0:00 You rub it inside the walls of the
0:01 vagina, like that.
0:02 >> rub it in like you would rub sunscreen
0:04 on your face. And if you do that twice a
0:06 week, it makes sex not painful and dry.
0:08 It helps with arousal and orgasm. It's
0:10 literally better than Viagra. And it's
0:13 cheap. And I'm telling you all this as a
0:14 urologist that this cream can also help
0:16 prevent death from urinary tract
0:18 infections. But more than 75% of people
0:21 in large database collections are not
0:23 getting prescriptions for this. And so
0:25 women are not getting access to generic
0:27 medications that could save their lives
0:29 and also really improve quality of life.
0:32 And so I am filled with rage because
0:34 people are limiting their ability to
0:36 have great sex, great health because
0:38 they aren't having access to all the
0:39 information that they could. For
0:41 example, women are not orgasming as much
0:43 as men. The data is very clear there.
0:45 And women come to see me all the time as
0:46 I'm a sex doctor. And they say, "I'm
0:48 broken and you have to fix me. I'm not
0:49 orgasming during sex." And I think the
0:51 majority of problem is education. Women
0:54 think that orgasm comes from
0:55 penetration. But the clitoris is how
0:57 most women orgasm. And yet most women do
1:01 not know where their clitoris is. And in
1:03 fact, the word clitoris today in 2026
1:06 does not exist in the checklist for what
1:09 an OBGYN has to learn in their training.
1:11 >> And as men, what are we getting wrong in
1:14 heterosexual relationships when we're
1:16 trying to arouse our partners?
1:18 >> Well, men are constantly asking about
1:20 they want their penises bigger, harder,
1:22 straighter, girthier, lasting longer.
1:25 But none of that has anything to do with
1:27 how women experience pleasure [music]
1:28 and satisfaction in the bedroom. So
1:30 that's why I'm so loud about these
1:31 things because no one is getting good
1:33 sex ed. Because the basic information is
1:35 not being shared. And we fundamentally
1:37 don't give a crap about women's sexual
1:39 health, about their menstrual cycles,
1:40 pregnancy, menopause, hormones, pain
1:42 with sex, libido. [music]
1:44 But we actually do have a lot of
1:45 information that we are not using
1:47 because everyone forgot to teach your
1:48 doctor.
1:49 >> And I want to focus today's conversation
1:50 on women's health cuz I have so many
1:52 questions and curiosities.
1:53 >> Right.
1:54 >> So let's start with the subject of
1:55 hormones.
1:56 >> This is going to be so [ __ ] good.
2:00 >> This is super interesting to me. My team
2:02 gave me this report to show me how many
2:03 of you that watch this show subscribe,
2:05 and some of you have told us, according
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2:10 all of you, please could you check right
2:12 now if you've hit the subscribe button
2:13 if you are regular viewer of the show
2:14 and you like what we do here. We're
2:16 approaching quite a significant landmark
2:18 on this show in terms of a subscriber
2:19 number. So, if there was one simple,
2:21 free thing that you could do to help us,
2:23 my team, everyone here, to keep this
2:25 show free, to keep it improving year
2:27 over year and week over week, it is just
2:29 to hit that subscribe button and to
2:30 double-check if you've hit it. Only
2:32 thing I'll ever ask of you.
2:33 Do we have a deal?
2:34 If you do it, I'll tell you what I'll
2:35 do. I'll make sure
2:37 every single week, every single month,
2:39 we fight harder and harder and harder
2:40 and harder to bring you the guests and
2:41 conversations that you want to hear. I
2:43 stayed true to that promise since the
2:44 very beginning of The Diary of a CEO,
2:45 and I will not let you down. Please help
2:48 us. Really appreciate it. Let's get on
2:50 with the show.
2:52 >> [music]
2:54 >> Dr. Rachel Rubin.
2:57 Before we started recording, you said a
2:58 line to me, which I found to be very
3:01 interesting. You said, "I'm filled with
3:04 rage."
3:06 Why are you filled with rage?
3:08 >> I am filled with rage because I do think
3:10 that people are limiting their ability
3:12 to have great sex, great relationships,
3:15 and great health because they aren't
3:17 having access to all the information
3:18 that they could, and they're going to
3:20 see doctors who actually don't know how
3:23 to help them with these problems.
3:25 >> And on the subject of women's health,
3:27 sexual health, hormones, etc., can you
3:29 give me the background context of the
3:32 disservice that's been done? I remember
3:33 you you were talking previously about
3:35 how even the most affluent women in the
3:37 world are being let down.
3:39 >> Yeah, I think this is the great
3:40 equalizer in the fact that no one is
3:43 getting good medical care here when it
3:45 comes to hormone therapy, menopause, and
3:47 sexual health. Melinda Gates just came
3:49 out and said she had to see three
3:50 doctors before she got proper hormone
3:52 therapy prescriptions. Oprah had to see
3:55 five doctors and still they didn't
3:57 understand that her heart palpitations
3:59 was from perimenopause and menopause.
4:01 How about Halle Berry, right, who has
4:03 access to all the doctors in the world
4:05 and she publicly came out and said she
4:07 was diagnosed with genital herpes when
4:09 she really just had the genitourinary
4:12 syndrome of menopause. The rich people
4:14 are not getting good information about
4:16 their bodies, about their hormonal
4:18 health, about their sexual health. So,
4:20 what are the rest of us doing? We don't
4:21 teach it in medical schools, we don't
4:23 teach it in residencies. I didn't learn
4:25 anything about it and so we are actually
4:27 getting worse at this, not better at
4:29 this. And so I'm full of rage because we
4:32 actually do have a lot of data and we do
4:34 have a lot of information that we are
4:35 not using because everyone forgot to
4:37 teach your doctor.
4:39 >> It's staggering to me that, you know,
4:42 those very affluent women that you've
4:44 mentioned still are being let down by a
4:46 medical system. Um, it also sort of begs
4:49 the question that if men were in that
4:51 situation, this probably wouldn't be the
4:53 case. And that's says something about
4:55 the research and the investment that's
4:57 gone into understanding women's health
4:58 relative to men's health.
5:00 >> It's a huge problem. We don't have
5:01 enough specialties of medicine that
5:03 focus on women's health and we don't
5:06 have enough like manpower behind us. We
5:08 can throw money at the situation, but
5:09 you need physical human beings to roll
5:12 up their sleeves and do this work. Like
5:14 doing research is challenging and you
5:16 need people to actually disseminate the
5:18 research and talk about the research and
5:20 you need the training to happen so it
5:21 has to trickle down. So, just because
5:23 someone wrote a paper doesn't mean it
5:25 automatically gets downloaded into every
5:27 doctor's brains. So, someone has to
5:29 teach someone how to do something. So, I
5:31 I lecture all the time. I do a lot of
5:33 trying to teach clinicians how to do
5:35 this. I travel all over to say, "Here's
5:37 how to write prescriptions." because
5:38 that's what it's going to take. There
5:40 was so much fear and misinformation 20
5:43 years ago about hormone therapy that it
5:45 is a lost art. Doctors don't know how to
5:47 write the prescriptions. Nobody taught
5:49 them how. So, even if they see headlines
5:51 and Melinda Gates giving $10 million to
5:53 the Menopause Society, that's wonderful,
5:56 but it doesn't translate into them
5:58 knowing how to actually write the
5:59 prescription, knowing the difference
6:01 between the type of hormones, knowing
6:02 the safety, the risk, the benefits,
6:04 because they never had the class. For
6:06 example, I'm a urologist. If someone
6:08 comes in to me asking about their blood
6:10 pressure, I'm not going to pretend like
6:12 I know everything about their blood
6:13 pressure. I'm going to be very honest
6:14 that I have the limitations in my
6:16 training. But, for some reason with
6:18 hormone therapy and women's health,
6:20 every doctor you go see has strong
6:22 opinions and will tell women what they
6:24 can and cannot have with their bodies
6:26 even when they don't know the data. I
6:28 come from the men's health world. We
6:30 don't tell men you can't have this. You
6:32 can't do this. We we talk about shared
6:34 decision-making. We talk about risks. We
6:36 talk about benefits. For some reason we
6:37 don't do that enough in women's health.
6:39 >> Why?
6:39 >> I think part of it I don't think your
6:41 doctor is evil. I actually have a
6:43 thought about this. So, I think your
6:44 doctor wasn't trained. I think they're
6:46 trying to save face. And I think 10
6:48 minutes is impossible to give good
6:50 medical care. I could never get to know
6:52 you fully in 10 minutes and really give
6:55 you great advice on your life that's
6:56 customized for you. It's almost like the
6:58 difference between a viral clip that
7:02 you're going to try to do from this
7:03 episode and the long-form nuanced
7:05 conversation that you're going to have.
7:07 You love the nuanced conversation. You
7:09 love spending those those 2 hours. And I
7:11 think patients want that, too. But, when
7:13 they go to the doctor, they're getting
7:14 the 10-minute version. And instead of
7:16 doctors saying I don't know, they're
7:18 sort of saying no no you can't have this
7:20 cuz it's easier than than sort of going
7:22 into that nuance, which can take time. I
7:24 also think that people are going to
7:26 their doctor, say say you want to talk
7:29 about your orgasm or your libido. Okay?
7:31 You go to your gynecologist. Of course,
7:33 my gynecologist should know everything
7:35 there is to know about the clitoris,
7:37 about orgasm, about hormones, about
7:38 That's what they do. And the truth is
7:40 it's not what they do. And it's they
7:41 were never taught that. And they
7:43 >> taught about the clitoris.
7:44 >> They were The word clitoris today in
7:45 2026 does not exist in the checklist for
7:50 what an OB/GYN has to learn in their
7:51 training. The word doesn't exist.
7:53 >> What is an OB/GYN for anyone that
7:54 doesn't know?
7:55 >> An OB/GYN is a doctor who specializes in
7:58 obstetrics, so delivering babies, and
7:59 gynecology. So, your gynecologist has
8:02 never been taught about the clitoris,
8:05 about the vulva, about sexual health,
8:06 about sexual pain, about libido,
8:08 arousal, and orgasm. And so, the ones
8:10 who have taken it on their themselves to
8:12 get extra training, they're very few and
8:14 far between. And so, every day women,
8:17 and men too, are going to a doctor
8:19 expecting answers on a topic that their
8:23 doctor probably has never gotten
8:25 training on.
8:25 >> And I do want to focus today's
8:26 conversation on women's health. And I
8:28 want to preface all of this by saying
8:29 that I'm going to be as dumb as I am on
8:32 this subject. If you say something about
8:34 the vagina and I don't know what it
8:35 means, I'm not going to pretend to know.
8:37 I'm going to ask you what it means. And
8:38 I say that because I sometimes think
8:40 with these conversations
8:42 um the host
8:44 often
8:45 is too shy to admit their ignorance. And
8:48 I have lots of ignorance on this. But I
8:50 also have lots of curiosity, and I want
8:51 to fill those gaps. And that's going to
8:52 require me to be very, very
8:55 dumb. And also, my second reason why is
8:58 because I have so many women in my life.
9:00 Um if you just look at my company, my
9:01 entire executive team in my company are
9:03 all women. And also, I've got my fiance,
9:05 my mom, my sister. And understanding the
9:09 women in my life um one element of
9:11 understanding them is understanding
9:12 their health. Women's health isn't
9:14 something that I was ever taught in
9:15 school. It's not like a lesson I had.
9:16 So, I also think this conversation
9:19 is for men. Every man has um four
9:21 important women in their lives. So, my
9:23 question to you is if if a woman has
9:25 clicked on this conversation right now,
9:27 what are they going to get from it?
9:28 Let's start with that first question.
9:30 >> So, I think it's really important
9:32 because as men, we expect the women to
9:34 know. Surely the woman knows about their
9:36 menstrual cycle, about pregnancy, about
9:38 postpartum, about menopause, about
9:40 hormones. Surely my partner knows, you
9:42 know, or the woman in my life, my mom,
9:44 my sister, my my daughter, they know all
9:46 of that, so I don't have to. And the
9:48 truth is, they don't know. When the
9:51 women in your life go to their doctor
9:53 and they're getting a pelvic exam, say
9:54 they're getting a Pap smear, a doctor is
9:56 looking at their their genitalia,
9:58 putting a speculum in, going inside the
10:01 canal and looking around. We put a sheet
10:03 over you like we are me chanics looking
10:05 under the hood. So, we put a sheet to
10:07 keep you comfortable, to keep you
10:09 modest, but we we hide your genitalia
10:12 from you and we don't teach as we go.
10:15 So, I became famous again because I I I
10:18 when I started my practice, I didn't buy
10:20 any fancy equipment, I bought two
10:22 mirrors on Amazon and I give women a
10:24 mirror and as I'm examining them, I say
10:27 to them, "This is your labia majora.
10:29 This is your labia minora. This is your
10:30 clitoris. This is your your urethra, the
10:32 tube that you pee through." Because
10:34 women can't see it. You've got skin,
10:36 you've got bones, you've got muscles,
10:38 you've got nerves, you've got, you know,
10:40 all the organs that are on the inside
10:43 and women don't have access to this
10:45 language. Certainly men don't have
10:47 access to this language. And so, it's
10:49 that basic ability to give women
10:51 language, you can learn about your body
10:53 parts, you can learn how hormones work
10:56 in your body, and you can learn basic
10:59 medicine for you that becomes important
11:01 for how you advocate for what you want,
11:03 what you care about, and who you bring
11:05 into your medical life. You may have a
11:07 physical therapist, you may have a
11:08 mental health person, you may have a
11:10 primary care, a gynecologist, you may go
11:12 on Instagram and get great information
11:14 from people on Instagram. And so, that
11:16 doctor that makes you feel like crap
11:18 because they they tell you something
11:19 that you don't agree with, find a
11:21 different one, right? You have to
11:23 advocate for yourself and I find we are
11:25 starting to empower women to do that, um
11:28 which is very challenging.
11:29 >> What is the most popular question you
11:31 get asked now that you've been on these
11:33 podcasts and you know you're out there
11:35 and you've done millions and millions of
11:36 views all over the place and on clips
11:38 and so forth. What is the number one
11:39 most popular question you get asked?
11:41 >> I'm asked a lot about hormones. Like
11:44 people want to know about hormones.
11:46 People want to know about pain with sex.
11:49 And I think people want to know about
11:50 libido. I think those are the three I
11:52 would say most common things that we
11:54 talk about.
11:54 >> go in that order then. So let's start
11:56 with the subject of hormones. What is it
11:58 about hormones that people are so
12:00 desperate to understand?
12:01 >> So hormones are fascinating because we
12:03 forgot to teach doctors anything about
12:05 hormones.
12:07 And what we have taught about them, they
12:09 think it's dangerous, they think they're
12:10 harmful, they think that you know it's
12:12 it's almost like this thing that is
12:14 natural in your body is somehow
12:16 dangerous once you get over a certain
12:18 age. And that is all politics and bad
12:22 interpretation of science.
12:24 >> I've got this graph here which um
12:26 shows female testosterone levels by age.
12:30 And again, as someone that has started
12:32 to understand more about female
12:33 hormones, I was quite surprised because
12:35 you think of testosterone as a male
12:37 hormone.
12:38 >> Yeah, so that's the biggest
12:39 misconception is that women don't make
12:40 testosterone. Testosterone is just a
12:42 hormone. It's not a male hormone, a
12:44 female, it's just a hormone. It's also
12:45 not a menopausal hormone. We think of
12:47 menopause as estrogen starts to drop,
12:50 right? So menopause is a castration
12:52 event. If I cut your testicles off right
12:54 now, you would have hot flashes, night
12:56 sweats, osteoporosis, depression, low
12:58 libido, erectile dysfunction, metabolic
13:01 syndrome, your weight would go up and
13:03 you would be generally pretty unhappy.
13:05 It's a big deal when we castrate people.
13:07 And yet, we don't do it for men
13:09 regularly unless there's a very
13:10 significant medical reason to do so. And
13:13 yet, every woman over the age of 50,
13:16 her estrogen goes to essentially zero.
13:18 And that affects bone health, it affects
13:20 the brain, it affects the heart, it
13:22 affects sexual health, it affects UTIs
13:24 start to go up. And so it's a whole body
13:26 event that happens. Now, testosterone's
13:28 really interesting cuz it actually isn't
13:30 at menopause that you lose testosterone.
13:33 It happens in your 30s. So, if you look
13:35 at this graph, right? You can see
13:37 testosterone starts to precipitously
13:39 drop in your 30s. So, what do we see
13:41 clinically? Sometimes nothing, but we
13:43 have a lot of people who will start in
13:45 their 30s, mid-30s, late 30s start to
13:47 say, "Ooh, my libido's not as high as it
13:49 used to be. Huh, my orgasm takes a
13:51 little bit longer. I don't feel as
13:53 aroused. My engorgement is not the same.
13:55 My lubrication
13:56 >> Engorgement.
13:57 >> Engorgement of the clitoris. It's the
13:58 same as an erection, right? So, the
14:00 clitoris and the penis are the same.
14:01 They get hard with blood flow. And so,
14:03 this happens in your 30s and no one's
14:05 paying attention because if you look at
14:07 the graphs that we are taught in med
14:09 school, they look more like this. So,
14:11 the books all talk about estrogen and
14:13 progesterone. They don't talk about
14:15 testosterone very often. And there's
14:17 also a lot of things we do to worsen
14:20 this problem. When you play with
14:21 hormones, there are consequences,
14:23 sometimes good and sometimes bad because
14:25 we do so much to mess with our hormone
14:27 levels. Again, birth control pills, the
14:29 way that they work is changing hormone
14:31 levels. Medications for acne,
14:34 medications for hair loss that people
14:36 are using can affect your testosterone
14:38 levels. So, birth control is wonderful,
14:41 but there are side effects to birth
14:43 control just like there's side effects
14:44 to any medication. And so, one of the
14:46 side effects is it lowers testosterone.
14:49 And so,
14:50 that can cause low libido, pain with sex
14:53 in a small subset of people who take it.
14:55 So, if you're someone who does have side
14:57 effects, then it's worth having
14:58 conversations of different forms of
15:00 birth control which may not lower your
15:01 testosterone as much. Does that Does
15:03 that make sense?
15:04 >> It does make sense and it's
15:06 it's interesting. My My partner's talked
15:07 about this before. My fiance, she was on
15:10 birth control for a long time
15:12 and she also had concurrently libido
15:14 problems.
15:16 Now, we don't know whether it was the
15:18 birth control, whether it was something
15:19 else, but when she came off the birth
15:22 control pills, her libido
15:25 challenges also evaporated.
15:27 >> So, can explain cuz I think again,
15:29 knowing the basics and the fundamentals
15:31 give women and men access to the
15:33 information so they can make choices
15:35 with what they want to do with it. Okay,
15:36 so how do birth control pills work? Um
15:39 when you take a combined birth control
15:41 pill, it has a fake amount of estrogen
15:43 and a fake amount of progestin in it so
15:46 high that it tricks your body into not
15:48 ovulating. So, when you have so much
15:50 hormone around, your body says, "Oh, I
15:51 don't need to make my own cuz there's
15:53 plenty around." And so, the ovaries shut
15:55 down. So, your ovaries are no longer
15:57 making their own hormones because this
15:59 happens to men, too. When you take high
16:01 doses of testosterone, you become
16:02 infertile because your testicles say,
16:04 "Oh, I don't need to produce sperm right
16:05 now cuz there's plenty of testosterone
16:07 around." And so, birth control causes
16:09 your ovaries to just stay quiet. They
16:10 shut down for a bit. But, your ovary
16:12 does three things. It does estrogen,
16:14 progesterone, and testosterone. It
16:16 doesn't add back testosterone. So, her
16:18 experience possibly was because she
16:21 wasn't making her own testosterone. And
16:24 when she went off that birth control,
16:25 her ovaries woke back up and make
16:27 estrogen, progesterone, and
16:28 testosterone, which to you equaled more
16:31 pleasure. Now, because we focus on the
16:33 psychosocial, I'll have a lot of people
16:35 saying, "No, no, no, it's all
16:36 communication." And all of that is
16:38 important. Don't get me wrong. But, the
16:40 biology matters too. And we know there
16:43 is a biological basis to sexual health
16:45 for everybody.
16:47 >> I was just looking at some data and it
16:48 said that in some studies, up to 27% of
16:51 people on birth control report a
16:54 decrease in their libido/sex drive.
16:57 >> Yeah.
16:57 >> Which is shocking cuz, you know, it
16:58 varies in these studies from one to
17:00 seven people to one to that's almost
17:02 like one one in three people
17:04 are experiencing it. How does one
17:05 navigate that, you know, cuz birth
17:07 control has tremendous um upsides?
17:10 So, how do you navigate that?
17:11 >> I think that everything that we do,
17:13 there's the risk of doing something and
17:15 the risk of not doing something. No drug
17:17 is going to be without possible side
17:19 effects and so that's where becomes
17:21 important to know what are the
17:22 non-negotiables. Antidepressants is a
17:25 perfect example. We know that they can
17:28 help people, right? A lot of people, but
17:30 we know there are sexual side effects
17:31 like low libido, delayed orgasm. And so
17:34 it has to do with informed consent,
17:36 which means I Stephen, if I'm going to
17:38 give you a medicine, I want you to know
17:40 that there is the common side effects,
17:43 the less common side effects, and then
17:45 the disastrous side effects. That's why
17:46 on the commercials they talk about all
17:48 the disastrous side effects. But often
17:50 they don't even research the sexual side
17:52 effects. So for example, GLP-1s, okay?
17:56 >> What's a GLP-1?
17:56 >> Yep, the GLP-1s are the weight loss
17:58 drugs that everybody's talking about.
17:59 Ozempic, Mounjaro, all the all the
18:02 celebrities are on these injections that
18:04 are making them lose tons of weight. We
18:06 are starting to look at these drugs in
18:08 women, but they're not nobody's looking
18:10 at it for sexual health. Everyone's
18:12 looking at it for can you get pregnant?
18:14 Reproductive health. There is not a
18:15 single published paper on sexual health
18:18 side effects for women. So we did a
18:20 survey, it's not published yet, but we
18:22 presented it at a conference at a
18:24 medical conference. We surveyed a
18:26 thousand women online who have taken
18:28 these medications and about 25% report
18:32 sexual side effects from these
18:34 medications. Again, that's not to say
18:35 the medicines are good or bad, right or
18:37 wrong, but there are side effects. Now
18:39 of those 25% about 50% of those people
18:42 said it lowered their sexual function
18:44 whether it's libido, arousal, and
18:46 orgasm. And about 25% said it made it
18:48 better.
18:48 >> So carrying on in this track about
18:51 women's hormone levels through time and
18:53 through age and through life phases,
18:55 what else do I need to know or
18:56 understand about how important
18:58 testosterone is?
19:00 >> So we know we have global consensus
19:02 actually that testosterone helps for
19:04 libido in postmenopausal women, okay?
19:07 Now there is also data in perimenopausal
19:10 women as well and that is clear data. It
19:13 helps with libido, but it also helps
19:15 with arousal, it helps with orgasm, and
19:17 satisfaction. It can also help with body
19:20 image, which is like a cool a really
19:22 cool thing. In my clinic, I use FDA
19:24 approved testosterone for men, and I
19:26 give it to them in doses appropriate
19:28 like 1/10 the dose for a man, I give it
19:30 to my female patients. And I see that
19:33 over the 3 to 6 months of taking it,
19:36 they get this
19:38 it clicks. Now, does that mean every
19:39 woman on Earth needs it? No, we're not
19:42 there yet, but if you want it and you
19:44 want to try it and you're curious about
19:45 it, then you should have access to
19:47 physicians who understand how this works
19:49 and they know how to write the damn
19:51 prescription.
19:52 >> There's five life stages on here. We
19:53 have puberty, your fertile years,
19:55 perimenopause, menopause, and then post
19:58 menopause.
19:59 When you think about a woman's hormonal
20:01 journey through these different life
20:03 stages,
20:05 what is the sort of advice you would
20:06 give them to make sure they're
20:07 hormonally healthy across every life
20:09 stage? What are like the basics? What
20:11 are the tactics, strategies, medications
20:14 that they should be thinking about? And
20:16 I say this because I've got women women
20:17 in my life for every stage in this life
20:20 phase at the moment. I've got you know,
20:21 I've got my nieces in the sort of
20:23 puberty era. I've got my my fiance in
20:26 the fertile years. I've got my mom and
20:28 grandparents etc. in the peri- and
20:30 post-menopause years as well.
20:31 >> Yeah. So, if you look at your nieces for
20:34 example, when they were babies compared
20:36 to now, there are changes happening.
20:38 Their bodies are transforming because
20:40 they're getting a surge of hormones in
20:41 their body and that's estrogen,
20:43 progesterone, and testosterone. They're
20:44 cycling, which means they're getting
20:46 periods. So, let's talk about the
20:48 menstrual cycle for a second. I think
20:49 it's helpful.
20:50 >> Okay.
20:51 >> So, [clears throat] when women have
20:51 their period,
20:53 they bleed for a few days, right? And
20:56 that's when their hormones, their
20:57 estrogen and their progesterone is at
20:59 its lowest, okay? So, hormones are at
21:01 their lowest. And then
21:04 the hormones start to increase. Your
21:05 estrogen starts to go up. You don't make
21:07 progesterone yet in the beginning. Your
21:08 estrogen starts to go up and it make
21:11 there's a a follicle in your ovary which
21:13 has an egg, right? It's going to pop out
21:14 an egg.
21:16 Ovulation is when the egg pops out. So,
21:18 you get this big surge of estrogen and
21:20 then when the egg pops out of the ovary,
21:22 right? That's what's going to make a
21:23 baby if it gets fertilized, there is a
21:25 shell of the egg, right? The egg has a
21:27 shell which makes progesterone. So, the
21:30 second half of the cycle there's
21:31 progesterone around, okay? First half of
21:33 the cycle no progesterone.
21:35 >> Mhm.
21:35 >> And so, that [clears throat] second half
21:36 of the cycle the shell has making
21:38 progesterone and then when you don't
21:40 have fertilization, the shell starts to
21:43 break down.
21:43 >> Okay.
21:44 >> And that natural breakdown is a drop in
21:46 progesterone which causes the lining of
21:48 the uterus to shed and you get a period
21:50 again. And so, it's estrogen goes high
21:53 in the beginning and then pops out an
21:55 egg, progesterone gets high in the
21:56 second half and then they both fall and
21:58 you have a period. And so, the hormones
22:00 being low in the beginning, estrogen is
22:02 not zero. It's about 50, okay? So, when
22:04 we talk about numbers, if you get your
22:06 your hormones checked, if they're at
22:07 their low it's like 50, but when you
22:09 ovulate, your estrogen may be 150, 200,
22:12 300. And then when you're pregnant, your
22:15 estrogen may be as high as 3,000 or
22:17 higher, right? It's very many thousands.
22:19 And so, these hormones have actions in
22:21 our bodies. And so, the reason it's
22:23 important is cuz when we give back
22:24 hormone therapy, well, are we giving
22:26 back 10,000 like pregnancy? No, we're
22:28 giving back to be like 50, 60, 70, the
22:31 way that you are early in your cycle
22:33 kind of a thing. Now, testosterone's not
22:35 even on this graph that everybody gets
22:37 taught of estrogen then progesterone,
22:39 but we do know testosterone is pretty
22:41 stable through the cycle, although we do
22:43 believe it peaks during ovulation which
22:45 makes sense cuz you want to have a baby,
22:47 right? So, evolution says, "Okay, you
22:49 need to be horny around the time that
22:50 you are going to ovulate." And so, your
22:53 testosterone starts to go up. Now, it's
22:55 really important cuz you're probably not
22:56 having a conversation with your nieces
22:57 about their menstrual cycles, but it's a
22:59 problem because no one's talking about
23:00 it if they're painful, if they're
23:02 abnormal, if they're um uh uh uh we
23:05 don't have a lot of conversations around
23:07 what is a normal amount of bleeding. We
23:09 have so many people who have problems,
23:11 whether it's PCOS, which is now called
23:13 PMOS, which is a metabolic issue that
23:16 causes you to have irregular periods.
23:18 There's endometriosis where you have
23:19 painful periods. There are so many
23:21 medications we give to people that can
23:23 alter their hormonal health and and
23:25 sexual health for that matter. And then
23:27 it all starts to get even more chaotic
23:29 in perimenopause, which is again age 35
23:32 to 45. If menopause we say is 45 to 55,
23:35 right, is normal menopausal age. Average
23:37 age is 52, and we think perimenopause is
23:40 when things start to change for people
23:41 about 10 and it can be about 10 years.
23:44 That means 35 to 45. So, how old are
23:46 you? I don't remember.
23:47 >> 33.
23:48 >> 33. And my partner's 33.
23:49 >> All right, so 33. So, this idea that I'm
23:51 too young or it's too early or I'm not
23:54 there yet, the truth is things do start
23:57 to change.
23:58 >> What changes for a woman?
23:59 >> So, there are so many symptoms to
24:01 hormonal fluctuations. So, for some
24:03 people it's temperature changes, for
24:04 some people it's fatigue, for some
24:06 people it's remembering things, for some
24:07 people it's low libido. Some people get
24:09 dry eyes, itchy ears, burning mouth,
24:12 joint pain. Some people get irregular
24:14 periods. Some people get pain with sex.
24:17 Some people get UTIs. I would love to
24:19 talk about what why hormones are so
24:21 important for the bladder and UTI
24:23 prevention. And so, there are so many
24:25 symptoms and everyone says, "Oh, we're
24:27 blaming everything on hormones." And the
24:30 truth is, we haven't talked about
24:31 hormones enough to actually start
24:33 looking at this to figure out what is
24:35 important and what is hormonally
24:36 important.
24:37 >> So, when you start to lose progesterone,
24:39 when you arrive at perimenopause, what
24:41 are the symptoms you feel? Are they
24:42 different symptoms to decline in
24:44 estrogen?
24:45 >> So, it's hard to know for sure, but some
24:47 people think that as the progesterone,
24:49 so your sleep starts to get a little
24:50 crazy, anxiety starts to go up. And so,
24:53 some people will start with progesterone
24:55 as a support for
24:57 you know sort of perimenopausal hormone
24:59 therapy but estrogen can also help with
25:01 many of those symptoms. So it's not a
25:03 one size fits all of whether we give
25:05 people everybody gets progesterone or
25:06 everybody gets estrogen. Sometimes
25:08 people just get testosterone because
25:09 remember that falls in your 30s you know
25:12 so there's sometimes where we
25:14 do all three and there's sometimes where
25:15 we do just one or two. Now it's a very
25:18 evolving conversation because most of
25:20 the book answers most of the guidelines
25:23 really talk about menopause and how we
25:25 treat people in this menopause when
25:26 you're flatlined. Remember that
25:28 castration event where everything's zero
25:30 and then we add back hormones. So now
25:32 we're starting to talk about
25:33 perimenopause as a place to to start
25:36 giving women hormones and that's a a
25:38 very important and evolving conversation
25:41 that is happening.
25:41 >> And so this conversation that's
25:44 sort of raging on about HRT
25:47 about safety about what age you should
25:50 take it who should take it what form you
25:51 should take it in. What's your
25:53 perspective on that and what do women
25:54 need to know about that?
25:55 >> Yeah so so it's important because
25:58 >> is HRT?
25:59 >> Yeah it's a great question. So hormone
26:00 replacement therapy which is a term that
26:03 we used to use for hormones in
26:05 menopause. It has a bunch of different
26:07 names and everyone tries to change the
26:08 marketing around it but hormone therapy
26:10 in general is this idea of giving back
26:13 hormones when you have hot flashes night
26:15 sweats osteoporosis you know sort of
26:18 this over 50 crowd that has this
26:20 declining estrogen and progesterone
26:23 levels. And so typically classic hormone
26:25 therapy is estrogen and progesterone.
26:28 Now again taking just estrogen estrogen
26:31 grows things it helps your bone health
26:33 it helps your hair skin and nails it
26:35 helps you not have hot flashes it helps
26:36 you sleep. It can also grow the lining
26:39 of the uterus and so if it gets thicker
26:41 thicker thicker there is worry over
26:43 years that leads to endometrial or
26:45 uterine cancer. So endometrium is the
26:48 lining of the uterus so here I can okay
26:50 so this is a this is a vagina and then
26:54 at the the vagina's like a socket. The
26:56 very end of the socket is a tiny hole
26:58 and that hole is the the pinpoint
27:00 opening of the cervix and that hole if
27:03 you go through that tiny tiny hole, it
27:06 gets to the uterus and the uterus is a
27:08 cavity where we hold babies
27:11 where the lining comes out. That's what
27:12 period blood is is the lining of the
27:15 uterus here which we'll call the
27:16 endometrial lining. So progesterone is
27:18 very important for this lining here. If
27:21 the the lining of the uterus gets too
27:23 thick with just estrogen, that can lead
27:25 to problems, but if you match it with
27:27 progesterone, those problems go away.
27:29 >> Right. So so if you just gave someone
27:31 estrogen, then the linings of the uterus
27:33 would get so thick that that would cause
27:34 a problem, but if you give it to both
27:36 hormones together, it sort of balances
27:38 itself.
27:39 >> them out and so that's why you'll hear
27:41 hormone therapy talked about estrogen
27:42 and progesterone just like the birth
27:43 control pill your partner was on was an
27:45 estrogen and a progestin. There was a
27:47 combination.
27:48 >> Okay, got you.
27:49 >> And also the history is kind of
27:50 important here of why your mothers and
27:52 grandmothers weren't given access to
27:54 this medication and the stigma behind
27:57 it. In the late 90s, a lot of people
28:00 were on hormone replacement therapies
28:02 and they were seeing benefits. They
28:04 actually were all these observational
28:06 studies that showed wow, the heart
28:07 disease is less and like
28:09 >> During menopause.
28:10 >> during menopause and a billion dollars
28:12 went into the NIH to study this in women
28:15 and they did they that was called the
28:16 Women's Health Initiative. It was
28:18 thousands and thousands of people age 50
28:20 to 79. They gave a hormone pill like a
28:23 birth control pill almost to all of
28:25 these women and they followed them and
28:27 they stopped the study early in the
28:29 early 2000s and they did a press
28:31 conference and at this press conference
28:32 they said we're shutting down the the
28:34 study early. Hormone therapy causes
28:36 cardiovascular disease and breast
28:38 cancer. And overnight, a multi-billion
28:41 dollar industry went to nothing.
28:43 Everyone was told throw your hormones in
28:45 the garbage. This is dangerous. What was
28:47 crazy is those people who were
28:49 prescribing hormone therapy were looking
28:51 around saying, "I don't understand. My
28:53 patients aren't dying of heart disease.
28:55 They're not getting extra breast
28:56 cancers. Like, this doesn't make any
28:58 sense." And when people actually looked
29:00 at the study, it didn't say any of those
29:02 things. It was wild how misinterpreted
29:04 this study was. In fact, the same
29:07 authors of this study back in the early
29:08 2000s published this year, in 2025
29:11 actually, that below age 70 that type of
29:15 hormone therapy, which we don't really
29:16 use anymore, has no increased risk of
29:19 cardiovascular disease or stroke. And
29:21 yet now you have a generation of doctors
29:23 who weren't taught how to do this. Only
29:25 1.7% of women have are getting
29:28 prescriptions for hormone therapy who
29:30 who should be offered prescriptions. So,
29:32 it is a disaster.
29:34 >> Only 1.7%?
29:35 >> Only 1.7%.
29:36 >> Oh, really? Hmm. Wow.
29:38 >> And so, hormone therapy is not something
29:41 that I'm saying every woman must have,
29:43 but every woman should have access to
29:45 the toolbox. I like to think about
29:47 hormone therapy is really four buckets
29:49 that we talk about. Hormone therapy is
29:51 whole body estrogen, which helps with
29:52 hot flashes, night sweats,
29:54 uh bone loss, progesterone, whole body
29:57 progesterone therapy, which protects the
29:59 uterus and is this yin yang, especially
30:00 if you have a uterus, but it helps with
30:02 sleep, and it can help with anxiety
30:03 reduction in many of our patients, not
30:05 everybody, but a lot of them. The third
30:07 thing is testosterone, which we talked
30:09 about, which can help with libido. Um
30:11 that's what we have the most evidence
30:13 for. And then the fourth thing is
30:14 vaginal hormones. Now, vaginal hormones
30:17 are microdoses of estrogen or what we
30:20 call DHEA vaginally, that supports the
30:23 bladder and the vagina. So, it helps
30:24 with pain with sex, dryness, urinary
30:27 frequency, urinary urgency, leakage, and
30:30 it prevents urinary tract infections
30:32 massively. It is safe for your great
30:34 grandmother in the nursing home. It is
30:36 safe for your wife who's breastfeeding.
30:39 So, if you know anyone in your life who
30:41 is a woman, who's having urinary
30:43 frequency, urgency, leakage, urinary
30:46 tract infections, pain with sex,
30:48 dryness, there is a magical solution
30:51 that is safe for everybody on Earth um
30:54 that is microdosing these hormones
30:56 vaginally.
30:57 >> At any age?
30:57 >> At any age at all. In fact, even more
30:59 important for people who are older
31:02 because they are dying of urinary tract
31:03 infections. So, it's it's it's one thing
31:06 when a young person gets a urinary tract
31:08 infection and they go to the urgent care
31:09 and they get an antibiotic. Even they
31:11 deserve prevention and this is prevents
31:14 uh those problems in those people, too.
31:15 >> Again, what is this?
31:17 >> So, vaginal hormones. So, this is a
31:18 really important topic. It's called
31:20 genitourinary syndrome of menopause or
31:22 GSM. Say GSM loudly for your listeners.
31:25 >> GSM.
31:26 >> GSM, genitourinary syndrome of
31:28 menopause. Genital, urinary, syndrome of
31:32 menopause. But, really, it's kind of a
31:35 dumb name because it's any hormonal
31:37 changes in your body can affect the
31:40 bladder and the genitals.
31:41 >> So, UTI. What is a UTI? And what's
31:44 what's causing a UTI? U- urinary tract
31:47 infection.
31:48 >> Yeah, very good. So, urinary tract
31:49 infections are when there is bacteria in
31:52 the bladder and it can be a lot of uh of
31:55 bad bacteria that can grow and create uh
31:57 inflammation. It causes bladder pain,
32:00 pain with urination. It feels like razor
32:02 blades. Um but, it can also go into your
32:04 bloodstream and cause fevers and chills
32:06 and cause kidney infections. It can
32:08 cause something called urosepsis where
32:10 you have to go to the intensive care
32:12 unit and need uh antibiotics through an
32:14 IV and it can kill you if you have an
32:17 infection go through your whole body.
32:18 And this gets worse and worse as you get
32:20 older.
32:21 >> Why is there a link between hormones and
32:22 UTIs?
32:23 >> Yeah, because what happens is the vagina
32:26 is supposed to be acidic and healthy and
32:29 hormones help keep it. It is the
32:31 hormones, the estrogen and the
32:32 testosterone, that keep healthy bacteria
32:34 growing in the vagina and suppress or
32:37 lower the bad bacteria.
32:39 >> So, there really is a vagina microbiome.
32:42 >> There is and There's There's no
32:43 probiotic on Earth that is proven to do
32:46 what the vagina needs quite like
32:48 hormones. Hormones make the tissue go
32:50 from uh not acidic to quite acidic, and
32:53 it is that acidic environment that
32:55 protects it from infection. And so,
32:57 perimenopause and menopause or other
32:59 situations happen, and it changes that
33:02 microbiome, so the good bacteria are are
33:05 lower and the bad bacteria start to
33:07 grow, which can increase your risk of
33:09 infections. And sex Right, sex is a
33:12 contact sport. So, uh you're bringing
33:14 the outside environment into the inside
33:16 environment. Uh ejaculate is also not
33:18 acidic, and that can change the
33:20 microbiome as well. And so, we know
33:21 women who are sexually active also have
33:23 an increased risk of urinary tract
33:25 infections. So again, like a plant
33:28 needing water, vaginal hormones help
33:30 support the vagina and the bladder to
33:33 maintain that acidic environment. And
33:35 research has been clear since the 1990s
33:39 that using vaginal hormones prevent
33:41 UTIs, urinary tract infections, by more
33:43 than half.
33:44 >> So, what have we got here in front of
33:45 me?
33:46 >> All right. So, there's a bunch of
33:47 different ways you can give yourself
33:49 vaginal hormones. The most common way is
33:51 a cream. Now, this cream is uh $14 on
33:55 Mark Cuban's pharmacy, and it lasts
33:57 about 2 and 1/2 months. Now, this cream
34:00 that comes with an applicator, which you
34:02 don't ever have to use if you don't want
34:03 to, but what you can do is you want to
34:06 use 1 g of this cream. So, this amount
34:09 is 1 g of this cream. We'll put it on
34:11 this paper here to show you. 1 g of this
34:15 cream rubbed into the vagina. So, you
34:18 take it You can take it on your fingers
34:20 and rub it into the walls like you If
34:21 you put sunscreen on your face, you
34:23 don't glob it on and walk out the door.
34:24 You rub it in, so it doesn't look all
34:26 white and filmy. So, you put it in You
34:28 take it with your finger and you put it
34:31 in the vagina and you rub it into the
34:33 walls of the vagina you can rub it on
34:35 the outer this area as well at the
34:37 opening.
34:37 >> Let me try it. I don't have a vagina but
34:40 So you take the this what what is this
34:43 cream called?
34:43 >> It's estradiol cream.
34:45 >> Estradiol take it on your finger you rub
34:47 it inside the walls of the vagina like
34:49 this.
34:49 >> rub it in like you would rub sunscreen
34:51 on your face and if you do that twice a
34:53 week you can prevent death from urinary
34:56 tract infections. You can help with
34:58 urinary frequency, urinary urgency,
35:00 leakage, you make sex not painful and
35:02 dry, it helps with arousal and orgasm.
35:04 It's literally better than Viagra and
35:07 this is over the counter in the UK. In
35:09 the United States you need a
35:10 prescription um but it's as little as
35:12 $14 if you use Mark Cuban's online
35:15 website it should be covered by your
35:16 insurance. Now some women hate creams
35:18 and so we have things that are not as
35:20 messy as what you're showing right there
35:22 and we have little tablet inserts. So
35:24 here is a it comes with an applicator
35:27 and so what a woman does is put this in
35:28 her vagina and press a button
35:32 and this little tablet so instead of a
35:34 cream you could just put this little
35:35 tablet in twice a week and that does the
35:38 same thing as the cream.
35:40 >> Ah okay.
35:40 >> Okay so it's a little less messy so
35:42 people tend to like the creams better.
35:44 Now if you really don't want to do
35:45 anything twice a week this is a ring
35:47 that goes in the vagina and it can stay
35:49 in there for 3 months. Now this it's
35:52 sort of like a tampon you can kind of
35:54 put it in the vagina and the vagina does
35:55 not feel it. By the way the vagina is
35:57 not very sensitive in terms of
35:59 nerve endings and so when women put
36:01 tampons in they don't feel them. When
36:03 you put this ring in that you wouldn't
36:05 feel it either and it would stay in for
36:06 3 months at a time.
36:07 >> It's quite it's quite quite a big ring.
36:09 >> Vagina can hold like a bowling ball of a
36:12 baby can come out of a vagina so it can
36:13 actually withstand quite a lot of
36:16 volume.
36:16 >> And there's a chemical inside this ring
36:18 that's going to diffuse
36:19 >> Estradiol that slowly diffuses estrogen
36:21 for the ring. So that's nice for women
36:23 who have dementia, who have very bad
36:25 dexterity with their fingers, they're in
36:27 a nursing home, uh for someone who's on
36:29 the go and they can't remember something
36:31 twice a week. So, our ADHD patients like
36:33 things like that. And so, there's just
36:34 different It's all the same stuff. It's
36:37 just in different formulations. Now, the
36:38 one different one, this is something
36:40 called DHEA. Now, DHEA is the precursor
36:44 hormone to estrogen and testosterone.
36:47 And remember I said the vulva, the
36:48 vagina, the bladder need testosterone,
36:51 too. It So, this is a a chemical that
36:54 converts into estrogen and testosterone.
36:57 And so, DHEA is a supplement you can
36:59 buy, you know, sort of in the in the
37:01 supplement aisle, but if you put it
37:03 locally in the vagina, this is an
37:04 FDA-approved product. It's called
37:05 Intrarosa. And if you just put this in
37:07 the vagina, uh uh it's meant for every
37:10 night, but you can do it twice a week.
37:12 Um it it melts at bedtime. When you wake
37:14 up, and it prevents UTIs. It helps with
37:17 pain with sex.
37:18 >> And just to be clear again, so you think
37:20 a lot of people should be taking these
37:22 these things?
37:23 >> believe it's preventative. So, I think
37:25 And we wrote guidelines by the American
37:27 Urological Association uh why this is so
37:29 important, how to do it. So many women
37:32 have symptoms of urinary frequency,
37:33 urgency, leakage, uh urinary tract
37:36 infections, pain with sex, dryness. And
37:38 this is a safe option for all of those
37:41 women. Does that make sense?
37:42 >> It does make sense. And one of the
37:43 things that doctors sometimes tell their
37:45 patients to take to help with the UTI
37:48 situation is that?
37:51 >> Okay, this is a disaster. So,
37:53 women get urinary tract infections a
37:55 lot. And so, what do we tell women? Pee
37:57 after sex. Wipe from front to back.
38:00 Like, that's not data-driven, by the
38:02 way. That's all a folk folk tale. Like,
38:04 that's that's folklore. There is some
38:05 data that cranberry pills can help uh
38:08 with preventing UTIs, but the uh amount
38:11 that you'd have to drink is uh very
38:14 sugary and diabetes-inducing and won't
38:16 taste that good. And so, there they do
38:18 make pills, but it's a small These
38:20 things are small things that help.
38:22 Drinking lots of water can help, but
38:24 vaginal hormones, vaginal estrogen or
38:26 vaginal DHEA, which we just showed a
38:28 bunch of, prevent UTIs by more than
38:31 half. They don't just prevent UTIs, they
38:33 help with urinary frequency, urgency,
38:36 leakage, pain with sex. They help your
38:38 arousal, they help your orgasm, and
38:40 they're safe for every age with every
38:43 medical problem. If you've had cancer,
38:45 blood clot, stroke, any problems at all,
38:47 vaginal hormones are safe and could save
38:50 your life. And so this is such an
38:52 important topic.
38:53 >> There should be a button just down below
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39:10 Thank you so much.
39:11 My my partner's 33 years old now. She's
39:13 not yet in the perimenopause stage. At
39:16 what point does someone start taking
39:18 HRT? Is it when they're in
39:21 the menopause stage, which is defined as
39:23 12 consecutive months without your
39:25 period? Is it when they're
39:26 postmenopausal? Is it in perimenopause?
39:29 >> Yeah, this is a very important question
39:31 cuz it's not a one-size-fits-all. At
39:32 this age, start this medicine. It's
39:34 really when people start having
39:35 symptoms. And so I'll give you an
39:37 example. So say your partner um
39:40 gets pregnant, okay? You decide to have
39:42 a baby. Her estrogen is going to go to
39:44 10,000 uh for 9 months. It's going to be
39:46 super super high. And the day she gives
39:49 birth, it's going to crash to zero. So
39:51 you go from super high hormones down to
39:54 zero. And if she chooses to breastfeed
39:56 or pump or or do any of that, they stay
39:59 extremely low in the menopausal range
40:02 for the entire time you're
40:03 breastfeeding. So when you are
40:04 breastfeeding or pumping or doing
40:06 anything uh and your periods don't come
40:09 back, you're basically menopausal.
40:10 >> And what are the symptoms then? So if
40:12 you just had a baby, you're
40:13 breastfeeding.
40:14 >> have hot flashes, she may have night
40:15 sweats, she may, you have urinary
40:17 frequency, urgency, leakage. There's all
40:19 sorts of symptoms that come come with
40:21 that.
40:21 >> Libido changes as well.
40:22 >> Libido definitely changes, pain with sex
40:23 goes up. And so we call this the
40:25 genitourinary syndrome of lactation. And
40:28 so there's all sorts of hormonal changes
40:30 that can happen at that time. So we see
40:31 a big need for vaginal hormones in this
40:34 patient population. It's safe for the
40:35 breast milk, it's safe for the baby, it
40:37 doesn't cause any problems, but it can
40:38 really help with all of those symptoms.
40:41 Now say she is done having babies and
40:43 now she's 30 8 39 40 and she is doing
40:48 fine and she has regular periods and she
40:50 has no symptoms and no problem. She may
40:51 not need anything at all. But what if
40:53 she starts getting a lot of urinary
40:54 tract infections or having dry scratchy
40:56 painful sex or her libido just doesn't
40:58 feel it sort of feels like back it when
41:00 it did on birth control pills. That may
41:03 be an indication where she may benefit
41:05 from whether it's testosterone or
41:08 vaginal hormones or some kind of
41:09 combination. What if she's 43 and her
41:12 sleep starts to get really bad and that
41:14 may be an indication for progesterone. I
41:17 have a patient who was
41:19 having hot flashes and night sweats and
41:21 brain fog and fatigue. I see her and she
41:24 says I will not take hormone therapy.
41:26 It's not safe. My mother told me it
41:27 causes cancer. At no point am I going to
41:30 do this. I said, okay. We had a long
41:32 conversation. I shared data and papers
41:34 and we did a shared we just worked with
41:36 each other and I wasn't pushing anything
41:38 on her, but ultimately she started with
41:40 vaginal hormones. Her orgasms come back.
41:43 Her arousal gets back and she comes back
41:45 to see me and says, "Rubin, what are you
41:46 doing here? I'm feeling much better.
41:48 Like this is you've given me my life
41:50 again. I'm not peeing in the middle of
41:52 the night so I'm sleeping better. I
41:54 don't have as much dryness. Sex is no
41:55 longer painful. I haven't had a UTI in
41:57 months. What else do you got?" Well, she
41:59 was still suffering with hot flashes and
42:01 night sweats. She had a bone density
42:03 scan which showed osteopenia and she was
42:06 worried about osteoporosis cuz her
42:07 mother died of osteoporosis fractures.
42:10 Well, if she did whole body estrogen,
42:12 she would prevent her risk of a of a
42:14 fracture. She would make her hot flashes
42:15 and night sweats go away, which would
42:17 have benefit on how she sleeps, and
42:20 ultimately probably benefit on her whole
42:21 vascular system. And so, she started
42:24 estrogen, and cuz she had a uterus, she
42:25 took progesterone at night, and she
42:27 said, "Well, my libido is still a bit
42:29 low." We looked at her testosterone. We
42:31 said, "Testosterone will likely help
42:33 with your libido, but it's going to take
42:34 4 to 6 months." So, 4 to 6 months, she
42:36 comes back to see me. Not only is her
42:39 libido so much better, but she feels
42:41 that she has the cognitive ability to
42:43 enroll in law school. Like, this woman
42:46 literally decides that she wants to
42:47 change the trajectory of her career and
42:50 enrolls in law school, and her brain is
42:53 working in like ways she hasn't seen it
42:55 in so long, and she is competing against
42:58 22-year-olds in law school. And when I
43:00 tell you she finished at the top of her
43:02 class, she finished at the top of her
43:03 class, whereas she said, "I would have
43:05 never even considered this opportunity
43:08 uh if I hadn't been doing all of these
43:10 things." So, in
43:11 >> And what age is she?
43:11 >> She's in Now, she's in her 60s.
43:14 And so, that's why I'm so loud about
43:16 these things, because what other organ
43:18 in medicine do we let fail completely
43:21 before we like do something about it. We
43:23 don't make you go blind completely
43:25 before we give you eyeglasses. We don't
43:27 let your kidneys run out completely
43:29 before we give you dialysis or
43:30 medications to help your kidneys along.
43:32 We don't let you go into full liver
43:34 failure before you get the transplant.
43:36 Like, this idea of your ovaries have to
43:38 fail, and you have to suffer for 12
43:40 months before someone intervenes is
43:43 insanity.
43:44 >> But for some women, they do start HRT
43:46 during the perimenopausal phase.
43:48 >> Yeah.
43:49 >> And for some, they start it during
43:50 menopausal postmenopausal stage.
43:51 >> Correct.
43:52 >> And it's all depending on you how you're
43:53 feeling.
43:53 >> It's all depending on how you're feeling
43:55 and what you want, what your objectives
43:56 are.
43:57 >> Okay. But it's never too early to start
44:00 necessarily.
44:00 >> not necessarily. Like, so again, we give
44:02 birth control all the time to people in
44:04 their reproductive years. Birth control
44:05 is just high-dose fake hormone therapy,
44:08 right? So, we're giving women hormone
44:09 therapy as young as in their teens,
44:12 right? To help with different things in
44:14 birth control. But, so if you think of
44:15 it as all of it is some form of hormone
44:18 therapy, it just depends are we using
44:19 the natural form of hormone therapy or
44:21 we using the synthetic hormone hormone
44:23 therapy? We have to get comfortable with
44:25 hormones at all ages. And the thing that
44:27 we see most commonly, Steven, is sort of
44:29 what we call NFLM, not feeling like
44:32 myself. I love that statement because
44:34 women are coming to the doctor every day
44:36 saying NFLM, I'm not feeling like
44:39 myself, and they're getting dismissed.
44:40 And the truth is there are often
44:42 hormonal reasons why you may not be
44:45 feeling like yourself. So, for some
44:46 people it might be musculoskeletal pain,
44:48 so we see plantar fasciitis and frozen
44:51 shoulder, and we think of as those
44:53 having underlying hormonal causes as
44:55 well. So, there's published data that
44:57 less than 9% of Medicare patients are
44:59 getting prescriptions for this.
45:01 More than 75% of people in large
45:04 database collections are not getting
45:06 prescriptions for this. And so, women
45:08 are not getting access to generic
45:10 medications that could save their lives
45:13 and also really improve quality of life.
45:15 I don't know about you, but dryness
45:17 People are not having sex anymore
45:19 because of the pain, the dryness, the
45:20 irritation when it's fixable.
45:26 >> I don't speak Vietnamese, but this show
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47:27 You said um earlier that one of the
47:29 questions people come to you about is
47:30 pain during sex. Why are are women
47:33 experiencing pain during sex? What is
47:35 What is What is going on there
47:36 physiologically?
47:37 >> Yeah, pain with sex is actually not rare
47:39 at all. There are some published reports
47:41 that up to 75% of women will say at some
47:43 point in their life sex is painful.
47:46 >> So, a really dumb question here.
47:48 Sex is not supposed to be painful.
47:50 >> Sex is not supposed to be painful. If
47:52 sex is painful, you need to figure out
47:54 why it's You deserve a diagnosis. You
47:56 deserve an answer. You deserve to
47:57 understand exactly why sex is painful.
48:00 You could have a problem with the
48:02 tissue. So, you could have a skin
48:04 problem, which as we know the tissue of
48:06 the vulva is very hormonally sensitive.
48:08 So, that tissue could be impacted by
48:10 hormones. It's skin. So, people can get
48:12 eczema. They can get autoimmune skin
48:15 conditions. So, you may have a skin
48:16 condition. You may have problem with
48:18 your muscles. So, remember the vagina
48:20 and the vulva are surrounded by these
48:22 big pelvic floor muscles. And just like
48:25 you can get tight muscles in your neck
48:27 and in your back, you can get tight
48:29 muscles in your pelvis. We also know
48:31 there's nerves that are involved in this
48:33 area. So, if you have a back problem and
48:35 you feel it running down your leg,
48:36 right? That's called sciatica or sciatic
48:38 pain, you can have a back problem that
48:41 actually causes you to have pelvic pain.
48:43 So, we see people with penis pain or
48:45 vulva pain because of problems in their
48:47 spines. If you have scar tissue inside
48:50 your body from endometriosis, that's
48:52 pushing and scarring this tissue from
48:54 the inside, you may have pain with sex.
48:57 And so, there are many different things
48:59 that can cause pain with sex. But
49:01 remember I said your OBGYN got almost no
49:04 training in this.
49:05 >> So, if if I'm currently experiencing
49:07 pain during sex as a woman,
49:09 what advice would you give them? What
49:11 should they do?
49:12 >> Yeah, so I would really try to see
49:15 someone who has an active interest in
49:17 this. See a specialized gynecologist or
49:20 a specialized urologist who has an
49:22 interest in pelvic pain. And you may
49:24 need a couple of opinions. Just like if
49:26 you go to the first plumber, you want to
49:27 get a couple quotes on well, who's going
49:29 to do the best job? It's okay to see a
49:31 few different people for this problem.
49:33 >> And in terms of prevalence, up to 75% of
49:35 women as you say will experience painful
49:37 intercourse at some point in their
49:38 lives. Between 10 and 20% of US women
49:41 suffer from persistent chronic pain
49:43 during sex. And during menopause, it
49:45 climbs drastically
49:47 with estimates ranging to 20 to almost
49:50 half of women
49:52 having pain during sex.
49:54 >> And that probably doesn't even add to
49:55 the people who stopped having sex
49:57 because either they don't have a partner
49:58 or because they it's too painful to even
49:59 consider it. And I think it's important
50:02 to know that hormones play a fundamental
50:04 role here. Not a like a not it's not the
50:06 whole story, but it's a huge part of it.
50:08 >> In different seasons of life, if
50:11 if a woman wanted to have the best sex
50:13 of her life, what are the fundamental
50:14 things you'd aim at to make sure she can
50:16 have the best sex of her life?
50:17 >> Yeah, so as you know, this is Diary of a
50:19 CEO. So I love how you you love the
50:22 health topics, but obviously financial
50:24 literacy is really important to for you
50:26 to help people because for some reason
50:28 people stink about talking about money
50:30 and talking about sex, and yet we all
50:32 want to be really great at both, right?
50:33 We all want a lot of money and we all
50:35 want to have great sex, and yet people
50:37 stink at talking about it. They they
50:38 don't know the fundamentals, they don't
50:40 know the basics. And so I actually use
50:42 financial literacy sort of as a as a
50:44 framework in how we talk about good sex.
50:47 And so you've got your savings account
50:49 and your you know, your your checking
50:51 account. Those are the those are the
50:52 basics. Everyone needs money in their
50:53 checking and savings account, right?
50:55 That's what everybody needs. So that's
50:56 going to be your education, your
50:58 nutrition, your exercise, your sleep,
51:01 your your your communication, uh safety.
51:04 Like are you safe in your relationship?
51:05 Like the basics. Are you doing the basic
51:07 things you need to have great sex? You
51:09 know, communication is probably the most
51:11 important thing. Can you talk about it?
51:12 Can you use words? Um can you explore?
51:15 Can you ask questions? So so that's
51:16 really important for great sex. Then
51:18 there's the 401k, right? The 401k is
51:20 something that we all want and should
51:23 have access to, right? It's important
51:25 for compounding growth and long-term
51:27 support of your financial life. Think
51:29 about hormones. Think about going to a
51:31 doctor who's going to make sure that
51:34 everything is optimized the way that it
51:36 should be. Your your pelvic muscles are
51:38 in good condition. Your mental health is
51:39 in good Do you know do you have Do you
51:41 need a sex therapist? Do you want to
51:43 bring toys into the bedroom and devices
51:45 to have even more fun? That's kind of
51:46 like the really important. Not everybody
51:48 has access to it. Not everyone's going
51:50 to do it, but I think it's really,
51:51 really important for everyone to talk
51:52 about. Then there's like crypto. Okay,
51:55 so crypto, that's not to say don't do
51:58 crypto. Like don't put all your money in
52:00 crypto. Don't do everything and don't
52:02 start with crypto. So that's going to be
52:04 when you're watching, you're scrolling
52:06 Instagram and you see these ads for do
52:09 this injection, do this, you know,
52:11 cosmetic procedure, do this supplement
52:15 that's going to make sex great again. Uh
52:17 the truth is if it looks too good to be
52:19 true on TV and in the ads like it
52:21 probably isn't going to fix what if if
52:24 other things are are are struggling. So
52:26 I think great sex is within everybody's
52:29 reach, but I think your great sex is
52:32 different than other people's great sex.
52:34 >> So let's go through these slowly and one
52:36 one at a time. I kind of broke it down
52:37 into three categories, which is there's
52:40 biological and physical blockers to
52:41 great sex, which are some of the things
52:43 we talked about, um hormone crashes,
52:45 etc. You mentioned the pelvic floor.
52:49 How is an issue with your pelvic floor
52:51 going to impact your sex? And what is
52:53 the pelvic floor? Why would you have an
52:54 issue with it? What do you see in
52:56 patients?
52:56 >> Yeah, so everyone has a pelvis has a
52:58 pelvic floor. So men have a pelvic
52:59 floor, women have a pelvic floor. It
53:01 just means the bones of your pelvis, so
53:03 your hips, right? And your pelvis bone,
53:06 your butt bones, all of this is this big
53:08 bony structure that holds all of your
53:10 organs in place. And your genitals are
53:13 attached to this pelvic floor. And the
53:16 pelvic floor is surrounded by thick big
53:19 muscles. So if we look at the inside of
53:22 the pelvic floor, it's these big thick
53:24 muscles. And muscles are just like your
53:27 biceps, right? Like muscles are
53:28 something that contract and relax and
53:31 there can be problems with muscles,
53:33 right? just like if you work out too
53:35 much and you've got a sore trap and you
53:37 got to go get it massaged and and or you
53:39 got to do physical therapy cuz your
53:40 shoulder is hurting. A lot can go wrong
53:43 with the pelvic floor. And so, sex is a
53:45 contact sport. So, if you're going to
53:47 get erections, if you're going to have
53:48 an orgasm, if you're going to allow for
53:50 penetration to happen, you have to have
53:53 healthy muscles because you're asking
53:55 your muscles to contract and relax in a
53:57 sexual way. And so, as blood is flowing
54:00 through the area, blood is going to
54:02 engorge the clitoris and it's going to
54:04 get bigger and erect, it's going to
54:05 engorge the penis, it's going to get
54:07 bigger and erect. These muscles are
54:09 going to have to relax so that you can
54:10 have penetration cuz if they're too
54:12 tight, tight muscles are painful,
54:14 they're sore, they're they're they burn.
54:16 And so, penetration can happen if you're
54:18 relaxed, but then orgasm is a series of
54:21 muscle contractions which equates to
54:23 pleasure and release, which is all has
54:25 to do with the nerves and the muscles.
54:27 Does Does that make sense?
54:28 >> I'm trying to understand how the pelvic
54:30 floor would would give me bad sex and
54:33 how I would know if the pelvic floor is
54:35 the reason I'm currently having bad sex.
54:37 >> Yeah, so if if sex hurts, so if the
54:39 muscles are too tight and you can't have
54:41 penetration but you want it, yeah, that
54:42 can be bad sex. If orgasm is painful,
54:46 weak, or impossible, it could have to do
54:49 with the muscles. It's not always the
54:50 muscles, but it could have to do with
54:52 the muscles of the pelvic floor. If
54:54 arousal, your ability to engorge and
54:56 lubricate are diminished or less, that
54:59 could be due to pelvic floor cuz you're
55:00 not getting enough blood flow to the
55:02 area. And so, there are multiple
55:04 different ways and if you're not feeling
55:06 your genitals, you watch something sexy
55:08 on TV and then you feel it in your
55:10 genitals or you see someone attractive
55:12 walking down the street and you feel it
55:13 in your genitals, there's this brain
55:15 genital connection. And sometimes that
55:18 you So, you have to have perfect wiring
55:20 and of your nerves, your hormones, and
55:22 your muscles, and so that could have be
55:24 affected by your pelvic floor. Now, we
55:26 do a lot to mess up our pelvic floor, by
55:28 the way. People do surgery, people have
55:30 babies, uh people um muscle uh health
55:33 changes for many reasons, and so when
55:35 you have problems, there may be
55:37 biological reasons to these problems.
55:40 >> Should we be going to the gym and like
55:41 doing pelvic floor exercises to improve
55:43 our sex lives?
55:43 >> You typically don't do them at the gym.
55:45 There are typically trained physical
55:47 therapists who help you know what's
55:49 going on with your pelvic floor. So for
55:51 some people it's to strengthen it and to
55:53 do like almost contractions, we call
55:55 them Kegel exercises, but for many
55:57 people it's just learn the coordination.
55:59 >> And you can go and get an exam.
56:00 >> You can go get an exam and work with a
56:02 pelvic floor physical therapist.
56:03 >> So some women, uh cuz we sometimes have
56:06 them writing with questions, talk about
56:08 the fact that they're they're not having
56:09 orgasms. Is that normal or is that not
56:12 normal as it relates to um sexual
56:14 contact?
56:15 >> So about 20% of women will say that they
56:18 can't have an orgasm. And the real
56:21 question, I'm I'm fascinated by this
56:23 data because not 20 20% of men do not
56:25 have orgasm problems. And so again, if
56:28 we go back to the financial literacy
56:30 equation, we have a pay gap in this
56:32 country, right? Women are not paid as
56:34 much as men. Well, women are not
56:35 orgasming as much as men. And so the
56:37 data's very clear there. And I think the
56:40 majority of problem is education. Women
56:43 think that orgasm comes from
56:44 penetration. Surely if the in and out
56:47 penetration is happening, I should be
56:48 able to have an orgasm. And the truth is
56:51 that's not how most women orgasm. Some
56:53 can, but the reason why women don't
56:56 orgasm from penetration is cuz the
56:58 clitoris is up here. So the clitoris is
57:00 how women orgasm, right? Penetration is
57:03 not how most women orgasm. Just like if
57:05 you rub your thigh over and over again,
57:07 you're not going to have an orgasm. Now
57:09 you could keep rubbing your thigh for
57:10 the whole duration of this podcast, you
57:12 still won't have an orgasm cuz it's
57:14 close to your penis, but it's not
57:15 actually your penis, which is where men
57:17 have orgasms from. And so the clitoris,
57:20 if you follow those labia minora, those
57:22 inner wings, you get to the hood of the
57:24 clitoris or a foreskin, we call it a
57:26 prepuce, and that, if you pull it back,
57:29 you see what is the tip of the head of
57:31 the clitoris, but that's just the tip of
57:33 the iceberg. The clitoris is this huge
57:36 structure.
57:37 My necklace is, of course, like a gold
57:39 clitoris. Um the this a huge structure
57:42 that goes all the way down to your butt
57:44 bones. It's a penis. Under the
57:46 microscope, it looks like a penis. It is
57:47 made up of the same tissue as a penis.
57:49 It works exactly the way a penis does.
57:51 It's just that we have a whole field of
57:53 medicine devoted to the male penis. I'm
57:55 a urologist. And no one is even taught
57:58 how to examine a clitoris or where it
58:00 is. So, if the penis is going in here or
58:03 a toy or a finger or a device, that is
58:05 not activating the the clitoris, which
58:08 is a mostly internal structure.
58:10 >> There's something called a clitoral
58:11 adhesion, which people don't know about
58:13 as well, which I've heard you talk about
58:14 before.
58:15 >> Yeah.
58:15 >> What is that? And how many people suffer
58:16 with that?
58:17 >> Yeah, so the clitoris has this hood to
58:19 it, okay? And about 23% of the time, the
58:22 hood can get stuck to the head. So, for
58:25 example, I'm wearing a sleeve here. So,
58:28 you should be able to pull back the hood
58:30 of the clitoris to see the whole head.
58:32 It looks like a mushroom. You know how
58:34 penises have like that almost like a
58:35 mushroom rim rim around it. So, the
58:38 clitoris should have that, too. But
58:39 about 23% of the time it gets stuck. So,
58:42 you actually cannot see the full head of
58:44 the clitoris. It's called a clitoral
58:45 adhesion. And so, you should be able to
58:47 pull it back, but in about a quarter of
58:49 the time you cannot. And we published
58:51 data that if you remove these adhesions
58:53 in an office-based very simple
58:55 procedure, we saw improvements in
58:57 orgasm, arousal, and satisfaction up to
59:00 60 to 70%.
59:01 >> Wait. So, so one
59:03 five women
59:04 >> Yeah.
59:04 >> have a clitoral adhesion. And when
59:06 solved, it improves their sexual
59:08 satisfaction by up to 60%.
59:10 >> Yes, but no one's examined any woman in
59:12 your life. No one has ever examined
59:13 their clitoris, ever. In any exam, in
59:16 any doctor's visit, and nobody's asking
59:19 women about their orgasm, about their
59:21 satisfaction. Where like they come in
59:23 with pain or they come in with libido
59:25 issues, but no one is examining this
59:27 part of the body. And so, it's this
59:29 question of is it cuz we haven't or cuz
59:31 we shouldn't? It's cuz we haven't. We
59:33 haven't We have never done this before.
59:35 >> You pulled up the sex toys though. I
59:37 think we were talking about orgasm gaps.
59:39 >> So, again, when you were talking about
59:42 orgasm and how women experience
59:44 pleasure, it's all buried inside the
59:47 body. So, if your penis was entirely
59:50 inside your body, say you gained 500 lb,
59:52 okay? And your your belly was so big you
59:55 couldn't hold on to your penis to to do
59:57 what it takes to have an How would you
59:58 orgasm?
1:00:00 >> Uh probably I don't know.
1:00:02 >> The vibrator industry would be a
1:00:03 gazillion dollar industry instead of
1:00:05 just a billion dollar industry because
1:00:06 vibration can help activate this blood
1:00:09 flow. And so, for women, vibration on
1:00:12 the outside can be extremely helpful cuz
1:00:15 remember the clitoris is kind of around
1:00:17 this area. And so, by putting vibrators
1:00:20 on the outside Now, inside, you can also
1:00:22 have pleasure, but not everyone
1:00:23 experiences pleasure the same way. And
1:00:26 so, understanding devices and trying
1:00:28 different things is really really
1:00:30 important.
1:00:30 >> I don't know. Oh, here we go. Okay, so
1:00:32 this is vibrating now.
1:00:33 >> So, this one This kind of device is
1:00:34 interesting because it is a wand that
1:00:37 can help just like with trigger points.
1:00:39 So, if you have pain in in these
1:00:41 muscles, this can go inside, vibrate to
1:00:43 help with engorgement, but can also get
1:00:45 rid of some of the tension in some of
1:00:47 those muscles.
1:00:48 >> As men, what are we getting wrong in
1:00:51 heterosexual relationships when we're
1:00:52 trying to arouse our partners um both of
1:00:56 the context of using sex toys, but also
1:00:58 without sex toys? What is it that we
1:00:59 just don't understand?
1:01:00 >> I think that men
1:01:03 are constantly asking about they want
1:01:05 their penises bigger, harder,
1:01:07 straighter, girthier, uh lasting longer,
1:01:12 and none of that has anything to do with
1:01:13 how women experience pleasure and and
1:01:16 satisfaction in the bedroom. And so, the
1:01:17 question needs to be how do women
1:01:19 experience pleasure? What is their
1:01:21 anatomy like? How can we activate the
1:01:24 clitoris, the arousal response? What are
1:01:26 the brain things that we need to do to
1:01:28 make women interested, right? What what
1:01:30 gets women excited cuz it's different
1:01:32 than what gets men excited. And your
1:01:33 part every partner's different in terms
1:01:35 of what gets them excited. And I would
1:01:37 love to see more curiosity. I wish
1:01:40 everyone was were as curious as you
1:01:41 about what do we need to learn about
1:01:44 women and how they behave and how they
1:01:45 act and what they want.
1:01:47 >> Yeah, so you need
1:01:48 >> I'd like to implement it tonight.
1:01:49 >> Communication, right? It's that question
1:01:51 and also understanding that your partner
1:01:54 never got told any of these things. And
1:01:57 so this is where watching this podcast
1:01:59 together could be really helpful to say,
1:02:00 "Did you know that? Was it What do you
1:02:02 like? Do you know? Like can we look at
1:02:04 your clitoris together? Like do you know
1:02:06 what these body parts are called? Where
1:02:07 is it that you experience pleasure?" Cuz
1:02:09 some people find direct stimulation of
1:02:11 their clitoris is too sensitive. Cuz we
1:02:13 know the clitoris has like 10,000 nerve
1:02:15 endings. So going directly over the
1:02:16 clitoris can sometimes be too much. Some
1:02:18 partners love it. Some partners want
1:02:20 more stimulation on just the outside
1:02:22 here. Some people need vibration. So
1:02:24 that's another big problem.
1:02:25 >> I can So she's going to orgasm at some
1:02:27 point if this is sufficiently
1:02:28 stimulated.
1:02:29 >> there's sort of a build-up and release
1:02:31 of pleasure, right? That's orgasm. And
1:02:33 again, that is often not happening
1:02:36 during penetration.
1:02:37 >> And once she experiences that, what
1:02:39 happens immediately after for her? Cuz I
1:02:41 know from a man's perspective, if I
1:02:42 orgasm, there's some kind of like
1:02:44 decline in arousal and I don't want you
1:02:46 to touch it again.
1:02:47 >> That's very similar in women.
1:02:49 >> Okay, so it's the same thing.
1:02:50 >> Except women can bounce back faster. Not
1:02:51 all of them, but but but women can have
1:02:53 multiple orgasms.
1:02:54 >> So she orgasms, it's very very
1:02:56 sensitive, she doesn't want me to touch
1:02:57 it for a while.
1:02:58 >> Yeah.
1:02:59 >> And then she could she potentially could
1:03:01 bounce back faster.
1:03:02 >> She could potentially. Some people do,
1:03:04 some people don't, but that's the
1:03:05 conversation of is this something that
1:03:07 is pleasurable? Is this something to try
1:03:08 again? Is multiple orgasms something
1:03:10 that you want to have or try to have?
1:03:12 When does penetration happen during the
1:03:14 dance? Because often times men orgasm
1:03:16 and then they're done, they all over, go
1:03:17 to sleep, whatever it is. Is the orgasm
1:03:19 happening after your orgasm, before your
1:03:21 orgasm? Is it happening before and after
1:03:23 your orgasm? Like are there cuz that
1:03:25 could be a nice way to sandwich it of
1:03:27 like there is, you know, giving the the
1:03:29 sensitive tissue some time to rest, then
1:03:32 your orgasm happens and then you
1:03:33 potentially go for round two.
1:03:35 >> So, if the
1:03:36 sensitive pleasurable part is on the
1:03:39 outside here on the clitoris, then what
1:03:41 do they get from penetrative sex if the
1:03:44 this one of main event is here in the
1:03:46 clitoris?
1:03:46 >> Many times nothing. Many times
1:03:48 [clears throat] connection. Many times
1:03:50 uh sort of this need for closeness and
1:03:52 pleasure. Many times there are women who
1:03:55 have extra nerve endings sort of inside
1:03:57 the vagina on the top of the vagina and
1:03:59 the cervix. So, there are women who love
1:04:01 penetration, but many women get the main
1:04:04 event from the clitoris and so it's part
1:04:06 of the whole menu as opposed to
1:04:09 penetration is the whole story. And I
1:04:11 think every woman's body is different
1:04:14 and so kind of making these broad
1:04:15 statements of every partner likes this,
1:04:18 but many women are asking for
1:04:19 penetration mainly because they're like,
1:04:22 "Okay, that's when you have your orgasm
1:04:24 it's done and then I can go to bed, I
1:04:26 can read my book, I can do all these
1:04:27 other things." But the pleasure often
1:04:30 comes from that clitoral stimulation.
1:04:31 Now, some women can orgasm from penetra-
1:04:34 I have a theory. It's a really
1:04:35 interesting theory that maybe your
1:04:36 listeners can prove with science or help
1:04:38 me prove with science.
1:04:39 So, you know how there's men who
1:04:41 prematurely ejaculate? Like who
1:04:43 ejaculate very quickly?
1:04:44 >> Yeah.
1:04:45 >> There are men who orgasm in a minute or
1:04:46 less.
1:04:47 That's probably [clears throat] 8% of
1:04:49 men, okay? So, if we think men and
1:04:50 women's bodies are very similar, could
1:04:52 we argue that 8% of women will orgasm
1:04:56 within a minute or less?
1:04:58 Theoretically, it makes sense, right? I
1:05:00 think those are the women who orgasm
1:05:02 with penetration. They're so sensitive,
1:05:04 their nerves are so sensitive that
1:05:06 penetration's very pleasurable and then
1:05:08 they have this magical orgasm and they
1:05:10 do it very quickly. So, it's good in a
1:05:12 way, it's often seen as like great in a
1:05:13 woman and not great in men. And so, I
1:05:16 just have this theory that like there
1:05:17 are women who have extra sensitive body
1:05:20 parts.
1:05:20 >> So,
1:05:21 I mean, one of the things I've learned
1:05:22 from everything you've said is just like
1:05:24 how much porn has messed up
1:05:27 our perception of sex.
1:05:30 >> I mean, WWF has messed up our perception
1:05:33 of
1:05:34 I don't know.
1:05:35 Like what people's bodies are like
1:05:37 exercise fighting like like it's all
1:05:39 manufactured. And it's all manufactured
1:05:41 because that's the algorithm that has
1:05:43 been working to get men excited. And it
1:05:46 doesn't like again, it's that question
1:05:47 of that curiosity of who's watching
1:05:50 porn, what do people want from porn,
1:05:52 what are they getting from porn because
1:05:53 it's not what women want typically. And
1:05:56 it has really messed up people's
1:05:58 perceptions of what is actually fun and
1:06:00 pleasurable for the partner. So, seeing
1:06:01 that curiosity of like what does my
1:06:03 partner actually want? You know, you can
1:06:05 have great sex without penetration. And
1:06:07 so, the question is is what does great
1:06:09 sex look like?
1:06:10 >> For you and your partner. When I look at
1:06:11 a website, got some data here on a
1:06:12 website like Pornhub, which is one of
1:06:14 the leading porn websites, it says that
1:06:16 roughly 65% of their traffic
1:06:19 is men. Independent surveys tracking any
1:06:23 regular pornography use find a similar
1:06:25 gap, but note that women's consumption
1:06:26 is highly age dependent. Men between the
1:06:28 age of 18 and 35,
1:06:31 75 to 95% of them report viewing porn
1:06:34 regularly, whereas women age 18 to 35,
1:06:39 only 34% roughly,
1:06:41 report viewing porn regularly. And if we
1:06:44 think about these systems as catering to
1:06:46 demand, it means that porn websites are
1:06:48 catering to
1:06:50 predominantly male
1:06:53 demand. And that explains why for most
1:06:55 young men, we learn about sex from porn
1:06:57 websites.
1:06:58 >> Right.
1:06:59 >> And then we assume that's the the woman
1:07:01 looked like she was having fun, and the
1:07:03 man was doing this particular thing, and
1:07:04 then And take that into our
1:07:05 relationships, and I think this is where
1:07:07 the misunderstanding begins.
1:07:08 >> And the women think they're broken
1:07:10 because they're not having magical
1:07:11 orgasms from penetration. They come to
1:07:13 see me all the time and say, "I'm
1:07:14 broken. You have to fix me. I'm not
1:07:16 orgasming during sex." They have wildly
1:07:18 good orgasms with a vibrator, with a
1:07:19 hand, with
1:07:21 a shower head, with whatever it is from
1:07:24 on their clitoris, and that's totally
1:07:25 normal, right? And then you show them
1:07:27 the body parts. You say, "This is right,
1:07:29 the clitoris and the penis are the same
1:07:30 thing. You activate a penis for a man to
1:07:32 orgasm. You activate a clitoris for a
1:07:33 woman to orgasm." And once you teach
1:07:35 them that, it makes perfect sense to
1:07:37 them. Like they were normal the whole
1:07:38 time.
1:07:38 >> What do you think of pornography?
1:07:40 >> I actually think pornography is great.
1:07:42 >> For relationships? For connection?
1:07:44 >> the right porn. Like look at Okay, let's
1:07:45 look at something like Heated Rivalry.
1:07:47 Have you heard of it?
1:07:47 >> No.
1:07:48 >> Okay, Heated Rivalry is an HBO show that
1:07:50 came out this year that is about two gay
1:07:54 male hockey players. Okay, it's based on
1:07:56 a romance novel book in came from
1:07:58 Canada, and HBO put it out there, and it
1:08:01 went viral in levels that the world has
1:08:03 never seen before. And it is about two
1:08:05 young men
1:08:06 who fall in love, but there's a very
1:08:08 sexual relationship between them. And
1:08:10 heterosexual women have watched this 10
1:08:13 times over. Like they are addicted to
1:08:15 this show. It's all over social media.
1:08:16 It's this huge thing. It's essentially
1:08:18 porn for women, right? It is women who
1:08:20 are watching these pornographic
1:08:22 episodes, and it's really important.
1:08:23 They love it. It's supported. Everyone's
1:08:25 talking about it. So, I don't think porn
1:08:27 in and of itself is bad. I think porn,
1:08:30 we, you know, watching people have sex,
1:08:32 watching people fall in love, watching
1:08:34 people with in romance. People like
1:08:35 that. It gets them excited. It gets them
1:08:37 aroused. But I think too much, if you
1:08:39 are watching porn because and not
1:08:41 interacting with humans, if you are
1:08:43 watching porn all the time, if you need
1:08:45 to if you can only watch porn to have
1:08:47 good sex, like then
1:08:49 that may not be the best, you know, and
1:08:51 healthiest thing to do.
1:08:52 >> I guess the question I was asking is, if
1:08:54 you're in a relationship and one partner
1:08:55 is using a lot of porn, won't that kill
1:08:58 the sexual desire to be intimate with
1:09:01 your partner?
1:09:02 >> It depends. It depends on the
1:09:03 relationship and it depends on what each
1:09:05 person needs in order to feel supported
1:09:07 and connected, right? I don't think we
1:09:09 can say blanketly it's good or bad,
1:09:11 right or wrong. I think if it is good or
1:09:14 bad, right or wrong for that couple,
1:09:16 then it's a problem. Cuz there are
1:09:17 couples who like to watch porn together.
1:09:19 There are couples where oh, that maybe
1:09:21 someone has a much higher libido than
1:09:22 the other person. So they said, "Okay,
1:09:24 the high libido person can use porn and
1:09:26 then once a week we'll circle together
1:09:28 and we'll have a great experience
1:09:29 together." Because it's not everyone's
1:09:31 job to meet each other on the libido.
1:09:34 >> The study that I was looking at was a
1:09:35 couple dozen studies including a major
1:09:36 meta-analysis show a consistent link
1:09:38 between solo porn consumption and lower
1:09:40 relationship and sexual satisfaction.
1:09:43 The erosion of intimacy is usually
1:09:44 driven by deception. Finding a partner
1:09:47 is hiding porn use is usually triggers
1:09:49 intense feelings of betrayal, rejection,
1:09:50 and insecurity.
1:09:52 And heavy solo use can desensitize
1:09:55 the brain's reward system leading to
1:09:57 performance anxiety and erectile issues
1:09:59 during real-life partner sex. It can
1:10:01 also create highly unrealistic
1:10:03 expectations regarding body types,
1:10:05 stamina, and performance making real sex
1:10:08 feel less stimulating.
1:10:10 >> Again, it was that deception. It's the
1:10:12 hiding. If your that that ex of yours
1:10:14 didn't tell you what was really going on
1:10:15 and so you felt disconnected from that
1:10:18 person because you didn't get that
1:10:19 honest truth of what was going on.
1:10:21 >> But also the desensitization of it. Like
1:10:23 it's never going to you know
1:10:25 I guess it depends on how you're using
1:10:26 pornography.
1:10:27 >> It depends on how you use it. So again,
1:10:29 that's the truth.
1:10:29 >> Like you can like train your brain to
1:10:31 get pleasure in a certain way.
1:10:34 And then when you're with your partner,
1:10:35 one could argue that it's going to be
1:10:36 quite difficult for them to replicate
1:10:38 that particular way that you've pleasure
1:10:39 you've learned to pleasure yourself.
1:10:41 >> Right. And that's a that's a problem,
1:10:43 right? If you're only able to do
1:10:44 something in one way, in one position,
1:10:46 with one watching one specific thing,
1:10:49 that may not translate into great
1:10:51 intimate sex with a partner.
1:10:53 >> For the last couple years I've been
1:10:54 working on something that I realized
1:10:55 every podcaster listening to this, but
1:10:57 actually probably every creator
1:10:58 listening to this might just need.
1:11:00 Podcasting is difficult for many
1:11:01 reasons, and one of them is that these
1:11:03 hosting platforms don't give you much
1:11:04 information, and also because they're so
1:11:06 fragmented, you kind of have to go
1:11:08 through every single platform uploading
1:11:10 it to YouTube and then taking the same
1:11:11 big old video file and uploading it to
1:11:13 Spotify's platform. It takes huge
1:11:15 amounts of time, and that friction means
1:11:17 most of us don't do it. That is the
1:11:19 problem we set out to solve, and so we
1:11:20 built something called Flight School,
1:11:21 which you can find at flightcast.com.
1:11:23 And today Flight School is also one of
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1:11:27 world's biggest podcasters are now using
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1:11:50 now.
1:11:51 I've done almost 700 interviews with
1:11:54 some of the most interesting people in
1:11:55 the world, and one of the things you
1:11:56 learn, which is unexpected, is that
1:11:58 vulnerability is the doorway to
1:12:00 connection. And after sitting here for 2
1:12:02 3 hours with a guest, I feel a deep
1:12:04 sense of connection to them. And as they
1:12:06 leave, what I get them to do is to write
1:12:09 a question in the Diary of a CEO. We've
1:12:12 taken all of the questions from the
1:12:14 Diary of a CEO. We have put the question
1:12:17 here on this card with the name of the
1:12:20 person that wrote it. So, you can sit at
1:12:21 home, as I do with my fiance, and my
1:12:23 colleagues at work, and other people in
1:12:25 my life, whenever we get a minute, we
1:12:27 play the Diary of a CEO conversation
1:12:29 cards, and it is incredible what
1:12:32 happens. These are great if you're in a
1:12:33 romantic relationship and you want to
1:12:35 connect your partner more. These are
1:12:36 also great if you're in a team and you
1:12:38 want to bond your team together. And I
1:12:40 have to say they're also great for
1:12:41 families that want to learn more about
1:12:42 each other and that need a good excuse
1:12:44 to spend some time in a digital world in
1:12:47 the analog environment connecting human
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1:12:52 right question at the right time can do.
1:12:55 Go to the diary.com
1:12:57 and you can get these conversation cards
1:12:59 right now.
1:13:01 And there's different types of arousal,
1:13:02 right? I was I heard from a sex expert I
1:13:05 spoke to that men and women often have
1:13:07 different types of arousal, spontaneous
1:13:09 and like reactive. Is it?
1:13:11 >> Yep. Yep. So there again, this idea of
1:13:13 like I want to have sex, I'm ready to go
1:13:15 versus I want to have sex because we've
1:13:17 started having sex and we've started
1:13:19 that process and now I can get into it.
1:13:21 Sort of like exercise. Some people are
1:13:22 like ready to go to the gym and exercise
1:13:25 and other people like I don't want to I
1:13:26 never want to exercise, but once they
1:13:28 start getting going, oh I know this is
1:13:29 good for me, I should do this. This
1:13:31 feels really good and that's sex for a
1:13:33 lot of people. But again, it's also a
1:13:36 question of what kind of sex are you
1:13:37 having? If you have sex the same way
1:13:39 every single time and it's not that fun
1:13:42 and it's not that interesting to your
1:13:43 partner, are they going to look forward
1:13:45 to it? Are they going to Are they going
1:13:46 to want it? Are they going to seek it
1:13:47 out? And is that really low libido at
1:13:49 all or is that sort of the product of
1:13:51 like we just aren't talking about it
1:13:53 improving. If you had the same podcast
1:13:55 guest on every single week and it was
1:13:57 the same conversation every single week,
1:13:59 it's not going to last you very long,
1:14:01 right? You do different things. You try
1:14:02 different things. Oh, what worked? What
1:14:04 didn't work? How could we do this
1:14:05 better? What does the algorithm want us
1:14:07 to do now? No one's doing that in their
1:14:09 sex lives. Like Like no one's even
1:14:10 talking about it. Like honey, what's
1:14:12 working? What do we like? What's going
1:14:13 on? I saw this thing like
1:14:14 >> Why? Why don't we talk about it?
1:14:16 >> Because we don't talk about money
1:14:17 either. We don't talk about sex. Because
1:14:18 we're trying to be a pro I don't know.
1:14:19 What do you think?
1:14:20 >> I think that's a little bit of it, but I
1:14:21 think the subjects are like deeply
1:14:24 personal, emasculating
1:14:26 and so intrinsically linked to like
1:14:29 self-esteem.
1:14:30 >> It's vulnerable.
1:14:31 >> Yeah, it's like super vulnerable. So And
1:14:33 if someone I remember I had a
1:14:36 partner turn around to me who
1:14:38 interestingly was going through some of
1:14:39 the issues that were undiagnosed, turn
1:14:41 around once upon a time and expressed
1:14:43 that she didn't like having sex and I
1:14:44 didn't understand that at like a 20 as a
1:14:45 23 22-year-old guy.
1:14:48 >> Yeah.
1:14:48 >> And so you kind of look yourself in the
1:14:49 mirror and go, "Oh shit." Like it's
1:14:51 super emasculating.
1:14:53 It turned out that there was actually a
1:14:54 physiological challenge she'd had.
1:14:56 >> Yeah.
1:14:56 >> But we'd been in a relationship for a
1:14:59 long time and she wasn't enjoying sex
1:15:01 for because there was a physiological
1:15:02 issue.
1:15:03 >> Mhm.
1:15:03 >> She didn't say anything to me.
1:15:04 >> Yeah.
1:15:05 >> I didn't know. And then the day she said
1:15:07 something to me, my I didn't know
1:15:09 anything about sex. So I just
1:15:10 interpreted it as like, "Damn, I'm not
1:15:12 good in the you know I might I must not
1:15:13 be good in the bedroom or something."
1:15:15 Um which is super like hurtful. Yeah.
1:15:17 And then that kind of breaks the
1:15:17 relationship down and it's all
1:15:19 predicated on this like
1:15:21 highly emotional, highly self-esteem
1:15:23 linked, poorly educated subject which
1:15:26 destroys relationships.
1:15:27 >> Destroys it. I
1:15:28 And that's such an important story,
1:15:31 right? Because if you had had access to
1:15:34 the information, she thought she was
1:15:36 protecting you by not telling you that
1:15:38 information.
1:15:38 >> interesting? I went to one of my friends
1:15:40 and one of my best friends and said,
1:15:41 like, "My partner's just said this to
1:15:42 me. Like what does that mean?" And he
1:15:43 went to me, he goes, "Mine too." I was
1:15:46 like, "What?" I was like, "So you're not
1:15:47 having sex with your partner?" He goes,
1:15:48 "No." And we And by the way, I'm talking
1:15:49 about 30 year olds. He was like, "No, we
1:15:51 haven't had sex in 3 months." And I was
1:15:53 like, "What What's the reason?" And he
1:15:54 said to me, "She said she just doesn't
1:15:56 like having sex." And I'm like, "Oh,
1:15:58 okay. So that's
1:16:00 that's the same in my relationship. My
1:16:01 my former ex-girlfriend said she just
1:16:02 doesn't like having sex."
1:16:04 And
1:16:05 I can't tell you how ignorant and poor
1:16:10 and insufficient the conclusions in such
1:16:14 a situation we arrive at are. We're
1:16:16 like, "Well, maybe maybe there's
1:16:18 something wrong with me. Maybe it's a
1:16:20 sexuality challenge. Maybe it's a
1:16:22 genetic thing. Maybe they were just but
1:16:23 they were born in didn't want to have
1:16:25 sex like we don't we just don't know
1:16:26 what it is."
1:16:28 From doing this podcast and speaking to
1:16:30 people like you, I like, "Oh my god. I
1:16:33 just wish like 5 10 years ago when I had
1:16:35 these conversations with my guy friends
1:16:37 and also with my the ex-partner that I'm
1:16:38 referencing, I just wish I knew that it
1:16:42 wasn't any of those things.
1:16:44 >> Mhm.
1:16:44 >> It was something that um
1:16:46 could have been helped.
1:16:47 >> Yeah.
1:16:48 What's so important is that you were
1:16:51 able to learn and see and grow in this,
1:16:54 right? A little bit of information gave
1:16:56 you empathy for this partner where you
1:16:58 took it on as a you problem, it became a
1:17:01 you problem cuz it was both of you
1:17:02 together, but it started with biology.
1:17:05 And so, if we actually taught people the
1:17:07 biology or to think about biology or to
1:17:10 like be able to talk about sex, to talk
1:17:12 about sexual health, to talk about
1:17:14 genitals, to make them not private
1:17:15 parts, how much better would your sexual
1:17:18 upbringing really have been? How much
1:17:20 less hurt and shame and guilt would you
1:17:22 have felt because it actually wasn't you
1:17:24 at all, right?
1:17:25 >> It's the horrible conclusions you arrive
1:17:26 at and the the conclusions you arrive at
1:17:29 are often seen as both unchangeable and
1:17:32 therefore, in my situation back then,
1:17:34 the conclusion was, well, this
1:17:35 relationship's never going to work.
1:17:37 Because the false conclusion we'd
1:17:38 arrived at was not something we could we
1:17:41 could change.
1:17:42 >> Mhm.
1:17:43 >> Uh whereas, when I hear about all of
1:17:44 these different things we've talked
1:17:45 about today, I go, "Oh my god, there's
1:17:47 so many other conclusions I could have
1:17:48 arrived at or my friends could have
1:17:49 arrived at that would have been fixable
1:17:51 and therefore, the relationship, which
1:17:53 is a perfectly great relationship with a
1:17:54 person, was therefore savable." One of
1:17:56 them is the thing we just talked about,
1:17:58 which is this idea that men and women
1:18:00 have different types of arousal,
1:18:01 spontaneous and responsive. And I was
1:18:03 looking at some of the data on the
1:18:05 variance, which I think is very
1:18:06 important for people to know.
1:18:08 And it says that men are highly
1:18:10 spontaneous in their arousal, which kind
1:18:12 of means, from my interpretation, and
1:18:13 please correct me if I'm wrong, that as
1:18:15 a man, I can literally be I can
1:18:17 literally think about something
1:18:20 and get aroused. And it's not to say
1:18:22 that women can't, but it the data
1:18:24 suggests that men are more that way
1:18:26 inclined. The data here says that their
1:18:28 spontaneous rate in a man is about 70%,
1:18:30 whereas in women, it's about 10 to 15%.
1:18:33 It says the responsive rate, which I
1:18:34 guess is like I get aroused once the
1:18:36 ship starts moving, once we start
1:18:38 foreplay, once contact starts, is 10 to
1:18:41 15% in men, and in women in this
1:18:44 particular report is 40 to 50%.
1:18:47 >> Mhm.
1:18:47 >> So, that would suggest to me that women
1:18:49 are much more likely to be aroused once,
1:18:52 you know,
1:18:53 foreplay or contact or the sexual
1:18:55 actions have taken place, I'm guessing.
1:18:57 >> Mhm.
1:18:58 >> And then the mixed style
1:19:01 is 15 to 20% in men and 35% in women.
1:19:05 Um is that all accurate?
1:19:06 >> It's accurate, and I think it really
1:19:08 comes to this idea of your path to
1:19:11 having a better understanding of that
1:19:13 prior relationship was actually
1:19:15 education and communication.
1:19:17 >> Yes.
1:19:18 >> Right?
1:19:18 >> If you had a better understanding of the
1:19:20 biology, if she had a better
1:19:22 understanding of the biology, if she
1:19:24 were vulnerable enough to be real with
1:19:26 you and honest with you up front as
1:19:28 opposed to kind of a bombshell that
1:19:30 happened too late, um all of that pain,
1:19:32 all of that hurt probably would have
1:19:34 looked different.
1:19:35 >> Right? It would have looked like the
1:19:36 world would have looked very different.
1:19:37 Now, that's what I'm fighting against
1:19:40 because I think that to your point, I
1:19:42 think men are suffering. They're feeling
1:19:45 disconnected from their partners.
1:19:46 They're feeling a difficulty of even
1:19:48 finding a partner, and part of that is
1:19:50 cuz they lack that curiosity of like,
1:19:52 what like, what do they want? What do
1:19:55 they need? What kind of communication
1:19:57 helps me get to where I want to go with
1:19:58 this person? And a lot of that is
1:20:00 vulnerability and curiosity and
1:20:03 interest, and I think that's what women
1:20:05 often are looking for in partners. Is
1:20:07 they're looking for someone who's going
1:20:09 to give a crap about them enough to care
1:20:11 what they specifically need and want,
1:20:14 not what gen What do women want, and
1:20:16 what is it like like, what specifically
1:20:19 about this person in front of me? What
1:20:21 does she need to feel that erotic love,
1:20:25 support, connection, lust? And for the
1:20:27 man, too. Like, what do you need to feel
1:20:30 all of those things? And what a good
1:20:32 relationship is is when people work
1:20:35 together to try to optimize that for
1:20:37 everybody.
1:20:38 >> are the questions that you would ask
1:20:40 your patients to ask their partner
1:20:43 to start to tease out some of these
1:20:44 things? Couples will come up to me when
1:20:46 I'm in a restaurant or something, and
1:20:48 they'll come up together, and they'll
1:20:49 always they'll often say to me that the
1:20:52 episode they watched together was about
1:20:54 sex.
1:20:55 So, I I literally have this image of
1:20:57 this particular couple that came up to
1:20:58 me when I was abroad, and they said, "We
1:21:01 were just listening on the plane about
1:21:02 your sex episode." So, I'm like they're
1:21:05 listening now.
1:21:06 >> Like again, I think it's that basic
1:21:08 thing of like what does great sex mean
1:21:09 for you?
1:21:10 >> Okay.
1:21:11 >> [clears throat]
1:21:11 >> What what do you want? Like what what is
1:21:13 a great time? What's it something fun?
1:21:15 Like what is it about sex that you
1:21:17 enjoy? When you ask people what do they
1:21:19 get out of sex, it's like 200 different
1:21:21 reasons. Everyone wants something
1:21:23 different, and everyone doesn't always
1:21:25 know what they want. And then having
1:21:26 that ability, if you don't know what you
1:21:27 want, is having that curiosity to
1:21:30 explore together.
1:21:31 >> So, with that said, 200 different
1:21:33 opinions on what good sex is. And this
1:21:36 is kind of what I think you find in
1:21:37 couples. And when I've sat with my
1:21:38 partner before and said like what do you
1:21:39 what arouses you during sex? What do you
1:21:41 like?
1:21:42 The two things can often be different.
1:21:44 >> Totally.
1:21:44 >> And so, is this not a problem that one
1:21:47 partner might say, "I really want you to
1:21:50 tie me up and da da da da da." And then
1:21:52 the other partner might say, "I really
1:21:54 want you to not tie me up and be really
1:21:57 soft and gentle." And there's a bit of a
1:21:59 dichotomy between sorts of sex
1:22:01 preferences,
1:22:02 >> Mhm.
1:22:03 >> which means no one's really ever getting
1:22:04 what they want. Like how do you navigate
1:22:06 that?
1:22:06 >> When you go to buy a house, you don't
1:22:08 always get to choose what house you get
1:22:09 unless you you know you build it
1:22:11 yourself. Like there are compromises in
1:22:13 life, and and there is no all good or
1:22:15 all bad. You're never going to find this
1:22:16 is actually the problem with pornography
1:22:18 is you figure out the exact porn in the
1:22:20 exact situation or even worse with AI.
1:22:22 Like you're going to have a sex robot
1:22:24 who's going to be able to do exactly
1:22:25 what you want in the way that you want
1:22:26 to do it and people are afraid about
1:22:29 what that means for intimacy and
1:22:30 relationships and great sex going
1:22:32 forward because the truth is sex is
1:22:34 messy, it's awkward, it's smelly,
1:22:36 there's fluids, there's funny noises,
1:22:39 there's like it's it's vulnerable, it's
1:22:41 like really uncomfortable sometimes for
1:22:44 to like have these deep conversations,
1:22:46 but isn't that why life exists? Like
1:22:48 isn't that like the most fun part is
1:22:50 when you can kind of have that with
1:22:52 somebody else where they know all of you
1:22:54 and they want to explore that with you.
1:22:55 Now, if it's not the right relationship,
1:22:58 it's not the right relationship, right?
1:22:59 Like and and figuring out if that is an
1:23:01 important part of your life and it's a
1:23:02 non-negotiable, then find the rooms
1:23:05 where there are other people who do that
1:23:06 those things too. I mean, what you will
1:23:08 find is that people have all sorts of
1:23:10 agreements and relationship setups and
1:23:13 as a sex doctor, like the things I hear
1:23:15 in a room like would, you know, are
1:23:17 quite wild and you you wouldn't even
1:23:18 believe. Like people are doing Well, I
1:23:21 think people have multiple like there
1:23:23 are there are people who have open
1:23:24 relationships. So, they have multiple
1:23:26 partners or they have certain kinks,
1:23:29 right? So, there are things that they
1:23:30 really enjoy that maybe somebody would
1:23:32 look at that and be like, oh, that's
1:23:33 very strange, but there are other
1:23:34 consenting people who also are
1:23:36 comfortable and want to do those things.
1:23:37 There are websites that deal with
1:23:39 different erotica and different kinks
1:23:41 and things like that. And there's also
1:23:42 this idea of fantasy. It's also okay to
1:23:44 have things that you think about but
1:23:46 that you don't actually want to partake
1:23:48 in and and that you use.
1:23:50 >> On this point of fantasy, what if you
1:23:51 have a you probably have experience
1:23:53 where someone's come to you and they
1:23:54 have a fantasy
1:23:56 but they don't want to tell or a kink
1:23:58 and they don't want to tell their
1:23:59 partner because they're worried about
1:24:01 the reaction.
1:24:02 >> Yeah, this is where things like sex
1:24:03 therapy become really helpful of how do
1:24:05 you have a third party? Cuz again, when
1:24:07 your doctor's telling you to do
1:24:08 something or bringing something out,
1:24:09 it's it's so much less
1:24:11 scary than if you're doing it on your
1:24:13 own. There are also different like apps
1:24:15 and things like that where you can sort
1:24:17 of dip a toe where you you you have
1:24:20 There's one called Spicer, I believe,
1:24:21 where you can sext each other in ways
1:24:23 and they'll push questions. If you both
1:24:25 agree, it'll tell each other that you
1:24:26 both agree with things. So, there's ways
1:24:29 to dip a toe here and sort of be curious
1:24:31 about it, but again, that's where
1:24:32 watching things together or asking the
1:24:34 questions. This should happen not when
1:24:35 you're naked in the bedroom actively
1:24:37 having sex. Like it's okay to have
1:24:39 conversations about sex when you're not
1:24:41 having sex, right? Like you plan these
1:24:43 podcasts before you actually sit down to
1:24:45 record. Afterwards, you talk with your
1:24:47 team, "Hey, this is what I liked about
1:24:49 it. Here's what I didn't like. Let's
1:24:50 change this in the future. Let's never
1:24:52 have Dr. Ruth Westheimer on again,
1:24:53 right?" Like these are the conversations
1:24:55 you're going to have with your team.
1:24:56 People don't do that about sex very
1:24:57 often, right? They don't actually do
1:24:59 after action. What went well? What
1:25:01 didn't go well? Do you ever want to try
1:25:02 this? Like what would be fun here? Like
1:25:05 there there is often a a lack of
1:25:06 curiosity.
1:25:08 >> And to be you are sex doctor, but people
1:25:10 come to you and sort of offload their
1:25:11 sex lives to you.
1:25:12 >> My job is so fun. I love my job. It's so
1:25:15 fun because people will talk to me about
1:25:17 their most Like we do 2 hours and we
1:25:20 talk about their lives in the context of
1:25:22 their sexual health for 2 hours and
1:25:25 people never have those types of
1:25:27 conversations even with their partners.
1:25:29 And it is incredibly vulnerable. It's
1:25:31 incredibly important for people to see
1:25:33 that and see, "Oh, that was actually
1:25:35 really nice to talk about. I didn't know
1:25:37 this, that, and the other thing about my
1:25:38 body."
1:25:39 >> And what you find that men and women
1:25:41 typically are hiding from their partners
1:25:45 when they do confide in you?
1:25:47 >> I think they don't tell their partners
1:25:48 just about anything. Like they don't
1:25:50 There's a lot they don't tell their
1:25:51 partners, right?
1:25:52 >> Is there a difference between men and
1:25:52 women what they are not saying?
1:25:55 >> That's a great question. I would say
1:25:57 that no one is talking about sex at all.
1:26:00 Women are hiding their pain from their
1:26:02 partners. Men are hiding their um
1:26:06 insecurities and their frustrations and
1:26:08 there's a lot of shame around erectile
1:26:10 dysfunction and sexual problems in men
1:26:12 and so they a lot of people just either
1:26:14 stop having sex or stop talking about it
1:26:17 or sort of have a mediocre sex because
1:26:20 they are not that great at talking about
1:26:21 these things.
1:26:22 >> And I imagine your I mean my first
1:26:23 reaction would be like, "Oh, you should
1:26:24 tell them."
1:26:26 But I imagine that doesn't necessarily
1:26:27 work.
1:26:27 >> I think it's a challenge. Like if you
1:26:29 have had if you have been faking an
1:26:31 orgasm for your entire relationship
1:26:34 >> And women have been.
1:26:35 >> Yeah, many. The statistics are quite
1:26:36 clear. Like if you're only having
1:26:38 penetration and your partner orgasms
1:26:40 every time and it's a perfect orgasm
1:26:42 every time, I would say there's a high
1:26:43 percentage that that's not real. Because
1:26:46 the truth is is orgasm often takes a lot
1:26:49 of arousal and a like like again,
1:26:51 stopwatch. Every header if a penis
1:26:53 enters a vagina and they orgasm about 5
1:26:57 and 1/2 minutes is on average how long
1:26:58 men last, right? Like that's science.
1:27:00 It's about 5 and 1/2 minutes. Now, if
1:27:02 you're longer, great job. If it's
1:27:03 shorter, it's okay. It's all within the
1:27:04 range of normal. Women, if penetration
1:27:07 is happening, almost nobody orgasms in 5
1:27:10 and 1/2 minutes. It's usually well over
1:27:12 13, 14, 15 minutes and penetration is
1:27:15 usually not how that happens. Cuz again,
1:27:17 if you're distracted while you're trying
1:27:19 to stimulate your penis, it's going to
1:27:20 take longer. Women need focus on the
1:27:22 clitoris. So again, if your partner is
1:27:24 orgasming every time within that 5 and
1:27:26 1/2 minutes and it's like clockwork, I
1:27:29 would call [ __ ] on
1:27:30 a high percentage of it. So but but a
1:27:33 partner doesn't want to tell you, right?
1:27:34 Like they're afraid to tell you cuz
1:27:36 they're they want to make you happy,
1:27:37 right? It's not that they're having bad
1:27:38 sex. They just know that that's not
1:27:40 what's going to get them to orgasm and
1:27:42 they want you to be happy and to feel
1:27:44 supported.
1:27:45 >> So
1:27:46 that presents a pretty good case that
1:27:48 the woman should orgasm first.
1:27:50 >> I think so because I think orgasm first
1:27:53 will allow for pelvic floor release and
1:27:55 relaxation, which will make penetration
1:27:57 more pleasurable, enjoyable. I think
1:27:59 women can have multiple orgasms, so
1:28:01 there's a case to be made for before and
1:28:03 after. Why are women having zero
1:28:05 orgasms, men having one orgasm when
1:28:06 women could be having three orgasms and
1:28:08 men have one orgasm? So I think we
1:28:10 should be actively trying to change the
1:28:13 orgasm gap and focus on the pleasure and
1:28:16 I think making penetration the main
1:28:17 event is where the challenge I think
1:28:20 penetration can be part of the whole
1:28:22 story but doesn't necessarily always
1:28:23 need to be the main event.
1:28:26 >> On the physical blockers you talked
1:28:27 about some of them like anxiety. One of
1:28:29 them that I think isn't talked about
1:28:30 enough especially in the modern world is
1:28:32 what they call like the dopamine drain
1:28:33 where you've got mental burnout or
1:28:35 chronic stress or we talked a little bit
1:28:37 about depression but I did notice that
1:28:40 through my life when I'm very very
1:28:42 overworked shall I say
1:28:46 my libido is not the same.
1:28:48 >> Yeah.
1:28:49 >> And this is also the case for for women
1:28:51 as well. Do you have a lot of women come
1:28:53 to you or couples come to you where this
1:28:55 is quite clearly the problem this sort
1:28:56 of like dopamine drain it's actually
1:28:58 their stress and lifestyle it could be
1:28:59 the kids it could be
1:29:01 >> Oh it's a huge problem right? It makes
1:29:02 logical sense again if we go back to the
1:29:04 fundamentals of if you're not sleeping
1:29:06 if you're overworked if you're burned
1:29:08 out if you have no white space for
1:29:09 yourself why are why are you going to
1:29:11 have all this excitement for your
1:29:12 partner and all of these things like if
1:29:14 we're scrolling all the time at bedtime
1:29:16 or if we're watching porn all the time
1:29:18 or we're watching reading romance novels
1:29:20 all the time but we're not talking to
1:29:22 the partner with that we're with or
1:29:24 we're not creating that time and space I
1:29:26 think there's a big opportunity for
1:29:28 people in our modern society which is
1:29:30 over scheduled to schedule sex. I mean
1:29:33 they do this quite well. So when you
1:29:35 were dating right and you would ask your
1:29:37 your date you know let's go out Saturday
1:29:39 night you were literally scheduling
1:29:41 potential sex. You're like I could get
1:29:43 lucky I'm going to plan for it all week
1:29:45 I'm going to get excited I'm taking this
1:29:46 person out I'm like it's going to be
1:29:48 really fun and I'm going to do whatever
1:29:49 it takes to sort of cross that finish
1:29:51 line. So we were always scheduling sex
1:29:53 and it was very erotic and fun when
1:29:55 you're in your dating life and now you
1:29:57 live with a person and you sort of they
1:29:59 see you at your best they see you at
1:30:01 your worst they see you at your
1:30:02 crankiest and your most tired and so
1:30:04 it's really hard to get that level of
1:30:07 excitement when you're dealing with
1:30:10 those, you know, sort of life
1:30:12 circumstances.
1:30:13 >> People will say that, you know, there's
1:30:14 a spontaneity myth around sex that it
1:30:16 should be spontaneous and that's kind of
1:30:17 how we see it in films. Like they grab
1:30:19 you in the hallway and you start kissing
1:30:20 and whatever else.
1:30:21 >> not real. It's just the same as WWF.
1:30:23 Like it's not real. And so that's the
1:30:25 truth is like you If you see your
1:30:27 partner every day and you see your
1:30:28 partner your high and your low and the
1:30:30 crankiest and all of these things and
1:30:31 you're all working like crazy, where is
1:30:33 the space for that? Like that's not how
1:30:35 humans work. So creating That's why
1:30:36 vacation sex is always fun for people or
1:30:39 they find time, you know, so again, if
1:30:41 you've got kids and your kids are
1:30:42 staying up later than you are and you
1:30:44 don't have a lock on your door and
1:30:45 you're worried about making noises and
1:30:46 you don't want to be too loud. Like how
1:30:48 are you going to have great sex in that
1:30:49 situation?
1:30:50 >> One of the I guess the challenges people
1:30:51 might also bring up is that if you're
1:30:53 scheduling sex, it puts a lot of
1:30:55 performance pressure on you. If I know
1:30:57 tonight at 8:00 p.m. I have to have sex
1:31:00 because that's the time we scheduled
1:31:01 this week,
1:31:03 then like, gosh, I'm going to be
1:31:04 finishing my work at 5:00, 6:00, 7:00. I
1:31:06 don't know. I need to get home. [snorts]
1:31:07 I need to have I need to have sex as
1:31:08 well. Gosh.
1:31:09 >> So So this is where you schedule it
1:31:10 around a time that you know is going to
1:31:12 work for you. So I do I tell people to
1:31:13 do things like
1:31:15 quarterly dates. So I get I Listen, I'm
1:31:17 working in DC. Everyone is very
1:31:18 high-powered with very busy jobs. I say
1:31:21 one Friday a quarter, you and your
1:31:23 spouse can literally block your
1:31:24 calendars. One a quarter cuz quarter.
1:31:27 Okay, that means you might have sex
1:31:28 every week. You might have your your
1:31:29 your eight late night sex whenever. You
1:31:31 could might have sex whenever you have
1:31:32 sex. But once a quarter, have a day
1:31:35 where you just block it out and you have
1:31:37 a spouse day or a partner day or
1:31:39 whatever it looks like and maybe do an
1:31:41 act It doesn't necessarily have to be a
1:31:42 sex day, but you actually take time of
1:31:45 your little mini Maybe you go on a walk.
1:31:47 Maybe you go on a hike. Maybe take a
1:31:48 bath. Maybe get a massage. You kind of
1:31:50 create space for you to actually say,
1:31:52 "Oh, wait, we like each other. Oh, we
1:31:54 like talking to each other. We don't
1:31:55 have to just talk about the kids all the
1:31:56 time." So again, the more you invest in
1:31:59 each other and in a joyful way, the
1:32:02 better sex you're going to have.
1:32:03 >> What about self-esteem issues? You
1:32:05 mentioned that as well. Body image
1:32:07 issues. How often do you see that being
1:32:09 the blocker to great sex?
1:32:11 >> It's a huge problem. Again, I wish that
1:32:14 the energy that my female patients put
1:32:17 into wanting to be skinny
1:32:19 is is enormous and I wish that energy
1:32:22 was put into wanting to be strong, but
1:32:24 it's kind of funny because
1:32:27 what people think about themselves
1:32:28 versus what they think for their friends
1:32:30 are very different. Your best friend,
1:32:32 say they're overweight. Do they deserve
1:32:33 great sex?
1:32:34 >> Of course.
1:32:35 >> Of course they do, right? Your best
1:32:37 friend deserves great orgasms, great
1:32:38 sex, no matter what they look like, no
1:32:40 matter what they weigh. Everybody
1:32:41 deserves intimacy, pleasure, and
1:32:43 connection with someone that they can
1:32:44 have intimacy, pleasure, and connection
1:32:45 with. But for some reason when we think
1:32:47 of ourselves, "Oh, I can't be naked with
1:32:50 this person. Oh, I can't be happy until
1:32:52 I lose this much weight. I don't deserve
1:32:54 an orgasm unless I am, you know,
1:32:57 skinny." And that's a huge problem.
1:32:58 >> So, what do we do about it?
1:33:00 >> I think it's empowerment, it's
1:33:01 communication, it's explaining to
1:33:03 people. I think that all of the mindset
1:33:04 stuff that you do and you talk about is
1:33:06 so important cuz look, you changed your
1:33:08 mind around your own situation with this
1:33:11 ex of yours because you got education,
1:33:13 right? You were able to see that it was
1:33:14 more complicated than that. And I do
1:33:17 think by educating people on bodies, on
1:33:21 pleasure, on joy, on connection, on
1:33:24 intimacy, I actually think it changes
1:33:25 the narrative. I think people we're in a
1:33:27 sex recession, okay? People are having
1:33:29 less sex than ever. People are not
1:33:31 connecting, people are scrolling and
1:33:33 they're on their AI chatbots instead of
1:33:35 like human connection. We're getting
1:33:36 worse at this, not better. I I I just
1:33:39 think that like we have to reach humans
1:33:41 and we have to be able to talk about it
1:33:42 to change the narrative.
1:33:44 >> What is the the most important thing we
1:33:45 haven't talked about that we should have
1:33:46 talked about as it relates to all the
1:33:47 work that you do?
1:33:49 >> I think the most important thing is that
1:33:51 biology matters in women and we often
1:33:54 spend so much time talking about
1:33:56 psychosocial issues, about emotions, and
1:33:59 all of that is true. That is important
1:34:01 to sexual health, but we minimize
1:34:02 biology when it comes to women, and we
1:34:05 have to let women advocate for
1:34:07 themselves about the biology, and we
1:34:08 need to train doctors to care about the
1:34:10 biology. I would love to find out from
1:34:11 all the women in your life and the women
1:34:13 on your team, like what experience Like
1:34:16 I would love for you to ask them their
1:34:17 experiences with medical providers, cuz
1:34:21 I don't think we have that curiosity of
1:34:22 like what are you experiencing that's
1:34:24 different.
1:34:25 >> Yeah, I think that I Yeah, I think
1:34:26 that's probably going to have to If for
1:34:27 me to have like a healthy relationship
1:34:29 with my partner, I think that's going to
1:34:30 have to be
1:34:31 uh practice or like part of our You
1:34:34 know, we check in on our relationship,
1:34:36 etc. But we don't really check in on the
1:34:38 physiology.
1:34:39 >> So, super interesting. So, I spend 2
1:34:41 hours with people, and there are times
1:34:42 when the partner comes to that talk. And
1:34:45 so, they get to hear sort of what their
1:34:47 partner is describing. They even get to
1:34:49 see the exam, and they get sort of a
1:34:51 tour of their own partner's body parts.
1:34:53 And so, it is helpful sometimes to bring
1:34:55 partners into those conversations, the
1:34:57 biology conversations, of like she
1:34:59 doesn't want to have sex with you not
1:35:01 because you're bad at sex. Look how
1:35:03 painful it is right here at the opening
1:35:05 of her vulva. It's like a sunburn. I
1:35:07 touch it with a Q-tip, and she's on
1:35:08 fire. Like, what do you think your penis
1:35:10 is doing? And it gives that ability to
1:35:12 say, "Oh, it's not a me problem. How do
1:35:14 I support her best knowing that this is
1:35:16 the issue?" So, getting partners to
1:35:18 understand the biology is extremely
1:35:20 helpful. Or, say you have a man who's
1:35:22 taking an antidepressant or a hair loss
1:35:25 medication that can cause sexual
1:35:26 dysfunction as well. Um say you have a
1:35:28 man who takes an antidepressant and it
1:35:30 lowers his libido. Is it, "Oh, honey,
1:35:32 you're not attracted to me anymore. You
1:35:33 must not love me." Or, is it, "I
1:35:35 actually understand the biology that
1:35:37 your libido is lower because of this
1:35:38 antidepressant." And two things can be
1:35:40 true. So, so I think understanding your
1:35:42 partner's biology and your own biology
1:35:44 is quite important.
1:35:46 >> Yeah, I guess that's the the crux of the
1:35:47 conclusion really is that both education
1:35:50 and communication are where it all
1:35:52 begins.
1:35:53 >> Which is the fundamentals, right?
1:35:54 >> Yeah. And I think here gosh, if I had
1:35:56 better education on these subjects got
1:35:58 at the start of my adult life
1:36:01 and also I had like figured out how to
1:36:02 communicate with my partner and maybe
1:36:05 even also with yourself. And like to be
1:36:07 a bit honest with yourself about how
1:36:09 you're feeling, not to gaslight
1:36:10 yourself, not to gaslight your partner.
1:36:12 Just It just goes to show how better
1:36:14 relationships would have been, not just
1:36:16 with your romantic partner, but really
1:36:17 with all the people in your lives. And
1:36:19 this is easier said than done. Like
1:36:21 especially the communication part.
1:36:23 Because these are very, very sensitive
1:36:24 subjects.
1:36:25 And so we we'd rather just shut up about
1:36:28 them and keep them as these sort of like
1:36:29 secrets among that we whisper about with
1:36:31 the closest people in our lives, maybe
1:36:32 our best friend.
1:36:33 And I just think generally one of the
1:36:35 things I've come to learn from doing
1:36:36 this podcast as well is that
1:36:38 you know, there was this quote I read.
1:36:39 It said you can predict the long-term
1:36:40 health of a relationship by whether each
1:36:42 challenge heals to 101% or 99%.
1:36:46 Does your conflict make you stronger?
1:36:49 And what it's essentially saying is like
1:36:51 conflict is guaranteed in life, but the
1:36:53 thing that's going to turn your conflict
1:36:54 into a strengthened relationship or a
1:36:56 weakened one is
1:36:58 your how you deal with it. Like and
1:37:01 that's all predicated on communication.
1:37:03 And so
1:37:05 if we can just teach people how to
1:37:06 communicate, if we can become better
1:37:08 communicators, which is both function of
1:37:10 speaking and listening
1:37:12 and I guess curiosity
1:37:14 then all of these downstream challenges
1:37:15 and misunderstandings would have a
1:37:17 chance of being solved for. And I think
1:37:19 about this all often. I think often
1:37:20 think, okay, how I'm communicating with
1:37:22 my partner currently is really going to
1:37:24 determine whether we have an argument in
1:37:25 two years time or a year's time or six
1:37:28 months time. Our strategy
1:37:30 of communication. Does she feel safe
1:37:33 expressing a problem? How do I receive
1:37:35 the problem even when it feels like I'm
1:37:36 being blamed? And vice versa. And then
1:37:40 are we open-minded about solutions or do
1:37:42 we come with a bias around this is the
1:37:44 solution, this is what I think the
1:37:45 correct answer will be.
1:37:47 I've spent a lot of time, you know, I'm
1:37:48 like 7 years into my relationship now,
1:37:49 almost.
1:37:51 So, I spend a lot of time thinking,
1:37:52 okay, like how do people go how do they
1:37:53 build a relationship like 50 years? And
1:37:55 the crux of it seems to be
1:37:58 conflict resolution {slash}
1:37:59 communication. That seems to be the crux
1:38:00 of it. And actually with finance issues
1:38:02 that we talk about with finance experts,
1:38:04 always sex issues, the crux of it seems
1:38:07 to be
1:38:08 conflict resolution {slash}
1:38:09 communication.
1:38:11 And I also know, cuz I know lots of
1:38:12 couples, that we're all living on a
1:38:14 different spectrum here. Some couples
1:38:16 are like they come home at 6:00 p.m. and
1:38:18 all they want to do is talk about the
1:38:20 most sensitive subjects. And then you've
1:38:22 got this other group of couples
1:38:24 who almost don't talk about anything.
1:38:25 They're kind of like strangers that are
1:38:27 like burying everything in the cut
1:38:28 cupboard.
1:38:29 And they think burying it in the
1:38:30 cupboard means that it's
1:38:33 out of sight, out of mind, and it's not
1:38:34 impacting anything.
1:38:37 But again, you come to learn
1:38:39 that any problem buried raise its head
1:38:41 in unexpected ways.
1:38:44 And you know, I'm thinking of one
1:38:45 particular friend of mine who was in a
1:38:46 relationship for 14 years, had a baby,
1:38:49 they kind of stopped having sex, didn't
1:38:51 really talk about it.
1:38:54 They become
1:38:56 like parallel lines that are drifting
1:38:58 apart. And they get, you know, several
1:39:00 years later go, "What happened?
1:39:02 What happened to our relationship?"
1:39:04 Well, they never spoke about it.
1:39:07 So,
1:39:08 >> I think you understand this perfectly,
1:39:10 and for you to
1:39:12 see it in this you can help so many
1:39:14 people because I think these are the
1:39:16 fundamentals. How do we teach young
1:39:18 people and old people that conflict
1:39:21 resolution is important in intimacy and
1:39:23 vulnerability are important and biology
1:39:26 is important, science is important, and
1:39:28 we can do this. I I just taught you a
1:39:30 few things that I know today, and you
1:39:33 Not only did you understand it, but you
1:39:35 were curious about it to ask further
1:39:36 questions, and you can now
1:39:38 figure out how it works in your own
1:39:40 relationship, in your own life. You're
1:39:41 even caring enough about thinking about
1:39:43 your friends' lives. And so, if you've
1:39:45 shown that this matters and this is
1:39:47 important, I just think how many people
1:39:49 are going to benefit by your
1:39:50 vulnerability and your curiosity and
1:39:52 saying, "Oh, I could do that, too."
1:39:54 >> Yeah, it's crazy, isn't it? That like if
1:39:55 you love this person so much,
1:39:58 yet you don't often love them enough
1:40:00 just to communicate
1:40:02 about some of these like sensitive,
1:40:04 tricky subjects, which is like craziness
1:40:06 when you articulate it like that. Like
1:40:08 I've been in relationships where I just
1:40:09 absolutely love this person, but no, I
1:40:11 wouldn't I wouldn't raise X, Y, and Z
1:40:13 subject. It's just
1:40:15 it's just too uncomfortable.
1:40:16 >> And the few times, I guess I will ask
1:40:18 that you have been vulnerable, has it
1:40:20 gone well or not well?
1:40:22 >> gosh, it's like the most important
1:40:23 thing. I just I always think, "Why
1:40:24 didn't I do this sooner?"
1:40:25 >> Mhm.
1:40:27 >> I I Yeah, okay. So, to be even more
1:40:30 honest, I like didn't have conversations
1:40:32 with my partner about sex at all. Like I
1:40:34 just I assumed she liked it. I think she
1:40:37 assumed I liked it.
1:40:39 And it wasn't until like a year further
1:40:40 into the relationship that you start
1:40:41 going like, "Wait, I don't
1:40:43 think this is how this person wants to
1:40:45 have sex." Or I don't know. I actually
1:40:47 have to give her the credit cuz she's
1:40:49 the one that started like pushing on the
1:40:50 communication. I think sometimes as men
1:40:52 we just
1:40:55 You know, that that old slightly toxic
1:40:58 phrase, "Happy wife, happy life." I
1:40:59 think sometimes as men we just kind of
1:41:00 assume that if no one's saying anything,
1:41:02 then everything's great.
1:41:05 But it takes two to tango.
1:41:07 >> And I think expecting your partner to
1:41:10 have all the words and to know
1:41:11 everything is the wrong answer. So,
1:41:13 that's where again, that third party,
1:41:15 whether people come to see me together
1:41:17 as a medical person or a sex therapist
1:41:19 or or a third party to help you have
1:41:21 that conversation, cuz I think we assume
1:41:23 our partners know everything about their
1:41:25 own bodies and can communicate about
1:41:27 their own bodies, and that's just not
1:41:28 true. Even showing that curiosity
1:41:31 makes you quite evolved, right? And I
1:41:32 think that that's the energy that we
1:41:34 need in 2026 is breaking down those
1:41:37 barriers because it will lead to
1:41:39 stronger relationships, it will lead to
1:41:40 stronger partnerships, and it's those
1:41:43 hard moments that you grow the most
1:41:45 from.
1:41:46 >> You need the words though as you say.
1:41:48 >> Yeah.
1:41:49 >> When you say you need the words, what
1:41:51 what what specifically do you mean by
1:41:53 that? You need to know how to start the
1:41:54 conversation, how to handle the
1:41:56 conversation, how to receive a subject
1:41:58 that might be a little bit offensive,
1:42:00 that might hurt your ego a little bit.
1:42:01 Is this what you mean by like have the
1:42:02 words?
1:42:03 >> hard to do that on your own because
1:42:05 people
1:42:06 don't want to hurt other people's
1:42:07 feelings. And so just saying it as it is
1:42:09 may not be the right approach either.
1:42:11 That's where again couples therapists
1:42:13 are very good at holding space for those
1:42:14 different conversations. And I think one
1:42:17 of the other problems here Stephen is
1:42:19 many times there's no bad guy. Of course
1:42:22 when it's obvious someone cheats on
1:42:24 someone, someone breaks trust, yes
1:42:25 there's a bad guy. But so often, you
1:42:28 know, say someone has a higher libido
1:42:29 than someone else. There's no bad guy.
1:42:31 That person has a high libido and that
1:42:33 person has a low libido. There's no evil
1:42:34 bad guy, but there is still conflict.
1:42:37 And so how do you deal with conflict
1:42:39 when it's not a good guy bad guy
1:42:41 situation, but you and how do you love
1:42:43 someone and evolve with them, right?
1:42:46 Like I think it's not easy.
1:42:47 >> I think your point there though is
1:42:49 actually
1:42:50 where it starts often which is this
1:42:52 point of empathy. The minute you realize
1:42:53 that there is no bad guy. Just as you
1:42:54 said it, I thought oh my gosh, yeah.
1:42:56 Back when I had those intimacy
1:42:58 challenges in that relationship,
1:43:01 it was a case of trying to figure out
1:43:03 who the bad guy was. I was like, is it
1:43:04 me? Is that me problem? Is it a you
1:43:06 problem? That's kind of like what the
1:43:07 brain jumps to. But actually now that
1:43:10 had time passed and we figured out what
1:43:11 it was, turns out that it was neither of
1:43:13 us. It was really the whole time not me
1:43:16 against her or her against me. It was me
1:43:18 and her against the problem.
1:43:19 >> Mhm.
1:43:21 >> And that refrain, I think removes the
1:43:23 like shame, the blame, and all that
1:43:25 stuff that gets in the way and focuses
1:43:27 you as a team
1:43:29 on resolution and conflict resolution.
1:43:31 Thank you. You've you know, you said
1:43:33 that
1:43:34 I will help people, but actually you're
1:43:35 the one that's helping people. I'm just
1:43:37 asking questions
1:43:39 and uh
1:43:40 >> I disagree. I think it's the simple is
1:43:42 the vulnerability of watching others.
1:43:46 It's the simple stuff that makes the
1:43:48 biggest change.
1:43:49 >> Why does this matter so much, Jack? I
1:43:50 can see it in your face.
1:43:53 >> Because so many people are hurting.
1:43:55 Relationships are hurting. People's
1:43:56 health is hurting. People aren't having
1:43:58 as much pleasure and joy and quality of
1:44:00 life that they could be having using
1:44:02 what we already know to be true. Simple
1:44:05 things, communication, connection,
1:44:07 education, basic medical care. These
1:44:09 things can bring so much joy, health,
1:44:13 great relationships, great living. I see
1:44:16 it every day in my clinical practice and
1:44:18 I want that. I want that for every
1:44:20 person out there and I want them to
1:44:22 fight for it and I want them to advocate
1:44:24 for it and I want doctors to show up in
1:44:26 a big way to help them and I think we
1:44:29 can do it. But I I I am so passionate
1:44:31 about this because I see all the like I
1:44:34 see how much it's not being done.
1:44:37 >> Dr. Rachel, we have a closing tradition
1:44:39 where the last guest leaves a question
1:44:40 for the next not knowing who they're
1:44:41 leaving it for. The question left for
1:44:43 you is, what would be one thing you
1:44:45 would like to do or improve in your life
1:44:49 tomorrow?
1:44:54 >> I would like to get better about
1:44:56 practicing what I preach because we
1:44:59 always say the shoemakers kids don't
1:45:01 wear shoes. I am addicted and obsessed
1:45:04 with what I do. I love my work so much,
1:45:07 but I don't necessarily spend as much
1:45:10 time
1:45:11 lifting weights that I should or not
1:45:14 scrolling on my phone and paying
1:45:15 attention to my children that I should.
1:45:17 I don't spend as much time, you know,
1:45:20 scheduling those quarterly spouse dates
1:45:22 that I tell other people to do. And so I
1:45:24 think practicing what I preach is a huge
1:45:26 opportunity for me.
1:45:28 >> Well, that's refreshing to hear cuz none
1:45:29 of us are perfect in that regard. So,
1:45:31 it's good to know that just having all
1:45:33 the information doesn't necessarily mean
1:45:35 um it's easy to execute upon.
1:45:37 >> Easy to do, easy not to do.
1:45:40 >> Amen.
1:45:41 Um
1:45:42 where do people go to find more from
1:45:44 you? Do they go to your Instagram, your
1:45:46 website, your YouTube channel? Where
1:45:47 should you Where should they go?
1:45:49 >> Yeah, our website is really fabulous. We
1:45:51 are very big into research, education,
1:45:53 advocacy, and mentorship. So,
1:45:56 rachelrubinmd.com
1:45:58 that would lead you to sign up for our
1:45:59 newsletter which is really an incredible
1:46:01 source of education. We are extending
1:46:04 you the the latest and greatest in
1:46:05 studies, research that you can be a part
1:46:08 of, job opportunities, um and advocacy
1:46:10 for clinicians. We have courses in
1:46:13 teaching you how to do this both free
1:46:15 and uh ones that come with continuing
1:46:17 medical education. I would say Instagram
1:46:20 is um the most popular for me right now.
1:46:23 Uh although we're trying to get louder.
1:46:25 If only I had your skills, I I would
1:46:26 love to be louder on YouTube and other
1:46:28 places. Uh we do have a clinical
1:46:30 practice both in Washington D.C. and Los
1:46:32 Angeles. And so, if we can help in any
1:46:35 way on the sexual health side, please
1:46:36 reach out to us because sexual health is
1:46:38 just health and your quality of life
1:46:40 absolutely matters.
1:46:42 >> I'll link all of that below.
1:46:44 And I hope people sign up for your
1:46:45 newsletter as well. That sounds really
1:46:46 interesting.
1:46:46 >> Thank you.
1:46:47 >> Dr. Rachel Rubin, thank you so much for
1:46:49 all of this. Um I think it's it's so
1:46:51 so telling that your conversations are
1:46:53 often the most shared on the podcast and
1:46:56 in generally in podcasting because the
1:46:57 subjects are so um so important to so
1:47:01 many people's lives and they can relate
1:47:02 to feeling not themselves as you say,
1:47:05 but there's very few people out there
1:47:06 that have the credibility, the
1:47:08 experience with patients, but also the
1:47:11 the ability to articulate it in a way
1:47:13 that's highly accessible like you have.
1:47:14 So, I know that you you know, we talked
1:47:16 beforehand, you don't necessarily love
1:47:17 doing this,
1:47:18 but um it's a very very important worthy
1:47:20 cause cuz there's very few people that
1:47:21 can speak to these subjects with the in
1:47:23 the way that you can. So, please keep
1:47:24 doing it.
1:47:24 >> So kind.
1:47:25 >> Anybody who's listening now, I highly
1:47:27 recommend if there's somebody in your
1:47:28 life that might want to listen to this
1:47:29 conversation, I think there's a reason
1:47:31 why Dr. Rachel's conversations are
1:47:33 always the most shared.
1:47:35 Um please do share it with them. Dr.
1:47:39 Rachel, thank you so much for your time.
1:47:40 >> Thank you.
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