes in the vagina and it can stay
00:35:50
in there for 3 months. Now, this it's sort of like a tampon. You can kind of put it in the vagina and the vagina does
00:35:56
not feel it. By the way, the vagina is not very sensitive in terms of uh nerve endings. And so, when women put tampons
00:36:02
in, they don't feel them. When you put this ring in that you wouldn't feel it either, and it would stay in for three
00:36:06
months at a time. >> It's quite quite quite a big ring. >> Vagina can hold like a bowling ball of a
00:36:12
baby can come out of a vagina. So, it can actually uh withstand quite a lot of volume.
00:36:16
>> And there's a chemical inside this ring that's going to diffuse >> estradile that slowly diffuses estrogen
00:36:21
for the ring. So, that's nice for women who have dementia, who have very bad dexterity with their fingers, they're in
00:36:27
a nursing home, uh for someone who's on the go and they can't remember something
00:36:30
twice a week. So, our ADHD patients like things like that. And so, there's just different, it's all the same stuff. It's
00:36:37
just in different formulations. Now, the one different one, this is something called DHEA. Now, DHEA is the precursor
00:36:44
hormone to estrogen and testosterone. And remember, I said the vulva, the vagina, the bladder need testosterone,
00:36:51
too. It so this is a a chemical that converts into estrogen and testosterone. And so, DHEA is a supplement you can
00:36:59
buy, you know, sort of in the in the supplement aisle, but if you put it locally in the vagina, this is an FDA
00:37:04
approved product. It's called intraosa. And if you just put this in the vagina, uh uh it's meant for every night, but
00:37:11
you can do it twice a week. Um it it melts at bedtime when you wake up and it prevents UTI. It helps with pain with
00:37:18
sex. >> And just to be clear again, so you think a lot of people should be taking these
00:37:22
these things. >> I believe it's preventative. So I think and we wrote guidelines uh by the
00:37:27
American Neurologic Association uh why this is so important, how to do it. So many women have symptoms of urinary
00:37:33
frequency, urgency, leakage, uh urinary tract infections, pain with sex, dryness, and this is a safe option for
00:37:40
all of those women. Does that make sense? >> It does make sense. And one of the things that doctors sometimes tell their
00:37:45
patients to take to help with the UTI situation is that >> okay, this is a disaster. So, women get
00:37:54
urinary tract infections a lot. And so, what do we tell women? Pee after sex, wipe from front to back. Like that's not
00:38:01
data driven by the way. That's all a folk folk tale. Like that's that's folklore. There is some data that
00:38:06
cranberry pills can help uh with preventing UTI, but the uh amount that you'd have to drink is uh very sugary
00:38:14
and diabetes inducing and it wouldn't taste that good. And so there they do make pills, but it's a small these
00:38:20
things are small things that help. Drinking lots of water can help. But vaginal hormones, vaginal estrogen or
00:38:26
vaginal DHEA, which we just showed a bunch of, prevent UTI by more than half. They don't just prevent UTI, they help
00:38:34
with urinary frequency, urgency, leakage, pain with sex. They help your arousal. They help your orgasm. And
00:38:40
they're safe for every age with every medical problem. If you've had cancer, blood clots, stroke, any problems at
00:38:47
all, vaginal hormones are safe and could save your life. And so this is such an important topic.
00:38:54
>> There should be a button just down below here. And if it says subscribed, you're
00:38:57
already subscribed. If it says subscriber, that means you're not yet. And if you're not subscribed, please
00:39:02
could you do us a favor and hit that button? It helps the show more than you know. And according to the algorithm,
00:39:07
you're someone that watches our show, but you haven't yet hit that button. Thank you so much. My my partner's 33
00:39:12
years old now. She's not yet in the permenopause stage. At what point does someone start taking HRT? Is it when
00:39:19
they aren't in the menopause stage, which is defined as 12 consecutive months without your period? Is it when
00:39:26
they're post-menopausal? Is it in permenopause? >> Yeah, this is a very important question
00:39:31
because it's not a one-sizefits-all. At this age, start this medicine. It's really when people start having
00:39:36
symptoms. And so, I'll give you an example. So, say your partner um gets pregnant. Okay? You decide to have a
00:39:42
baby. Her estrogen is going to go to 10,000 uh for 9 months. It's going to be super super high. and the day she gives
00:39:49
birth, it's going to crash to zero. So, you go from super high hormones down to zero. And if she chooses to breastfeed
00:39:56
or pump or or do any of that, they stay extremely low in the menopausal range for the entire time you're
00:40:03
breastfeeding. So, when you are breastfeeding or pumping or doing anything uh and your periods don't come
00:40:09
back, you're basically menopausal. >> And what are the symptoms then? So you've just had a baby, you're
00:40:13
breastfeeding. >> She may have hot flashes. She may have night sweats. She may, you know, have
00:40:17
urinary frequency, urgency, leakage. There's all sorts of symptoms that come come with libido changes as well. Libido
00:40:22
definitely changes. Pain with sex goes up. And so we call this the genital urinary syndrome of lactation. And so
00:40:28
there's all sorts of hormonal changes that can happen at that time. So we see a big need for vaginal hormones in this
00:40:34
patient population. It's safe for the breast milk. It's safe for the baby. It doesn't cause any problems, but it can
00:40:39
really help with all of those uh symptoms. Now, say she is done having babies and now she's 38, 39, 40 and she
00:40:47
is doing fine and she has regular periods and she has no symptoms and no problems. She may not need anything at
00:40:52
all. But what if she starts getting a lot of urinary tract infections or having dry, scratchy, painful sex or her
00:40:58
libido just doesn't feel it sort of feels like back when it did on birth control pills? that may be an indication
00:41:04
where she may benefit from whether it's testosterone or vaginal hormones or some
00:41:09
kind of combination. What if she's 43 and her sleep starts to get really bad and that may be an indication for
00:41:15
progesterone? I have a patient who was uh uh having hot flashes and night sweats and brain fog and fatigue. I see
00:41:24
her and she says, "I will not take hormone therapy. It's not safe. My mother told me it causes cancer. At no
00:41:29
point am I going to do this." I said, "Okay." We had a long conversation. I shared data and papers and we did a
00:41:35
shared dis we just worked with each other and I wasn't pushing anything on her but ultimately she started with
00:41:40
vaginal hormones. Her orgasms come back. Her arousal gets back and she comes back
00:41:44
to see me and says, "Ruben, what are you doing here? I'm feeling much better. Like this is you've given me my life
00:41:50
again. I'm not uh peeing in the middle of the night, so I'm sleeping better. I don't have as much dryness. Sex is no
00:41:55
longer painful. I haven't had a UTI in months. What else do you got?" Well, she was still suffering with hot flashes and
00:42:01
night sweats. She had a a bone density scan which showed osteopenia. Uh, and she was worried about osteoporosis
00:42:07
because her mother died of osteoporosis fractures. Well, if she did whole body estrogen, she would prevent her risk of
00:42:13
a of a fracture. She would make her hot flashes and night sweats go away, which would have benefit on how she sleeps and
00:42:20
ultimately probably benefit on her whole vascular system. And so, she started estrogen and because she had a uterus,
00:42:25
she took progesterone at night. and she said, "Well, my libido is still a bit low." We looked at her testosterone. We
00:42:31
said, "Testosterone will likely help with your libido, but it's going to take four to 6 months." So, four to 6 months,
00:42:36
she comes back to see me. Not only is her libido so much better, but she feels that she has the cognitive ability to
00:42:43
enroll in law school. Like, this woman literally decides that she wants to change the trajectory of her career and
00:42:50
enrolls in law school. And her brain is working in like ways she hasn't seen it in so long. and she is competing against
00:42:58
22 year olds in law school. And when I tell you she finished at the top of her class, she finished at the top of her
00:43:04
class. Whereas she said, "I would have never even considered this opportunity uh if I hadn't been doing all of these
00:43:10
things." So it >> and what age is she? >> She's in now she's in her 60s. >> And so that's why I'm so loud about
00:43:16
these things because what other organ in medicine do we let fail completely before we like do something about it? We
00:43:24
don't make you go blind completely before we give you eyeglasses. We don't let your kidneys run out completely
00:43:29
before we give you dialysis or medications to help your kidneys along. We don't let you go into full liver
00:43:34
failure before you get the transplant. Like this idea of your ovaries have to fail and you have to suffer for 12
00:43:41
months before someone intervenes is insanity. >> But for some women they do start HRT
00:43:46
during the permenopausal phase >> and for some they start it during menopausal postmenopausal stage.
00:43:51
Correct. And it's all depending on how you're feeling. >> It's all depending on how you're feeling
00:43:55
and what you want, what your objectives are, >> okay? But it's never too early to start
00:44:00
necessarily. >> Not necessarily. Like, so again, we give birth control all the time to people in
00:44:04
their reproductive years. Birth control is just highdosese fake hormone therapy,
00:44:08
right? So we're giving women hormone therapy as young as in their teens, right? To help with different things and
00:44:14
birth control. But so so if you think of it as all of it is some form of hormone
00:44:18
therapy, it just depends. Are we using the natural form of hormone therapy? Are we using the synthetic hormone hormone
00:44:23
therapy? We have to get comfortable with hormones at all ages. And the thing that
00:44:27
we see most commonly, Stephen, is sort of what we call NFLM, not feeling like myself. I love that
00:44:33
statement because women are coming to the doctor every day saying, "Nm, I'm not feeling like myself." And they're
00:44:40
getting dismissed. And the truth is there are often hormonal reasons why you may not be feeling like yourself. So for
00:44:46
some people it might be muscularkeeletal pain. So we see plantar fasciitis and frozen shoulder and we think of as those
00:44:53
having underlying hormonal causes as well. So there's published data that less than 9% of Medicare patients are
00:44:59
getting prescriptions for this. Uh more than 75% of people in large database uh collections are not getting
00:45:06
prescriptions for this. And so women are not getting access to generic medications that could save their lives
00:45:13
and also really improve quality of life. I don't know about you, but dryness. People are not having sex anymore
00:45:19
because of the pain, the dryness, the irritation when it's fixable. >> I don't speak Vietnamese, but this show
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course, your shot at these signed gloves. You said um earlier that one of the questions people come to you about
00:47:30
is pain during sex. Why are are women experiencing pain during sex? What is what what is going on there
00:47:36
physiologically? >> Yeah, pain with sex is actually not rare at all. There are some published reports
00:47:41
that up to 75% of women will say at some point in their life sex is painful. >> So a really dumb question here. Sex is
00:47:49
not supposed to be painful. >> Sex is not supposed to be painful. If sex is painful, you need to figure out
00:47:54
why it's You deserve a diagnosis. You deserve an answer. You deserve to understand exactly why sex is painful.
00:48:00
You could have a problem with the tissue. So a you could have a skin problem which as we know the tissue of
00:48:06
the vulva is very hormonally sensitive. So that tissue could be impacted by hormones. It's skin. So people can get
00:48:12
eczema. They can get uh autoimmune skin condition. So you may have a skin condition. You may have problem with
00:48:18
your muscles. So remember the vagina and the vulva are surrounded by these big pelvic floor muscles. And just like you
00:48:25
can get tight muscles in your neck uh and in your back, you can get tight muscles in your pelvis. We also know
00:48:31
there's nerves that are involved in this area. So if you have a back problem and
00:48:35
you feel it running down your leg, right, that's called sciatica or sciatica pain, you can have a back
00:48:40
problem that actually causes you to have pelvic pain. So we see people with penis
00:48:44
pain or vulva pain uh because of problems in their spines. If you have scar tissue inside your body from
00:48:51
endometriosis that's pushing and scarring this tissue from the inside, you may have pain with sex. And so there
00:48:58
are many different things that can cause pain with sex. But remember I said your
00:49:02
OB/GYN got almost no training in this. >> So if I'm currently experiencing pain during sex as a woman, what advice would
00:49:10
you give them? What should they do? >> Yeah. So I would uh really try to see someone who has an active interest in
00:49:17
this. see a specialized gynecologist or a specialized urologist who has an interest in pelvic pain and you may need
00:49:24
a couple of opinions. Just like if you go to the first plumber, you want to get a couple quotes on, well, who's going to
00:49:29
do the best job, it's okay to see a few different people for this problem. >> And in terms of prevalence, up to 75% of
00:49:35
women, as you say, will experience painful intercourse at some point in their lives. Between 10 and 20% of US
00:49:41
women suffer from persistent chronic pain during sex, and during menopause, it climbs drastically. um with estimates
00:49:48
ranging to 20 to almost half of women having pain during sex. >> And that probably doesn't even add to
00:49:55
the people who stopped having sex because either they don't have a partner or because they it's too painful to even
00:50:00
consider it. And I think it's important to know that hormones play a fundamental
00:50:04
role here. Not a like not it's not the whole story, but it's a huge part of it. in different seasons of life, if um if a
00:50:11
woman wanted to have the best sex of her life, what are the fundamental things you'd aim at to make sure she could have
00:50:16
the best sex of her life? >> Yeah. So, as a you know, this is Diary of a CEO. So, I love how you you love
00:50:22
the health topics, but obviously financial literacy is really important to for you to help people because for
00:50:27
some reason people stink about talking about money and talking about sex, and yet we all want to be really great at
00:50:33
both, right? We all want a lot of money and we all want to have great sex. And yet people stink at talking about it.
00:50:38
They they don't know the fundamentals. They don't know the basics. And so I actually use financial literacy sort of
00:50:44
as a as a framework in how we talk about good sex. And so you've got your savings
00:50:49
account and your c, you know, your your checking account. Those are the those are the basics. Everyone needs money in
00:50:54
their checking and savings account, right? That's what everybody needs. So that's going to be your education, your
00:50:59
nutrition, your exercise, your sleep, your your your communication, uh safety, like are you safe in your relationship?
00:51:06
like the basics. Are you doing the basic things you need to have great sex? You know, communication is probably the most
00:51:11
important thing. Can you talk about it? Can you use words? Um, can you explore? Can you ask questions? So, so that's
00:51:16
really important for great sex. Then there's the 401k, right? The 401k is something that we all want and should
00:51:23
have access to, right? It's important for compounding growth and long-term support of your financial life. Think
00:51:29
about hormones. Think about going to a doctor who's going to make sure that everything is optimized the way that it
00:51:36
should be. Your your pelvic muscles are in good condition, your mental health is
00:51:39
in good, you know, do you have a do you need a sex therapist? Do you uh want to bring toys into the bedroom and devices
00:51:45
to have even more fun? That's kind of like the really important not everybody has access to it. Not everyone's going
00:51:50
to do it, but I think it's really really important for everyone to talk about. Then there's like crypto. Okay, so
00:51:56
crypto, that's not to say don't do crypto, but like don't put all your money in crypto. Don't do everything and
00:52:02
don't start with crypto. So that's going to be when you're watching, you're scrolling Instagram and you see these
00:52:08
ads for do this injection, do this, you know, cosmetic procedure, do this uh supplement that's going to make sex
00:52:16
great again. Uh, the truth is if it looks too good to be true on TV and in the ads, like it probably isn't going to
00:52:23
fix what if if other things are are are struggling. So, I think great sex is within everybody's reach, but I think
00:52:30
your great sex is different than other people's great sex. >> So, let's go through these slowly and
00:52:36
one one at a time. I kind of broke it down into three categories, which is there's biological and physical blockers
00:52:41
to great sex, which are some of the things we've talked about, um, hormone crashes, etc. You mentioned the pelvic
00:52:48
floor. How is an issue with your pelvic floor going to impact your sex? And what
00:52:53
is the pelvic floor? Why would you have an issue with it? What do you see in patients?
00:52:56
>> Yeah. So, everyone who has a pelvis has a pelvic floor. So, men have a pelvic
00:52:59
floor, women have a pelvic floor. It just means the bones of your pelvis. So, your hips, right, and your pelvis bone,
00:53:06
your butt bones, all of this is this big bony structure that holds all of your organs in place. And your genitals are
00:53:13
attached uh to this pelvic floor. And the pelvic floor is surrounded by thick big muscles. So if we look at the inside
00:53:21
of the pelvic floor, it's these big thick muscles. And muscles are uh just like your biceps, right? Like muscles
00:53:28
are something that contract and relax. And there can be problems with muscles, right? Just like if you work out too
00:53:35
much and you've got a sore trap and you got to go get it massaged and and or you
00:53:39
got to do physical therapy because your shoulder is hurting, a lot can go wrong with the pelvic floor. And so sex is a
00:53:45
contact sport. So if you're going to get erections, if you're going to have an orgasm, if you're going to allow for
00:53:50
penetration to happen, you have to have healthy muscles because you're asking your muscles to contract and relax in a
00:53:57
sexual way. And so as blood is flowing through the area, blood is going to engorg the clitoris and it's going to
00:54:04
get bigger and erect. It's going to engorg the penis. It's going to get bigger and erect. These muscles are
00:54:09
going to have to relax so that you can have penetration because if they're too tight, tight muscles are painful.
00:54:14
They're sore. They're they're they burn. And so penetration can happen if you're
00:54:18
relaxed. But then orgasm is a series of muscle contractions which equates to pleasure and release, which is all has
00:54:26
to do with the nerves and the muscles. Does does that make sense? >> I'm trying to understand how the pelvic
00:54:30
floor would would give me bad sex and how I would know if the pelvic floor is the reason I'm currently having bad sex.
00:54:37
>> Yeah. So if if sex hurts, so if the muscles are too tight, and you can't have penetration, but you want it, that
00:54:43
can be bad sex. If orgasm is painful, weak, or impossible, it could have to do with the muscles. It's not always the
00:54:50
muscles, but it could have to do with the muscles of the pelvic floor. If arousal, your ability to engorg and
00:54:56
lubricate are diminished or less, that could be due to pelvic floor because you're not getting enough blood flow to
00:55:02
the area. And so there's multiple different ways. And if you're not feeling your genitals, you watch
00:55:08
something sexy on TV and then you feel it in your genitals or you see someone attractive walking down the street, you
00:55:13
feel it in your genitals. There's this brain genital connection and sometimes that you so you have to have perfect
00:55:19
wiring and of your nerves, your hormones and your muscles. And so that could be affected by your pelvic floor. Now we do
00:55:26
a lot to mess up our pelvic floor by the way. People do surgery, people have babies, uh people um muscle uh health
00:55:33
changes for many reasons. And so when you have problems, there may be biological reasons to these problems.
00:55:40
>> Should we be going to the gym and like doing pelvic floor exercises to improve
00:55:43
our sex lives? >> You typically don't do them at the gym. Um there are typically trained physical
00:55:47
therapists who help you know what's going on with your pelvic floor. So for some people it's to strengthen it and to
00:55:53
do like almost contractions. We call them Keele exercises, but for many people it's just learn the coordination.
00:55:59
>> And you can go and get an exam. >> You can go get an exam and work with a pelvic floor physical therapist. So,
00:56:04
some women, because we sometimes have them write in with questions, talk about the fact that they're they're not having
00:56:09
orgasms. Is that normal or is that not normal as it relates to um sexual contact?
00:56:15
>> So, about 20% of women will say that they can't have an orgasm. And the real question I'm I I'm fascinated by this
00:56:23
data because not 20 20% of men do not have orgasm problems. And so again, if we go back to the financial uh literacy
00:56:31
equation, we have a pay gap in this country, right? Women are not paid as much as men. Well, women are not
00:56:36
orgasming as much as men. And so the data is very clear there. And I think the majority of problem is education.
00:56:42
Women think that orgasm comes from penetration. Surely if the in-n-out penetration is happening, I should be
00:56:48
able to have an orgasm. And the truth is that's not how most women orgasm. Some can, but the reason why women don't
00:56:56
orgasm from penetration is because the clitoris is up here. So the clitoris is how women orgasm, right? Penetration is
00:57:03
not how most women orgasm. Just like if you rub your thigh over and over again, you're not going to have an orgasm. Now,
00:57:09
you could keep rubbing your thigh for the whole duration of this podcast. You still won't have an orgasm because it's
00:57:14
close to your penis, but it's not actually your penis, which is where men have orgasms from. And so the clitoris,
00:57:20
if you follow those labia minora, those inner wings, you get to the hood of the clitoris or a foreskin. We call it a
00:57:26
prepuse. And that if you pull it back, you see what is the tip of the head of the clitoris, but that's just the tip of
00:57:33
the iceberg. The clitoris is this huge structure. My necklace is of course a gold clitoris. Um the this a huge
00:57:42
structure that goes all the way down to your butt bones. It's a penis. Under the
00:57:46
microscope, it looks like a penis. It is made up of the same tissue as a penis. It works exactly the way a penis does.
00:57:52
It's just that we have a whole field of medicine devoted to the male penis. I'm a urologist and no one is even taught
00:57:58
how to examine a clitoris or where it is. So, if the penis is going in here or a toy or a finger or a device that is
00:58:06
not activating the the clitoris which is a mostly internal structure, >> there's something called a clitoral
00:58:12
adion which people don't know about as well which I've heard you talk about before. Yeah.
00:58:15
>> What is that and how many people suffer with that? >> Yeah. So the clitoris has this hood to
00:58:19
it. Okay? And about 23% of the time the hood can get stuck to the head. So for example, I'm wearing a sleeve here. So
00:58:28
you should be able to pull back the hood of the clitoris to see the whole head. It looks like a mushroom. You know how
00:58:34
penises have like that almost like a mushroom rim rim around it? So the clitoris should have that too, but about
00:58:40
23% of the time it gets stuck. So you actually cannot see the full head of the clitoris. It's called a clitoreral
00:58:45
adhesion. And so you should be able to pull it back, but in about a quarter of the time you cannot. And we published
00:58:51
data that if you remove these adhesions in an office-based very simple procedure, we saw improvements in
00:58:57
orgasm, arousal, and satisfaction up to 60 to 70%. And so you understand, >> so one in five women,
00:59:04
>> yeah, >> have a clitoreral adesion. And when solved, it improves their sexual
00:59:08
satisfaction by up to 60%. >> Yes. But no one's examined any woman in your life, no one has ever examined
00:59:13
their clitoris ever. in any exam, in any doctor's visit, and nobody's asking women about their orgasm, about their
00:59:21
satisfaction where like they come in with pain or they come in with libido issues, but no one is examining this
00:59:27
part of the body. And so, it's this question of is it because we haven't or cuz we shouldn't. It's cuz we haven't.
00:59:33
We haven't. We have never done this before. >> You pulled up the sex toys there. I
00:59:37
think we were talking about orgasm gaps. So again, when you were talking about orgasm and how women experience
00:59:45
pleasure, it's all buried inside the body. So if your penis was entirely inside your body, say you gained 500 lb,
00:59:52
okay? And your p your belly was so big you couldn't hold on to your penis to to do what it takes to have an or how would
00:59:58
you orgasm? >> Uh probably I don't know. the vibrator industry would be a gajillion dollar
01:00:04
industry instead of just a billion-dollar industry because vibration can help activate this blood
01:00:09
flow. And so for women, vibration on the outside can be extremely helpful because
01:00:15
remember the clitoris is kind of around this area. And so by putting vibrators on the outside now inside you can also
01:00:22
have pleasure but not everyone experiences pleasure the same way. And so understanding devices and trying
01:00:28
different things is really really important. I don't. Oh, here we go. Okay. So, this is vibrating now.
01:00:33
>> So, this one, this kind of device is interesting because it is a wand that can help just like with trigger points.
01:00:39
So, if you have pain in these muscles, this can go inside vibrate to help with engorgment, but can also get rid of some
01:00:46
of the tension in some of those muscles. >> As men, what are we getting wrong in
01:00:51
heterosexual relationships when we're trying to arouse our partners? Um, both in the context of using sex toys, but
01:00:57
also without sex toys. What is it that we just don't understand? >> I think that men
01:01:03
are constantly asking about they want their penises bigger, harder, straighter, girthier, uh lasting longer.
01:01:12
And none of that has anything to do with how women experience pleasure and and satisfaction in the bedroom. And so the
01:01:17
question needs to be how do women experience pleasure? What is their anatomy like? How can we activate the
01:01:24
clitoris, the arousal response? What are the brain things that we need to do to make women interested, right? What what
01:01:30
gets women excited because it's different than what gets men excited and your part every partner is different in
01:01:35
terms of what gets them excited. And I would love to see more curiosity. I wish everyone was as curious as you about
01:01:42
what do we need to learn about women and how they behave and how they act and what they
01:01:47
>> Yeah. So you I'd like to implement it tonight. >> Communication, right? It's that question
01:01:51
and also understanding that your partner never got told any of these things. And
01:01:57
so this is where watching this podcast together could be really helpful to say, did you know that? Was it what do you
01:02:02
like? Do you know like can we look at your clitoris together? Like do you know what these body parts are called? Where
01:02:08
is it that you experience pleasure? Cuz some people find direct stimulation of their clitoris is too sensitive because
01:02:13
we know the clitoris has like 10,000 nerve endings. So going directly over the clitoris can sometimes be too much.
01:02:18
Some partners love it. Some partners want more stimulation on just the outside here. Some people need
01:02:23
vibration. So that's another big problem. >> Okay. So she's going to orgasm at some
01:02:27
point if this is sufficiently stimulated. >> If there's sort of a buildup and release
01:02:31
of pleasure, right? That's orgasm. And again, that is often not happening during penetration.
01:02:37
>> And once she experiences that, what happens immediately after for her? Cuz I know from a man's perspective, if I
01:02:43
orgasm, there's some kind of like decline in arousal. And I don't want you to touch it again. That's very similar
01:02:48
in women. >> Okay. So, it's the same way >> except women can bounce back faster. Not
01:02:52
all of them, but but but women can have multiple orgasms. >> So, she orgasms. It's very very
01:02:56
sensitive. She doesn't want me to touch it for a while. >> Yeah. >> And then she she potentially could
01:03:01
bounce back faster. >> She could potentially Some people do, some people don't. But that's the
01:03:05
conversation of is this something that is pleasurable? Is this something to try again? Is multiple orgasms something
01:03:10
that you want to have or try to have? When does penetration happen during the dance? Because often times men orgasm
01:03:16
and then they're done, they roll over, go to sleep, whatever it is. Is the orgasm happening after your orgasm,
01:03:21
before your orgasm? Is it happening before and after your orgasm? Like are there Cuz that could be a nice way to
01:03:26
sandwich it of like there is, you know, giving the the sensitive tissue some time to rest. Then your orgasm happens
01:03:33
and then you potentially go for round two. >> So if the sensitive pleasurable part is
01:03:39
on the outside here on the clitoris, then what do they get from penetrative sex? If the the sort of main event is
01:03:46
here in the clitoris, >> many times nothing, many [clears throat] times connection, many times uh sort of
01:03:51
this need for closeness and pleasure, many times there are women who have extra nerve endings sort of inside the
01:03:58
vagina on the top of the vagina in the cervix. So there are women who love penetration, but many women get the main
01:04:04
event from the clitoris. And so it's part of the whole menu as opposed to penetration is the whole story. And I
01:04:12
think every woman's body is different. And so kind of making these broad statements of every partner likes this,
01:04:18
but many women are asking for penetration mainly because they're like, "Okay, that's when you have your orgasm,
01:04:24
it's done, and then I can go to bed. I can read my book. I can do all these other things." But the pleasure often
01:04:30
comes from that clitoreral stimulation. Now, some women can orgasm from penetr. I have a theory. It's a really
01:04:35
interesting theory that maybe your listeners can prove with science or help me prove with science. So, you know how
01:04:40
there's men who premature ejaculate, like who ejaculate very quickly? Yeah. There are men who orgasm in a minute or
01:04:47
less. >> That's [clears throat] probably like 8% of men. Okay. So, if we think men and
01:04:51
women's bodies are very similar, could we argue that 8% of women will orgasm within a minute or less? Theoretically,
01:04:59
it makes sense, right? I think those are the women who orgasm with penetration. They're so sensitive. Their nerves are
01:05:05
so sensitive that penetration is very pleasurable. and then they have this magical orgasm and they do it very
01:05:11
quickly. So it's good in a it's often seen as like great in a woman and not great in men. And so I just have this
01:05:16
theory that like there are women who have extra sensitive body parts. >> So I mean one of the things I've learned
01:05:22
from everything you've said is just like how much porn has messed up our perception of sex. I mean WWF has messed
01:05:32
up our perception of I don't know like what people's bodies like exercise fighting like like it's all manufactured
01:05:40
and it's all manufactured because that's the algorithm that has been working to get men excited and it doesn't like
01:05:47
again it's that question of that curiosity of who's watching porn, what do people want from porn? What are they
01:05:52
getting from porn? because it's not what women want typically and it has really messed up people's perceptions of what
01:05:59
is actually fun and pleasurable for the partner. So seeing that curiosity of like what does my partner actually want?
01:06:05
You know, you can have great sex without penetration. And so the question is is what does great sex look like for you
01:06:10
and your partner? >> When I look at a website, I've got some data here on a website like Pornhub,
01:06:14
which is one of the leading porn websites. It says that roughly 65% of their traffic is men. Independent
01:06:22
surveys tracking any regular pornography use find a similar gap. But note that women's consumption is highly age
01:06:27
dependent. Men between the age of 18 and 35, 75 to 9% of them report viewing porn
01:06:35
regularly, whereas women age 18 to 35. Only 34% roughly report viewing porn regularly. And if we think about these
01:06:45
systems as catering to demand, it means that porn websites are catering to predominantly male demand. And that
01:06:54
explains why for most young men, we learn about sex from porn websites, >> right?
01:06:59
>> And then we assume that's the the woman looked like she was having fun. >> Um the man was doing this particular
01:07:04
thing and then we take that into our relationships. And I think this is where the misunderstanding begins.
01:07:08
>> And the women think they're broken because they're not having magical orgasms from penetration. and they come
01:07:13
to see me all the time and say, "I'm broken. You have to fix me." I'm not orgasming during sex. They have wildly
01:07:18
good orgasms with a vibrator, with a hand, with a a shower head, with whatever it is from on their clitoris,
01:07:25
and that's totally normal, right? And then you show them the body parts. You should This is right. The clitoris and
01:07:29
the penis are the same thing. You activate a penis for a man to orgasm. You activate a clitoris for a woman to
01:07:34
orgasm. And once you teach them that, it makes perfect sense to them, like they were normal the whole time.
01:07:38
>> What do you think of pornography? I actually think pornography is great for relationships connection potentially the
01:07:44
right porn like look okay let's look at something like heated rivalry have you heard of it no okay heated rivalry is an
01:07:50
HBO show that came out this year that is about two gay male hockey players okay it's based on a romance novel book in
01:07:57
can from Canada and HBO uh put it out there and it went viral in levels that the world has never seen before and it
01:08:04
is about two young men uh who fall in love but there's a very sexual relationship between them and
01:08:10
heterosexual women have watched this 10 times over. Like they are addicted to this show. It's all over social media.
01:08:16
It's this huge thing. It's essentially porn for women, right? It is women who are watching these pornographic uh
01:08:22
episodes and it's really important. They love it. It's supported. Everyone's talking about it. So, I don't think porn
01:08:27
in of itself is bad. I think porn we, you know, watching people have sex, watching people fall in love, watching
01:08:34
people in romance, people like that. It gets them excited. It gets them aroused.
01:08:38
But I think too much if you are watching porn because and not interacting with humans. If you are watching porn all the
01:08:44
time, if you need to if you can only watch porn to have good sex like then that may not be the best, you know, and
01:08:51
healthiest thing to do. >> I guess the question I was asking is if you're in a relationship and one partner
01:08:55
is using a lot of porn, won't that kill the sexual desire to be intimate with your partner?
01:09:02
>> It depends. It depends on the relationship and it depends on what each person needs in order to feel supported
01:09:07
and connected, right? I don't think we can say blanketly it's good or bad, right or wrong. I think if it is good or
01:09:14
bad, right or wrong for that couple, then it's a problem because there are couples who like to watch porn together.
01:09:19
There are couples where oh that maybe someone has a much higher libido than the other person. So he said, "Okay, the
01:09:24
high libido person can use porn and then once a week we'll circle together and we'll have a great experience together
01:09:30
because it's not everyone's job to meet each other on the libido." >> The stat that I was looking at was a
01:09:35
couple dozen studies, including a major meta analysis, show a consistent link between solo porn consumption and lower
01:09:40
relationship and sexual satisfaction. The erosion of intimacy is usually driven by deception. Finding out a
01:09:47
partner is hiding porn uses usually triggers intense feelings of betrayal, rejection, and insecurity. And heavy
01:09:52
solo use can desensitize the brain's reward system, leading to performance anxiety and erectile issues during real
01:10:00
life partner sex. It can also create highly unrealistic expectations regarding body types, stamina, and
01:10:06
performance, making real sex feel less stimulating. >> Again, it was that deception. It's the
01:10:12
hiding. if you're that that ex of yours didn't tell you what was really going on
01:10:16
and so you felt disconnected from that person because you didn't get that honest truth of what was going on
01:10:21
>> but also the desensitization of it like it's never going to you know I guess it
01:10:26
depends on how you're using pornography but >> it depends on how you use it so again
01:10:29
that's the truth >> you're going to like train your brain to get pleasure in a certain way and then
01:10:34
when you're with your partner one could argue that it's going to be quite difficult for them to replicate that
01:10:38
particular way that you've pleasured you've leared to pleasure yourself >> right and That's a that's a problem,
01:10:43
right? If you're only able to do something in one way, in one position with one watching one specific thing,
01:10:49
that may not translate into great intimate sex with a partner. >> For the last couple years, I've been
01:10:54
working on something that I realized every podcaster listening to this, but actually probably every creator
01:10:58
listening to this might just need. Podcasting is difficult for many reasons. And one of them is that these
01:11:03
hosting platforms don't give you much information. And also because they're so fragmented, you kind of have to go
01:11:08
through every single platform, uploading it to YouTube, and then taking the same
01:11:11
big old video file and uploading it to Spotify's platform. It takes huge amounts of time. And that friction means
01:11:17
most of us don't do it. That is the problem we set out to solve. And so we built something called Flightcast, which
01:11:22
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01:11:27
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advantage. So go to flightcast.com/doac. Now I've done almost 700 interviews with
01:11:54
some of the most interesting people in the world. And one of the things you learn which is unexpected is that
01:11:58
vulnerability is the doorway to connection. And after sitting here for 2 3 hours with a guest, I feel a deep
01:12:04
sense of connection to them. And as they leave, what I get them to do is to write
01:12:09
a question in the diary of a CEO. We've taken all of the questions from the diary of a CEO. We have put the question
01:12:17
here on this card with the name of the person that wrote it. So you can sit at home as I do with my fiance and my
01:12:24
colleagues at work and other people in my life. Whenever we get a minute, we play the diio conversation cards. And it
01:12:30
is incredible what happens. These are great if you're in a romantic relationship and you want to connect
01:12:35
your partner more. These are also great if you're in a team and you want to bond
01:12:39
your team together. And I have to say they're also great for families that want to learn more about each other and
01:12:43
that need a good excuse to spend some time in a digital world in the analog environment connecting human to human.
01:12:50
It is remarkable what the right question at the right time can do. Go to the diary.com
01:12:57
and you can get these conversation cards right now. >> And there's different types of arousal,
01:13:03
right? I was I heard from a sex expert I spoke to that men and women often have different types of arousal. Spontaneous
01:13:09
and like reactive is it? >> Yep. Yep. So there again this idea of like I want to have sex, I'm ready to go
01:13:15
versus I want to have sex because we've started having sex and we've started that process and now I can get into it.
01:13:21
Sort of like exercise. Some people are like ready to go to the gym and exercise and other people like I don't want to
01:13:26
they never want to exercise but once they start getting going oh I know this is good for me I should do this this
01:13:31
feels really good and that's sex for a lot of people but again it's also a question of what kind of sex are you
01:13:37
having if you have sex the same way every single time and it's not that fun and it's not that interesting to your
01:13:43
partner are they going to look forward to it? Are they going to are they going to want it? Are they going to seek it
01:13:47
out? And is that really low libido at all or is that sort of the product of like we just aren't talking about it
01:13:53
improving? If you had the same podcast guest on every single week and it was the same conversation every single week,
01:13:59
it's not going to last you very long, right? You do different things. You try different things. Oh, what worked? What
01:14:04
didn't work? How could we do this better? Uh what does the algorithm want us to do now? No one's doing that in
01:14:09
their sex lives. Like like no one's even talking about it. Like honey, what's working? What do we like? What's going
01:14:13
on? I saw this thing. Like >> why why don't we talk about it? >> Because we don't talk about money
01:14:17
either. We don't talk about sex because we're trying to be approp I I don't know. Why do you think
01:14:20
>> I think that's a little bit of it, but I think the subjects are like deeply personal emasculating
01:14:27
and so intrinsically linked as like self-esteem. >> It's vulnerable. >> Yeah. It's like super vulnerable. So,
01:14:33
and if someone I remember I had a um a partner turn around to me who interestingly was going through some of
01:14:39
the issues that were undiagnosed. Turn around once upon a time and express that she didn't like having sex. And I didn't
01:14:44
understand that at like a as a 23 22 year old guy. >> And so you kind of look yourself in the
01:14:50
mirror and go, "Oh shit." Like it's super can be super super emasculating. It turned out that there was actually a
01:14:54
physiological challenge she had had. >> But we'd been in a relationship for a long time and she wasn't enjoying sex
01:15:01
for because there was a physiological issue. >> She didn't say anything to me. >> I didn't know. And then the day she said
01:15:07
something to me, my I didn't know anything about sex. So, I just interpreted it as like, damn, I'm not
01:15:12
good in I must not be good in the bedroom or something. >> Um, which is super like hurtful.
01:15:17
>> And then that kind of breaks the relationship down. And it's all predicated on this like highly
01:15:22
emotional, highly self-esteem linked, poorly educated subject, which destroys relationships,
01:15:27
>> destroys it. And that's such an important story, right? Because if you had had access to the information, she
01:15:35
thought she was protecting you by not telling you that information. >> You know what's interesting? I went to
01:15:39
one of my friends and one of my best friends and said, "My partners just said this to me." Like, "What does that
01:15:43
mean?" And he went to me, he goes, "Mine, too." I was like, "What?" I was like, "So, you're not having sex with
01:15:47
your partner." He goes, "No, we And by the way, I'm talking about 30-year-olds."
01:15:51
>> He was like, "No, we haven't had sex in 3 months." >> And I was like, "What's the reason?" And
01:15:54
he said to me, "She said she just doesn't like having sex." >> And I'm like, "Oh, okay. So, that's
01:16:00
>> that's the same in my relationship. My my former ex-girlfriend has said she just doesn't like having sex." And I
01:16:06
can't tell you how ignorant and poor and insufficient the conclusions in such a situation we arrive at are. We're like,
01:16:17
well, maybe maybe there's something wrong with me. Maybe it's a sexuality challenge. Maybe it's a genetic thing.
01:16:23
Maybe they were just b they were born and didn't want to have sex. Like we don't we just don't know what it is.
01:16:28
from doing this podcast and speaking to people like you, I like, oh my god, I just wish like 5 10 years ago when I had
01:16:35
these conversations with my guy friendss and also with my the exartner that I'm referencing, I just wish I knew that it
01:16:42
wasn't any of those things. >> Mhm. >> It was something that um could have been helped.
01:16:48
>> Yeah. What's so important is that you were able to learn and see and grow in this, right? a little bit of information
01:16:56
gave you empathy for this partner where you took it on as a you problem. It became a you problem because it was both
01:17:02
of you together, but it started with biology. And so if we actually taught people the biology or to think about
01:17:09
biology or to like be able to talk about sex, to talk about sexual health, to talk about genitals, to make them not
01:17:15
private parts, how much better would your sexual upbringing really have been? How much less hurt and shame and guilt
01:17:21
would you have felt because it actually wasn't you at all? Right? >> It's the it's the horrible conclusions
01:17:26
you arrive at and the the conclusions you arrive at are often seen as both unchangeable and therefore in my
01:17:33
situation back then the conclusion was well this relationship's never going to work because the false conclusion we had
01:17:39
arrived at was not something we could we could change. >> Mhm. Whereas when I hear about all of
01:17:44
these different things we've talked about today, I go, "Oh my god, there's so many other conclusions I could have
01:17:49
arrived at or my friends could have arrived at that would have been fixable." And therefore, the
01:17:52
relationship, which was a perfectly great relationship with a person, was therefore savable. One of them is the
01:17:57
thing we just talked about, which is this idea that men and women have different types of arousal, spontaneous
01:18:02
and responsive. And I was looking at some of the data on the variance, which I think is very important for people to
01:18:07
know. And it says that men are highly spontaneous in their arousal, which kind of means from my interpretation, and
01:18:13
please correct me if I'm wrong, that as a man, I can literally be I can literally think about something and get
01:18:21
aroused. And it's not to say that women can't, but the data suggests that men are more that way inclined. The data
01:18:27
here says that their spontaneous rate in a man is about 70%. Whereas in women it's about 10 to 15%. It says the
01:18:34
responsive rate which I guess is like I get aroused once the ship starts moving once we start foreplay once contact
01:18:39
starts is 10 to 15% in men and in women in this particular report is 40 to 50%. >> So that would suggest to me that women
01:18:49
are much more likely to be aroused once you know foreplay or contact or the sexual actions have taken place I'm
01:18:57
guessing. >> Mhm. And then the mixed style is 15 to 20% in men and 35% in women.
01:19:05
Um, is that all accurate? >> It's accurate. And I think it really comes to this idea of your path to
01:19:11
having a better understanding of that prior relationship was actually education and communication. Yes. Right.
01:19:18
If you had a better understanding of the biology, if she had a better understanding of the biology, if she
01:19:24
were vulnerable enough to be real with you and honest with you upfront as opposed to kind of this bombshell that
01:19:30
happened too late, um, all of that pain, all of that hurt probably would have looked different, right? It would have
01:19:35
looked like the world would have looked very different. Now, that's what I'm fighting against because I think that to
01:19:42
your point, I think men are suffering. They're feeling disconnected from their partners. They're feeling a difficulty
01:19:48
of even finding a partner. And part of that is because they lack that curiosity of like what they're like what do they
01:19:54
want? What do they need? What kind of communication helps me get to where I want to go with this person? And a lot
01:20:00
of that is vulnerability and curiosity and interest. And I think that's what women often are looking for in partners
01:20:07
is they're looking for someone who's going to give a crap about them enough to care what they specifically need and
01:20:13
want. Not what g what do women want and what is it like like what specifically about this person in front of me? What
01:20:21
does she need to feel that erotic love, support, connection, lust? And for the man too, like what do you need to feel
01:20:30
all of those things? And what a good relationship is is when people work together to try to optimize that for
01:20:37
everybody. So, what are the questions that you would ask your patients to ask their partner to start to tease out some
01:20:44
of these things? Couples will come up to me when I'm at a restaurant or something
01:20:47
and they'll come up together and they'll always they'll often say to me that the
01:20:52
episode they watched together was about sex. So, I I literally have this image of this particular couple that came up
01:20:58
to me when I was abroad and they said, "We were just listening on the plane about your sex um episode." So, I'm like
01:21:05
they're listening now. Like again, I think it's that basic thing of like what does great sex mean for you?
01:21:10
>> Okay. [clears throat] >> What what do you want? Like what what is a great time? What's a something fun?
01:21:15
Like what is it about sex that you enjoy? When you ask people what do they get out of sex, it's like 200 different
01:21:21
reasons. Everyone wants something different. And everyone doesn't always know what they want and then having that
01:21:26
ability if you don't know what you want is having that curiosity to explore together.
01:21:31
>> So with that said, 200 different opinions on what good sex is. And this is kind of what I think you find in
01:21:37
couples. And when I've sat with my partner before and said like, "What do you what arouses you during sex? What do
01:21:41
you like?" The two things can often be different. >> Totally. >> And so, is this not a a problem that one
01:21:47
partner might say, "I really want you to tie me up and da da da da da." And then
01:21:53
the other partner might say, "I really want you to not tie me up and be really soft and gentle." And there's a bit of a
01:22:00
dichotomy between these two sort of sex preferences, >> which means no one's really ever getting
01:22:04
what they want. Like, how do you navigate that? >> When you go to buy a house, you don't
01:22:08
always get to choose what house you get unless you, you know, you build it yourself. Like, there are compromises in
01:22:13
life and and there is no all good or all bad. You're never going to find, this is
01:22:16
actually the problem with pornography is you figure out the exact porn in the exact situation or even worse with AI.
01:22:22
Like, you're going to have a sex robot who's going to be able to do exactly what you want in the way that you want
01:22:26
to do it. And people are afraid about what that means for intimacy and relationships and great sex going
01:22:32
forward. Because the truth is sex is messy. It's awkward. It's smelly. There's fluids. There's funny noises.
01:22:39
There's like it's it's vulnerable. It's like really uncomfortable sometimes to like have these deep conversations. But
01:22:46
isn't that why life exists? Like isn't that like the most fun part is when you can kind of have that with somebody else
01:22:53
where they know all of you and they want to explore that with you? you know, if it's not the right relationship, it's
01:22:58
not the right relationship, right? Like and and figuring out if that is an important part of your life and it's a
01:23:02
non-negotiable, then find the rooms where there are other people who do that those things too. I mean what you will
01:23:08
find is that people have all sorts of agreements and relationship setups and as a sex doctor like the things I hear
01:23:15
in a room like would you know are quite wild and you you wouldn't even believe like people are doing well I think
01:23:21
people have multiple like there are people who have open relationships so they have multiple partners or they have
01:23:28
certain kinks right so there are things that they really enjoy that maybe somebody would look at that and be like
01:23:33
oh that's very strange but there are other consenting people who also are comfortable want to do those things.
01:23:37
There are websites that deal with different erotica and different kinks and things like that. And there's also
01:23:42
this idea of fantasy. It's also okay to have things that you think about but that you don't actually want to partake
01:23:48
in and that you use. >> On this point of fantasy, what if you have a you probably have experience
01:23:53
where someone's come to you and they have a fantasy but they don't want to or a kink and
01:23:58
they don't want to tell their partner because they're worried about the reaction. Yeah, this is where things
01:24:03
like sex therapy become really helpful of how do you have a third party because again when your doctor's telling you to
01:24:08
do something or bringing something out, it's it's so much less uh scary than if you're doing it on your own. There are
01:24:14
also different like apps and things like that where you can sort of dip a toe where you you you have um there's one
01:24:20
called Spicer, I believe, where you can sex each other in ways and they'll push questions. If you both agree, it'll tell
01:24:26
each other that you both agree with things. So, there's ways to dip a toe here and sort of be curious about it.
01:24:31
But again, that's where watching things together or asking the questions. This should happen not when you're naked in
01:24:36
the bedroom actively having sex. Like it's okay to have conversations about sex when you're not having sex, right?
01:24:42
Like you plan these podcasts before you actually sit down to record. Afterwards,
01:24:47
you talk with your team. Hey, this is what I liked about it. Here's what I didn't like. Let's change this in the
01:24:51
future. Let's never have Dr. Rachel Rubin on again. Right? Like these are the conversations you're going to have
01:24:55
with your team. People don't do that about sex very often, right? They don't actually do after action. What went
01:25:01
well? What didn't go well? Do you ever want to try this? Like what would be fun here? Like there there is often a lack
01:25:06
of curiosity. >> And do people, you know, you're a sex doctor, right? But people come to you
01:25:10
and sort of offload their sex lives to you. >> My job is so fun. I love my job. It's so
01:25:15
fun because people will talk to me about their most full like we do two hours and
01:25:20
we talk about their lives in the context of their sexual health for two hours. And people never have those types of
01:25:27
conversations even with their partners. And it is incredibly vulnerable. It's incredibly important for people to see
01:25:33
that and see, "Oh, that was actually really nice to talk about. I didn't know this, that, and the other thing about my
01:25:39
body." >> And what do you find that men and women typically are hiding from their partners
01:25:45
when they do confide in you? >> I think they don't tell their partners just about anything. Like, they don't
01:25:50
there's a lot they don't tell their partners, right? >> Is there a difference between men and
01:25:53
women? What they're not saying? >> That's a great question. I would say that no one is talking about sex at all.
01:26:00
Women are hiding their pain from their partners. Men are hiding their um insecurities and their frustrations. And
01:26:08
there's a lot of shame around erectile dysfunction and sexual problems in men. And so they a lot of people just either
01:26:14
stop having sex or stop talking about it or sort of have mediocre sex because they are not that great at talking about
01:26:21
these things. And I imagine you're I mean my first reaction would be like oh you should tell them
01:26:26
>> but I imagine that doesn't necessarily work. I think it's a challenge like if
01:26:29
you have had if you have been faking an orgasm for your entire relationship >> and women have been
01:26:35
>> yeah many the statistics are quite clear like if you're only having penetration
01:26:39
and your partner orgasms every time and it's a perfect orgasm every time I would
01:26:43
say there's a high percentage that that's not real because the truth is is orgasm often takes a lot of arousal and
01:26:50
a like like again stopwatch every heterero if a penis enters a vagina and they orgasm about five and a Half
01:26:57
minutes is on average how long men last, right? Like that's science. It's about 5
01:27:01
and a half minutes. Now, if you're longer, great job. If it's shorter, it's okay. It's all within the range of
01:27:05
normal. Women, if penetration is happening, almost nobody orgasms in 5 1/2 minutes. It's usually well over 13,
01:27:12
14, 15 minutes. And penetration is usually not how that happens. Cuz again, if you're distracted while you're trying
01:27:19
to stimulate your penis, it's going to take longer. Women need focus on the clitoris. So again, if your partner is
01:27:24
orgasming every time within that 5 and a half minutes and it's like clockwork, I
01:27:29
would call [ __ ] on a high percentage of it. So, but but a partner doesn't want to tell you, right? Like they're
01:27:35
afraid to tell you cuz they're they want to make you happy, right? It's not that
01:27:38
they're having bad sex. They just know that that's not what's going to get them to orgasm and they want you to be happy
01:27:43
and to feel supported. >> So, that presents a pretty good case that the woman should orgasm first,
01:27:50
>> I think. So because I think orgasm first will allow for pelvic floor release and
01:27:55
relaxation which will make penetration more pleasurable, enjoyable. I think women can have multiple orgasms. So
01:28:01
there's a case to be made for before and after. Why are women having zero orgasms, men having one orgasm when
01:28:07
women could be having three orgasms and men have one orgasm. So I think we should be actively trying to change the
01:28:13
orgasm gap um and focus on the pleasure. And I think making penetration the main
01:28:18
event is where the challenge I think penetration can be part of the whole story but doesn't necessarily always
01:28:23
need to be the main event. >> On the physical blockers you talked about some of them like anxiety. One of
01:28:29
them that I think isn't talked about enough especially in the modern world is what they call like the dopamine drain
01:28:34
where you've got mental burnout or chronic stress or we talked a little bit about depression. But I did notice that
01:28:40
through my life when I'm very very overworked, shall I say, my libido is not the same.
01:28:48
>> Yeah. >> And this is also the case for for women as well. >> Do you have a lot of women come to you
01:28:54
or couples come to you where this is quite clearly the problem. This sort of like dopamine drain. It's actually their
01:28:58
stress and lifestyle. It could be the kids. It could be >> Oh, it's a huge problem. Right. It makes
01:29:02
logical sense. Again, if we go back to the fundamentals of if you're not sleeping, if you're overworked, if
01:29:07
you're burnt out, if you have no white space for yourself, why are why are you going to have all this excitement for
01:29:12
your partner and all of these things? Like, if we're scrolling all the time at bedtime or if we're watching porn all
01:29:18
the time or we're watching reading romance novels all the time, but we're not talking to the partner that we're
01:29:23
with, or we're not creating that time and space. I think there's a big opportunity for people in our modern
01:29:29
society which is overscheduled to schedule sex. I mean they do this quite well. So when you were dating, right,
01:29:36
and you would ask your your your date, you know, let's go out Saturday night. You were literally scheduling potential
01:29:42
sex. You were like, I could get lucky. I'm going to plan for it all week. I'm going to get excited. I'm taking this
01:29:47
person out. I'm like, it's going to be really fun and I'm going to do whatever it takes to sort of cross that finish
01:29:51
line. So, we were always scheduling sex and it was very erotic and fun when you're in your dating life and now you
01:29:58
live with a person and you sort of they see you at your best, they see you at your worst, they see you at your
01:30:02
crankiest and you're most tired and so it's really hard to get that level of excitement when you're dealing with
01:30:10
those, you know, sort of life circumstances. >> People will say that that, you know,
01:30:14
there's a spontaneity myth around sex that it should be spontaneous and that's kind of how we see it in films, like
01:30:18
they grab you in the hallway and you start kissing and whatever else. It's just not real. It's just the same as
01:30:22
WWF. Like it's not real. And so that's the truth is like you if you see your partner every day and you see your
01:30:28
partner, you're high and you're low and the crankiest and all of these things and you're all working like crazy, where
01:30:33
is the space for that? Like that's not how humans work. So creating that's why vacation sex is always fun for people or
01:30:39
they find time, you know? So again, if you've got kids and your kids are staying up later than you are and you
01:30:44
don't have a lock on your door and you're worried about making noises and you don't want to be too loud, like how
01:30:48
are you going to have great sex in that situation? One of the I guess the challenges people might also bring up is
01:30:53
that if you're scheduling sex, it puts a lot of performance pressure on you. If I
01:30:57
know tonight at 8:00 p.m. I have to have sex because that's the time we scheduled
01:31:02
this week. >> Yeah. >> Then like, oh gosh, I'm going to be finishing my work at 5 6 7 I need to get
01:31:07
home. [snorts] I need to have I need to have sex as well. >> So, this is where you schedule it around
01:31:11
a time that you know is going to work for you. So, I do I tell people to do things like um quarterly dates. So, I
01:31:16
get I listen I'm working in DC. Everyone is very highowered with very busy jobs.
01:31:20
I say one Friday a quarter. You and your spouse can literally block your calendars. One a quarter cuz quarter.
01:31:27
Okay, that means you might have sex every week. You might have your your your eight late night sex whenever you
01:31:31
might have sex whenever you have sex, but once a quarter have a day where you just block it out and you have a spouse
01:31:38
day or a partner day or whatever it looks like. And maybe do an act. It doesn't necessarily have to be a sex
01:31:43
day, but you actually take time of your little mini v. Maybe you want to walk, maybe you want to hike, maybe take a
01:31:48
bath, maybe get a massage. You kind of create space for you to actually say, "Oh, wait. We like each other. Oh, we
01:31:54
like talking to each other. We don't have to just talk about the kids all the time." So, again, the more you invest in
01:31:59
each other and in a joyful way, the better sex you're going to have. >> What about self-esteem issues? You you
01:32:05
mentioned that as well. Body image issues. How often do you see that being the blocker to great sex?
01:32:11
>> It's a huge problem. Again, I wish that uh the energy that my female patients
01:32:17
put into wanting to be skinny uh is is enormous. Uh and I wish that energy was put into wanting to be strong. But it's
01:32:25
kind of funny because what people think about themselves versus what they think for their friends are very different.
01:32:31
Your best friend, say they're overweight, do they deserve great sex? >> Of course.
01:32:35
>> Of course they do. Right? Your best friend deserves great orgasms, great sex, no matter what they look like, no
01:32:40
matter what they weigh. Everybody deserves intimacy, pleasure, and connection with someone that they can
01:32:44
have intimacy, pleasure, and connection with. But for some reason, when we think
01:32:47
of ourselves, oh, I can't be naked with this person. Oh, I can't be happy until I lose this much weight. I don't deserve
01:32:54
an orgasm unless I am, you know, skinny. And that's a huge problem. >> So, what do we do about it?
01:33:00
>> I think it's empowerment. It's communication. It's explaining to people. I think that all of the mindset
01:33:04
stuff that you do and you talk about is so important cuz look, you changed your mind around your own situation with this
01:33:11
ex of yours because you got education, right? You were able to see that it was more complicated than that. And I do
01:33:17
think by educating people on bodies, on pleasure, on joy, on connection, on intimacy. I actually think it changes
01:33:25
the narrative. I think people, we're in a sex recession, okay? People are having
01:33:29
less sex than ever. Uh people are not connecting. people are scrolling and they're on their AI chat bots instead of
01:33:35
like human connection. We're getting worse at this, not better. I I I just think that like we have to reach humans
01:33:41
and we have to be able to talk about it to change the narrative. >> What is the um the most important thing
01:33:45
we haven't talked about that we should have talked about as it relates to all the work that you do? I think the most
01:33:50
important thing is that biology matters in women and we often spend so much time
01:33:55
talking about psychosocial issues about emotions and all of that is true that is
01:34:00
important to sexual health but we minimize biology when it comes to women and we have to let women advocate for
01:34:07
themselves about the biology and we need to train doctors to care about the biology. I would love to find out from
01:34:12
all the women in your life and the women on your team like what experience like I
01:34:16
would love for you to ask them their experiences with medical providers cuz I don't think we have that curiosity of
01:34:22
like what are you experiencing that's different. >> Yeah, I think that I yes I think that's
01:34:27
going to have to for me to have like a healthy relationship with my partner. I think that's going to have to be
01:34:32
uh practice or like part of our you know we check in on our relationship etc >> but we don't really check in on the
01:34:38
physiology >> biology. So super interesting. So I spend two hours with people and there
01:34:42
are times when the partner comes to that talk and so they get to hear sort of what their partner is describing. They
01:34:49
even this see the exam and they get sort of a tour of their own partner's body parts. And so it is helpful sometimes to
01:34:55
bring partners into those conversations, the biology conversations of like she doesn't want to have sex with you not
01:35:01
because you're bad at sex. Look how painful it is right here at the opening of her velvets. Like a sunburn. I touch
01:35:07
it with a Q-tip and she's on fire. like what do you think your penis is doing and it gives that ability to say oh it's
01:35:13
not a me problem how do I support her best knowing that this is the issue so getting partners to understand the
01:35:19
biology is extremely helpful or say you have a man who's taking an anti-depressant uh or a hair loss
01:35:25
medication that can cause sexual dysfunction as well um say you have a man who takes an anti-epressant it
01:35:30
lowers his libido is it oh honey you're not attracted to me anymore you must not
01:35:34
love me or is it I actually understand the biology that your libido is lower because of this anti-depressant and two
01:35:40
things can be true. So, so I think understanding your partner's biology and your own biology is quite important.
01:35:46
>> Yeah. I guess that's the the crux of the conclusion really is that both education
01:35:50
and communication are where it all begins, >> which is the fundamentals, right? >> Yeah. And I think you gosh if I had
01:35:56
better education on these subjects God at the start of my adult life and also I had like figured out how to communicate
01:36:04
with my partner and maybe even also with yourself and like to be a bit honest with yourself about how you're feeling
01:36:10
not to gaslight yourself, not to gaslight your partner. It just it just goes to show how better relationships
01:36:15
would have been not just with your romantic partner but really with all the people in your lives. And this is easier
01:36:20
said than done like especially the communication part because these are very very sensitive subjects. And so we
01:36:26
we'd rather just shut up about them and keep them as these sort of like secrets among that we whisper about with the
01:36:31
closest people in our lives, maybe our best friend. >> And I just think generally one of the
01:36:35
things I've come to learn from doing this podcast as well is that you know there was this quote I read. It said you
01:36:39
can predict the long-term health of a relationship by whether each challenge heals to 101% or 99%.
01:36:46
Does your conflict make you stronger? And what it's essentially saying is like conflict is guaranteed in life, but the
01:36:53
thing that's going to turn your conflict into a strengthened relationship or a weakened one is you're how you deal with
01:37:00
it. >> Like, and that's all predicated on communication. And so if we can just teach people how
01:37:06
to communicate, if we can become better communicators, which is both a function of speaking and listening and I guess
01:37:12
curiosity, then all of these downstream challenges and misunderstandings would have a chance of being solved for. And I
01:37:19
think about this so often. I often think, okay, how I'm communicating with my partner currently is really going to
01:37:24
determine whether we have an argument in two years time >> or a year's time or 6 months time. our
01:37:29
strategy of communication. Does she feel safe expressing a problem? How do I receive the problem even when it feels
01:37:36
like I'm being blamed? And vice versa. And then are we open-minded about solutions or do we come with a bias
01:37:44
around this is the solution. This is what I think the correct answer will be. I've spent a lot of time, you know, I'm
01:37:48
like 7 years into my relationship now almost. So I spent a lot of time thinking, okay, like how do people go
01:37:53
how do they build a relationship like 50 years? And the crux of it seems to be conflict resolution/communication.
01:38:00
That seems to be the crux of it. And actually with finance issues that we talk about with finance experts or with
01:38:05
sex issues, the crux of it seems to be conflict resolution/communication. And I also know cuz I know lots of
01:38:13
couples that we're all living on a different spectrum here. Some couples are like they come home at 6 p.m. and
01:38:19
all they want to do is talk about the most sensitive subjects. And then you've got this other group of couples who
01:38:24
almost don't talk about anything. They're kind of like strangers that are like burying everything in the cupboard.
01:38:29
>> And they think burying it in the cupboard means that it's out of sight, out of mind, and it's not impacting
01:38:35
anything. >> But again, you come to learn that any problem buried rears its head in
01:38:42
unexpected ways. And uh you know I think of one particular friend of mine who was in a
01:38:46
relationship for 14 years had a baby they kind of stopped having sex didn't really talk about it
01:38:54
they become like parallel lines that are drifting apart >> and they get you know several years
01:39:00
later go what happened? >> Mhm. >> What happened to our relationship? >> Well they never spoke about it.
01:39:06
>> Mhm. So, >> I think you understand this perfectly and for you to um see it in this you can
01:39:14
help so many people because I think these are the fundamentals. How do we teach young people and old people that
01:39:20
conflict resolution is important in intimacy and vulnerability are important in biology is important. Science is
01:39:27
important and we can do this. I I just taught you a few things that I know today and you under not only did you
01:39:33
understand it, but you were curious about it to ask further questions and you can now um figure out how it works
01:39:40
in your own relationship, in your own life, you're even caring enough about thinking about your friends lives. And
01:39:44
so if you've shown that this matters and this is important, I just think how many
01:39:49
people are going to benefit by your vulnerability and your curiosity and saying, "Oh, I could do that, too."
01:39:54
>> Yeah. It's crazy, isn't it, that like if you love this person so much, yet you
01:39:58
don't often love them enough just to communicate about some of these like sensitive tricky subjects, which is like
01:40:06
craziness when you articulate it like that. Like I've been in relationships, I just absolutely love this person, but
01:40:10
no, I wouldn't I wouldn't raise X, Y, and Zed subject. It's just it's just too uncomfortable.
01:40:16
>> And the few times I guess I will ask that you have been vulnerable, has it gone well or not well?
01:40:22
>> Oh my gosh, it's like the most important thing. I just I always think why didn't
01:40:24
I do this sooner? >> Mhm. >> Yeah. Okay. So, to be even more honest, I like didn't have conversations with my
01:40:33
partner about sex at all. Like, I just I assumed she liked it. I think she assumed I liked it. And it wasn't until
01:40:40
you get further into relationship that you start going like, wait, I don't think this is how this person wants to
01:40:45
have sex or I don't know. I actually have to give her the credit cuz she's the one that started like pushing on the
01:40:51
communication. I think sometimes as men we just, you know, that old slightly toxic
01:40:58
phrase, happy wife, happy life. I think sometimes as men, we just kind of assume
01:41:00
that if no one's saying anything, then everything's great. >> But it takes two to tango.
01:41:08
>> And I think expecting your partner to have all the words and to know everything is the wrong answer. Yeah,
01:41:14
that's where again that third party whether people come to see me together as a medical person or a sex therapist
01:41:19
or or a third party to help you have that conversation cuz I think we assume our partners know everything about their
01:41:25
own bodies and can communicate about their own bodies and that's just not true. Even showing that curiosity makes
01:41:31
you quite evolved, right? And I think that that's the energy that we need in 2026 is h breaking down those barriers
01:41:38
because it will lead to stronger relationships. So will lead to stronger partnerships and it's those hard moments
01:41:44
that you grow the most from. >> You need the words though as you say. >> Yeah. >> When you say you need the words, what
01:41:51
what what specifically do you mean by that? You need to know how to start the conversation, how to handle the
01:41:56
conversation, how to receive a subject that might be a little bit offensive. It might hurt your ego a little bit. Is
01:42:01
this what you mean by like have the words? >> It's really hard to do that on your own
01:42:04
because people don't want to hurt other people's feelings. And so just saying it
01:42:09
as it is may not be the right approach either. That's where again couples therapists are very good at holding
01:42:14
space for those different conversations. And I think one of the other problems here, Stephen, is many times there's no
01:42:21
bad guy. Of course, when it's obvious someone cheats on someone, someone breaks trust, yes, there's a bad guy.
01:42:27
But so often, you know, say someone has a higher libido than someone else, there's no bad guy. That person has a
01:42:32
high libido and that person has a low libido, there's no evil bad guy, but there is still conflict. And so how do
01:42:38
you deal with conflict when it's not a good guy bad guy situation but and how do you love someone and evolve with them
01:42:46
right like I think it's not easy >> I think your point there though is actually where it starts often which is
01:42:52
this point of empathy the minute you realize that there is no bad guy just as you said it I thought oh my gosh yeah
01:42:56
back when I had those intimacy challenges in that relationship >> it was a case of trying to figure out
01:43:03
who the bad guy was I was like is it me is it a me problem is it a you problemm kind of like what the brain jumps to.
01:43:08
But actually, now that had time passed and we figured out what it was, turns out that it was neither of us. It was
01:43:14
really the whole time not me against her or her against me. It was me and her against the problem.
01:43:20
>> Mhm. >> And that reframe I think removes the like shame, the blame and all that stuff
01:43:25
that gets in the way and focuses you as a team on resolution and conflict resolution. Thank you. you've you know
01:43:32
you said that I will help people but actually you're the one that's helping people. I'm just asking questions. And
01:43:39
uh >> I disagree. I think it's the simple it's the vulnerability of watching others.
01:43:46
It's the simple stuff that makes the biggest change. >> Why does this matter so much? I can see
01:43:50
it in your face. >> Because so many people are hurting. Relationships are hurting. People's
01:43:56
health is hurting. people aren't having as much pleasure and joy and quality of life that they could be having. Using
01:44:02
what we already know to be true, simple things, communication, connection, education, basic medical care, these
01:44:10
things can bring so much joy, health, great relationships, great living. And I see it every day in my clinical
01:44:18
practice. And I want that. I want that for every person out there. And I want them to fight for it. And I want them to
01:44:24
advocate for it. And I want doctor just to show up in a big way to help them. And I think we can do it. But I I I am
01:44:31
so passionate about this because I see all the like I see how much it's not being done.
01:44:37
>> Dr. Rachel, we have a closing tradition where the last leaves a question for the
01:44:40
next not knowing who they're leaving it for. The question left for you is what would be one thing you would like to do
01:44:46
or improve in your life tomorrow? I would like to get better about practicing what I preach because we
01:44:59
always say the shoe makers uh kids don't wear shoes. >> I am addicted and obsessed with what I
01:45:05
do. I love my work so much, but I don't necessarily uh spend as much time um lifting weights that I should or not
01:45:14
scrolling on my phone and paying attention to my children that I should. I don't spend as much time, you know,
01:45:20
uh, uh, scheduling those quarterly spouse dates that I tell other people to do. And so, I think practicing what I
01:45:25
preach is a huge opportunity for me. >> Well, that's refreshing to hear cuz none
01:45:29
of us are perfect in that regard. So, it's good to know that just having all the information doesn't necessarily mean
01:45:35
um, it's easy to execute upon. >> Easy to do, easy not to do. >> Amen. Um, where do people go to find more from
01:45:44
you? Do they go to your Instagram, your website, your YouTube channel? Where should you where should they go?
01:45:49
>> Yeah, our website is really fabulous. We are very big into research, education,
01:45:54
advocacy, and mentorship. So, rachel rubinmd.com that would lead you to sign up for our
01:45:59
newsletter, which is really an incredible source of education. We are sending you the the latest and greatest
01:46:05
in studies, research that you can be a part of, job opportunities, um, and advocacy for clinicians. We have courses
01:46:12
and teaching you how to do this both free and uh ones that come with continuing medical education. I would
01:46:19
say Instagram is um the most popular for me right now. Uh although we're trying to get louder. If only I had your
01:46:26
skills. I I would love to be louder on YouTube and other places. Uh we do have a clinical practice both in Washington
01:46:32
DC and Los Angeles. And so if we can help in any way on the sexual health side, please reach out to us because
01:46:38
sexual health is just health and your quality of life absolutely matters. >> I'll link all of that below and I hope
01:46:44
people sign up for your newsletter as well. That sounds really interesting. >> Thank you,
01:46:47
>> Dr. Rachel Raven. Thank you so much for all of this. Um, I think it's it's so so
01:46:52
telling that your conversations are often the most shared on the podcast and generally in podcasting because the
01:46:58
subjects are so um so important to so many people's lives and they can relate to feeling not themselves as you say,
01:47:05
but there's very few people out there that have the credibility, the experience with patients, but also the
01:47:11
the ability to articulate it in a way that's highly accessible like you have. So I know that you you know we talked
01:47:16
beforehand you don't necessarily love doing this but um it's a very very important worthy course because there's
01:47:21
very few people that can speak to these subjects with it in the way that you can. So please keep doing it.
01:47:25
>> So kind >> anybody who's listening now I highly recommend if there's somebody in your
01:47:28
life that might want to listen to this conversation. I think there's a reason why Dr. Rachel's conversations are
01:47:33
always the most shared. Um please do share it with them. Dr. Rachel, thank you so much for your time.
01:47:40
>> Thank you. YouTube have this new crazy algorithm where they know exactly what
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And the algorithm says that this video is the perfect video for you. It's different for everybody looking right
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