Episode summary
Intimacy Expert: The Masterclass On Better Sex, Orgasms & Pleasure | Dr Rachel Rubin
The Diary of a CEO
· · Hosts: Steven Bartlett · Guests: Rachel Rubin
Summary
Dr Rachel Rubin argues that women’s sexual health is being systematically neglected because most doctors are not trained to diagnose or treat the hormonal and physical causes of pain, low libido, and poor orgasms. She says the result is that women are often dismissed with vague advice, even though many problems are treatable with basic, evidence-backed interventions.
A major theme is hormones, especially menopause, perimenopause, and testosterone. Rubin says testosterone is not just a “male hormone,” that it often starts dropping in women in their 30s, and that birth control, antidepressants, and GLP-1 weight-loss drugs can affect sexual function. She also argues that hormone therapy was set back by the misinterpretation of the Women’s Health Initiative, leaving only 1.7% of eligible women getting prescriptions.
Rubin is especially emphatic about vaginal estrogen and DHEA, which she says can prevent urinary tract infections, reduce dryness and pain, and improve arousal and orgasm. She also explains that painful sex is not normal, can come from the pelvic floor, tissues, nerves, or endometriosis, and should be evaluated by a specialist rather than shrugged off.
Key takeaways
- Rachel Rubin says most doctors were never trained in sexual medicine, which is why women are routinely dismissed on menopause, libido, and pain.
- She says testosterone in women begins dropping in their 30s and can affect libido, arousal, orgasm, and satisfaction.
- Rubin says the 2000s backlash after the Women’s Health Initiative still suppresses hormone therapy use, with only 1.7% of eligible women receiving prescriptions.
- She argues that vaginal estrogen or DHEA can prevent more than half of UTIs and help with dryness, urinary symptoms, and painful sex.
- Painful sex is not normal, and Rubin says it can come from hormonal changes, pelvic floor dysfunction, nerves, or conditions like endometriosis.
Notable quotes
“I am filled with rage because I do think that people are limiting their ability to have great sex, great relationships, and great health”
“the word clitoris today in 2026 does not exist in the checklist for what an OBGYn has to learn in their training”
“women are not getting access to generic medications that could save their lives and also really improve quality of life”
“hormone replacement therapy, which is a term that we used to use for hormones in menopause”
“Sex is not supposed to be painful. If sex is painful, you need to figure out why it's You deserve a diagnosis”
How the episode opens
You rub it inside the water, the vagina
And just rub it in like you would rub sunscreen on your face. And if you do that twice a week, it makes sex not painful and dry. It helps with arousal and orgasm.
It's literally better than Viagra. And it's cheap. And I'm telling you all this as a urologist that this cream can also help prevent death from urinary tract infections.
But more than 75% of people in large database collections are not getting prescriptions for this. And so women are not getting access to generic medications that could save their lives and also really improve quality of life. And so I am filled with rage because people are limiting their ability to have great sex, great health because they aren't having access to all the information that they could.
For example, women are not orgasming as much as men. The data is very clear there. And women come to see me all the time is I'm a sex doctor and they say I'm broke and you have to fix me.
I'm not orgasming during sex. And I think the majority of problem is education. Women think that orgasm comes from penetration, but their clitoris is how most women orgasm.
And yet, most women do not know where their clitoris is. And in fact, the word clitoris today in 2026 does not exist in the checklist for what an OBGYn has to learn in their training.
And as men, what are we getting wrong in heterosexual relationships when we're trying to arouse our partners? Well, men are constantly asking about they want their penises bigger, harder, straighter, girthier, lasting longer, but none of that has anything to do with how women experience pleasure and satisfaction in the bedroom.
From the episode’s captions: roughly the first two minutes, lightly cleaned. Keep watching on YouTube →
Topics
- women's sexual health
- hormone replacement therapy
- testosterone for women
- pelvic floor and orgasm
- medication effects on libido
Watch the episode
Summary, takeaways and quote selection by Octagon. Quotes are short excerpts; the full conversation is in the episode.
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