You rub it inside the walls of the

vagina, like that.

>> 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 as

I'm a sex doctor. And they say, "I'm

broken 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 the 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 [music]

and satisfaction in the bedroom. So

that's why I'm so loud about these

things because no one is getting good

sex ed. Because the basic information is

not being shared. And we fundamentally

don't give a crap about women's sexual

health, about their menstrual cycles,

pregnancy, menopause, hormones, pain

with sex, libido. [music]

But we actually do have a lot of

information that we are not using

because everyone forgot to teach your

doctor.

>> And I want to focus today's conversation

on women's health cuz I have so many

questions and curiosities.

>> Right.

>> So let's start with the subject of

hormones.

>> This is going to be so [ __ ] good.

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>> [music]

>> Dr. Rachel Rubin.

Before we started recording, you said a

line to me, which I found to be very

interesting. You said, "I'm filled with

rage."

Why are you filled with rage?

>> I am filled with rage because I do think

that people are limiting their ability

to have great sex, great relationships,

and great health because they aren't

having access to all the information

that they could, and they're going to

see doctors who actually don't know how

to help them with these problems.

>> And on the subject of women's health,

sexual health, hormones, etc., can you

give me the background context of the

disservice that's been done? I remember

you you were talking previously about

how even the most affluent women in the

world are being let down.

>> Yeah, I think this is the great

equalizer in the fact that no one is

getting good medical care here when it

comes to hormone therapy, menopause, and

sexual health. Melinda Gates just came

out and said she had to see three

doctors before she got proper hormone

therapy prescriptions. Oprah had to see

five doctors and still they didn't

understand that her heart palpitations

was from perimenopause and menopause.

How about Halle Berry, right, who has

access to all the doctors in the world

and she publicly came out and said she

was diagnosed with genital herpes when

she really just had the genitourinary

syndrome of menopause. The rich people

are not getting good information about

their bodies, about their hormonal

health, about their sexual health. So,

what are the rest of us doing? We don't

teach it in medical schools, we don't

teach it in residencies. I didn't learn

anything about it and so we are actually

getting worse at this, not better at

this. And so I'm full of rage because we

actually do have a lot of data and we do

have a lot of information that we are

not using because everyone forgot to

teach your doctor.

>> It's staggering to me that, you know,

those very affluent women that you've

mentioned still are being let down by a

medical system. Um, it also sort of begs

the question that if men were in that

situation, this probably wouldn't be the

case. And that's says something about

the research and the investment that's

gone into understanding women's health

relative to men's health.

>> It's a huge problem. We don't have

enough specialties of medicine that

focus on women's health and we don't

have enough like manpower behind us. We

can throw money at the situation, but

you need physical human beings to roll

up their sleeves and do this work. Like

doing research is challenging and you

need people to actually disseminate the

research and talk about the research and

you need the training to happen so it

has to trickle down. So, just because

someone wrote a paper doesn't mean it

automatically gets downloaded into every

doctor's brains. So, someone has to

teach someone how to do something. So, I

I lecture all the time. I do a lot of

trying to teach clinicians how to do

this. I travel all over to say, "Here's

how to write prescriptions." because

that's what it's going to take. There

was so much fear and misinformation 20

years ago about hormone therapy that it

is a lost art. Doctors don't know how to

write the prescriptions. Nobody taught

them how. So, even if they see headlines

and Melinda Gates giving $10 million to

the Menopause Society, that's wonderful,

but it doesn't translate into them

knowing how to actually write the

prescription, knowing the difference

between the type of hormones, knowing

the safety, the risk, the benefits,

because they never had the class. For

example, I'm a urologist. If someone

comes in to me asking about their blood

pressure, I'm not going to pretend like

I know everything about their blood

pressure. I'm going to be very honest

that I have the limitations in my

training. But, for some reason with

hormone therapy and women's health,

every doctor you go see has strong

opinions and will tell women what they

can and cannot have with their bodies

even when they don't know the data. I

come from the men's health world. We

don't tell men you can't have this. You

can't do this. We we talk about shared

decision-making. We talk about risks. We

talk about benefits. For some reason we

don't do that enough in women's health.

>> Why?

>> I think part of it I don't think your

doctor is evil. I actually have a

thought about this. So, I think your

doctor wasn't trained. I think they're

trying to save face. And I think 10

minutes is impossible to give good

medical care. I could never get to know

you fully in 10 minutes and really give

you great advice on your life that's

customized for you. It's almost like the

difference between a viral clip that

you're going to try to do from this

episode and the long-form nuanced

conversation that you're going to have.

You love the nuanced conversation. You

love spending those those 2 hours. And I

think patients want that, too. But, when

they go to the doctor, they're getting

the 10-minute version. And instead of

doctors saying I don't know, they're

sort of saying no no you can't have this

cuz it's easier than than sort of going

into that nuance, which can take time. I

also think that people are going to

their doctor, say say you want to talk

about your orgasm or your libido. Okay?

You go to your gynecologist. Of course,

my gynecologist should know everything

there is to know about the clitoris,

about orgasm, about hormones, about

That's what they do. And the truth is

it's not what they do. And it's they

were never taught that. And they

>> taught about the clitoris.

>> They were The word clitoris today in

2026 does not exist in the checklist for

what an OB/GYN has to learn in their

training. The word doesn't exist.

>> What is an OB/GYN for anyone that

doesn't know?

>> An OB/GYN is a doctor who specializes in

obstetrics, so delivering babies, and

gynecology. So, your gynecologist has

never been taught about the clitoris,

about the vulva, about sexual health,

about sexual pain, about libido,

arousal, and orgasm. And so, the ones

who have taken it on their themselves to

get extra training, they're very few and

far between. And so, every day women,

and men too, are going to a doctor

expecting answers on a topic that their

doctor probably has never gotten

training on.

>> And I do want to focus today's

conversation on women's health. And I

want to preface all of this by saying

that I'm going to be as dumb as I am on

this subject. If you say something about

the vagina and I don't know what it

means, I'm not going to pretend to know.

I'm going to ask you what it means. And

I say that because I sometimes think

with these conversations

um the host

often

is too shy to admit their ignorance. And

I have lots of ignorance on this. But I

also have lots of curiosity, and I want

to fill those gaps. And that's going to

require me to be very, very

dumb. And also, my second reason why is

because I have so many women in my life.

Um if you just look at my company, my

entire executive team in my company are

all women. And also, I've got my fiance,

my mom, my sister. And understanding the

women in my life um one element of

understanding them is understanding

their health. Women's health isn't

something that I was ever taught in

school. It's not like a lesson I had.

So, I also think this conversation

is for men. Every man has um four

important women in their lives. So, my

question to you is if if a woman has

clicked on this conversation right now,

what are they going to get from it?

Let's start with that first question.

>> So, I think it's really important

because as men, we expect the women to

know. Surely the woman knows about their

menstrual cycle, about pregnancy, about

postpartum, about menopause, about

hormones. Surely my partner knows, you

know, or the woman in my life, my mom,

my sister, my my daughter, they know all

of that, so I don't have to. And the

truth is, they don't know. When the

women in your life go to their doctor

and they're getting a pelvic exam, say

they're getting a Pap smear, a doctor is

looking at their their genitalia,

putting a speculum in, going inside the

canal and looking around. We put a sheet

over you like we are me chanics looking

under the hood. So, we put a sheet to

keep you comfortable, to keep you

modest, but we we hide your genitalia

from you and we don't teach as we go.

So, I became famous again because I I I

when I started my practice, I didn't buy

any fancy equipment, I bought two

mirrors on Amazon and I give women a

mirror and as I'm examining them, I say

to them, "This is your labia majora.

This is your labia minora. This is your

clitoris. This is your your urethra, the

tube that you pee through." Because

women can't see it. You've got skin,

you've got bones, you've got muscles,

you've got nerves, you've got, you know,

all the organs that are on the inside

and women don't have access to this

language. Certainly men don't have

access to this language. And so, it's

that basic ability to give women

language, you can learn about your body

parts, you can learn how hormones work

in your body, and you can learn basic

medicine for you that becomes important

for how you advocate for what you want,

what you care about, and who you bring

into your medical life. You may have a

physical therapist, you may have a

mental health person, you may have a

primary care, a gynecologist, you may go

on Instagram and get great information

from people on Instagram. And so, that

doctor that makes you feel like crap

because they they tell you something

that you don't agree with, find a

different one, right? You have to

advocate for yourself and I find we are

starting to empower women to do that, um

which is very challenging.

>> What is the most popular question you

get asked now that you've been on these

podcasts and you know you're out there

and you've done millions and millions of

views all over the place and on clips

and so forth. What is the number one

most popular question you get asked?

>> I'm asked a lot about hormones. Like

people want to know about hormones.

People want to know about pain with sex.

And I think people want to know about

libido. I think those are the three I

would say most common things that we

talk about.

>> go in that order then. So let's start

with the subject of hormones. What is it

about hormones that people are so

desperate to understand?

>> So hormones are fascinating because we

forgot to teach doctors anything about

hormones.

And what we have taught about them, they

think it's dangerous, they think they're

harmful, they think that you know it's

it's almost like this thing that is

natural in your body is somehow

dangerous once you get over a certain

age. And that is all politics and bad

interpretation of science.

>> I've got this graph here which um

shows female testosterone levels by age.

And again, as someone that has started

to understand more about female

hormones, I was quite surprised because

you think of testosterone as a male

hormone.

>> Yeah, so that's the biggest

misconception is that women don't make

testosterone. Testosterone is just a

hormone. It's not a male hormone, a

female, it's just a hormone. It's also

not a menopausal hormone. We think of

menopause as estrogen starts to drop,

right? So menopause is a castration

event. If I cut your testicles off right

now, you would have hot flashes, night

sweats, osteoporosis, depression, low

libido, erectile dysfunction, metabolic

syndrome, your weight would go up and

you would be generally pretty unhappy.

It's a big deal when we castrate people.

And yet, we don't do it for men

regularly unless there's a very

significant medical reason to do so. And

yet, every woman over the age of 50,

her estrogen goes to essentially zero.

And that affects bone health, it affects

the brain, it affects the heart, it

affects sexual health, it affects UTIs

start to go up. And so it's a whole body

event that happens. Now, testosterone's

really interesting cuz it actually isn't

at menopause that you lose testosterone.

It happens in your 30s. So, if you look

at this graph, right? You can see

testosterone starts to precipitously

drop in your 30s. So, what do we see

clinically? Sometimes nothing, but we

have a lot of people who will start in

their 30s, mid-30s, late 30s start to

say, "Ooh, my libido's not as high as it

used to be. Huh, my orgasm takes a

little bit longer. I don't feel as

aroused. My engorgement is not the same.

My lubrication

>> Engorgement.

>> Engorgement of the clitoris. It's the

same as an erection, right? So, the

clitoris and the penis are the same.

They get hard with blood flow. And so,

this happens in your 30s and no one's

paying attention because if you look at

the graphs that we are taught in med

school, they look more like this. So,

the books all talk about estrogen and

progesterone. They don't talk about

testosterone very often. And there's

also a lot of things we do to worsen

this problem. When you play with

hormones, there are consequences,

sometimes good and sometimes bad because

we do so much to mess with our hormone

levels. Again, birth control pills, the

way that they work is changing hormone

levels. Medications for acne,

medications for hair loss that people

are using can affect your testosterone

levels. So, birth control is wonderful,

but there are side effects to birth

control just like there's side effects

to any medication. And so, one of the

side effects is it lowers testosterone.

And so,

that can cause low libido, pain with sex

in a small subset of people who take it.

So, if you're someone who does have side

effects, then it's worth having

conversations of different forms of

birth control which may not lower your

testosterone as much. Does that Does

that make sense?

>> It does make sense and it's

it's interesting. My My partner's talked

about this before. My fiance, she was on

birth control for a long time

and she also had concurrently libido

problems.

Now, we don't know whether it was the

birth control, whether it was something

else, but when she came off the birth

control pills, her libido

challenges also evaporated.

>> So, can explain cuz I think again,

knowing the basics and the fundamentals

give women and men access to the

information so they can make choices

with what they want to do with it. Okay,

so how do birth control pills work? Um

when you take a combined birth control

pill, it has a fake amount of estrogen

and a fake amount of progestin in it so

high that it tricks your body into not

ovulating. So, when you have so much

hormone around, your body says, "Oh, I

don't need to make my own cuz there's

plenty around." And so, the ovaries shut

down. So, your ovaries are no longer

making their own hormones because this

happens to men, too. When you take high

doses of testosterone, you become

infertile because your testicles say,

"Oh, I don't need to produce sperm right

now cuz there's plenty of testosterone

around." And so, birth control causes

your ovaries to just stay quiet. They

shut down for a bit. But, your ovary

does three things. It does estrogen,

progesterone, and testosterone. It

doesn't add back testosterone. So, her

experience possibly was because she

wasn't making her own testosterone. And

when she went off that birth control,

her ovaries woke back up and make

estrogen, progesterone, and

testosterone, which to you equaled more

pleasure. Now, because we focus on the

psychosocial, I'll have a lot of people

saying, "No, no, no, it's all

communication." And all of that is

important. Don't get me wrong. But, the

biology matters too. And we know there

is a biological basis to sexual health

for everybody.

>> I was just looking at some data and it

said that in some studies, up to 27% of

people on birth control report a

decrease in their libido/sex drive.

>> Yeah.

>> Which is shocking cuz, you know, it

varies in these studies from one to

seven people to one to that's almost

like one one in three people

are experiencing it. How does one

navigate that, you know, cuz birth

control has tremendous um upsides?

So, how do you navigate that?

>> I think that everything that we do,

there's the risk of doing something and

the risk of not doing something. No drug

is going to be without possible side

effects and so that's where becomes

important to know what are the

non-negotiables. Antidepressants is a

perfect example. We know that they can

help people, right? A lot of people, but

we know there are sexual side effects

like low libido, delayed orgasm. And so

it has to do with informed consent,

which means I Stephen, if I'm going to

give you a medicine, I want you to know

that there is the common side effects,

the less common side effects, and then

the disastrous side effects. That's why

on the commercials they talk about all

the disastrous side effects. But often

they don't even research the sexual side

effects. So for example, GLP-1s, okay?

>> What's a GLP-1?

>> Yep, the GLP-1s are the weight loss

drugs that everybody's talking about.

Ozempic, Mounjaro, all the all the

celebrities are on these injections that

are making them lose tons of weight. We

are starting to look at these drugs in

women, but they're not nobody's looking

at it for sexual health. Everyone's

looking at it for can you get pregnant?

Reproductive health. There is not a

single published paper on sexual health

side effects for women. So we did a

survey, it's not published yet, but we

presented it at a conference at a

medical conference. We surveyed a

thousand women online who have taken

these medications and about 25% report

sexual side effects from these

medications. Again, that's not to say

the medicines are good or bad, right or

wrong, but there are side effects. Now

of those 25% about 50% of those people

said it lowered their sexual function

whether it's libido, arousal, and

orgasm. And about 25% said it made it

better.

>> So carrying on in this track about

women's hormone levels through time and

through age and through life phases,

what else do I need to know or

understand about how important

testosterone is?

>> So we know we have global consensus

actually that testosterone helps for

libido in postmenopausal women, okay?

Now there is also data in perimenopausal

women as well and that is clear data. It

helps with libido, but it also helps

with arousal, it helps with orgasm, and

satisfaction. It can also help with body

image, which is like a cool a really

cool thing. In my clinic, I use FDA

approved testosterone for men, and I

give it to them in doses appropriate

like 1/10 the dose for a man, I give it

to my female patients. And I see that

over the 3 to 6 months of taking it,

they get this

it clicks. Now, does that mean every

woman on Earth needs it? No, we're not

there yet, but if you want it and you

want to try it and you're curious about

it, then you should have access to

physicians who understand how this works

and they know how to write the damn

prescription.

>> There's five life stages on here. We

have puberty, your fertile years,

perimenopause, menopause, and then post

menopause.

When you think about a woman's hormonal

journey through these different life

stages,

what is the sort of advice you would

give them to make sure they're

hormonally healthy across every life

stage? What are like the basics? What

are the tactics, strategies, medications

that they should be thinking about? And

I say this because I've got women women

in my life for every stage in this life

phase at the moment. I've got you know,

I've got my nieces in the sort of

puberty era. I've got my my fiance in

the fertile years. I've got my mom and

grandparents etc. in the peri- and

post-menopause years as well.

>> Yeah. So, if you look at your nieces for

example, when they were babies compared

to now, there are changes happening.

Their bodies are transforming because

they're getting a surge of hormones in

their body and that's estrogen,

progesterone, and testosterone. They're

cycling, which means they're getting

periods. So, let's talk about the

menstrual cycle for a second. I think

it's helpful.

>> Okay.

>> So, [clears throat] when women have

their period,

they bleed for a few days, right? And

that's when their hormones, their

estrogen and their progesterone is at

its lowest, okay? So, hormones are at

their lowest. And then

the hormones start to increase. Your

estrogen starts to go up. You don't make

progesterone yet in the beginning. Your

estrogen starts to go up and it make

there's a a follicle in your ovary which

has an egg, right? It's going to pop out

an egg.

Ovulation is when the egg pops out. So,

you get this big surge of estrogen and

then when the egg pops out of the ovary,

right? That's what's going to make a

baby if it gets fertilized, there is a

shell of the egg, right? The egg has a

shell which makes progesterone. So, the

second half of the cycle there's

progesterone around, okay? First half of

the cycle no progesterone.

>> Mhm.

>> And so, that [clears throat] second half

of the cycle the shell has making

progesterone and then when you don't

have fertilization, the shell starts to

break down.

>> Okay.

>> And that natural breakdown is a drop in

progesterone which causes the lining of

the uterus to shed and you get a period

again. And so, it's estrogen goes high

in the beginning and then pops out an

egg, progesterone gets high in the

second half and then they both fall and

you have a period. And so, the hormones

being low in the beginning, estrogen is

not zero. It's about 50, okay? So, when

we talk about numbers, if you get your

your hormones checked, if they're at

their low it's like 50, but when you

ovulate, your estrogen may be 150, 200,

300. And then when you're pregnant, your

estrogen may be as high as 3,000 or

higher, right? It's very many thousands.

And so, these hormones have actions in

our bodies. And so, the reason it's

important is cuz when we give back

hormone therapy, well, are we giving

back 10,000 like pregnancy? No, we're

giving back to be like 50, 60, 70, the

way that you are early in your cycle

kind of a thing. Now, testosterone's not

even on this graph that everybody gets

taught of estrogen then progesterone,

but we do know testosterone is pretty

stable through the cycle, although we do

believe it peaks during ovulation which

makes sense cuz you want to have a baby,

right? So, evolution says, "Okay, you

need to be horny around the time that

you are going to ovulate." And so, your

testosterone starts to go up. Now, it's

really important cuz you're probably not

having a conversation with your nieces

about their menstrual cycles, but it's a

problem because no one's talking about

it if they're painful, if they're

abnormal, if they're um uh uh uh we

don't have a lot of conversations around

what is a normal amount of bleeding. We

have so many people who have problems,

whether it's PCOS, which is now called

PMOS, which is a metabolic issue that

causes you to have irregular periods.

There's endometriosis where you have

painful periods. There are so many

medications we give to people that can

alter their hormonal health and and

sexual health for that matter. And then

it all starts to get even more chaotic

in perimenopause, which is again age 35

to 45. If menopause we say is 45 to 55,

right, is normal menopausal age. Average

age is 52, and we think perimenopause is

when things start to change for people

about 10 and it can be about 10 years.

That means 35 to 45. So, how old are

you? I don't remember.

>> 33.

>> 33. And my partner's 33.

>> All right, so 33. So, this idea that I'm

too young or it's too early or I'm not

there yet, the truth is things do start

to change.

>> What changes for a woman?

>> So, there are so many symptoms to

hormonal fluctuations. So, for some

people it's temperature changes, for

some people it's fatigue, for some

people it's remembering things, for some

people it's low libido. Some people get

dry eyes, itchy ears, burning mouth,

joint pain. Some people get irregular

periods. Some people get pain with sex.

Some people get UTIs. I would love to

talk about what why hormones are so

important for the bladder and UTI

prevention. And so, there are so many

symptoms and everyone says, "Oh, we're

blaming everything on hormones." And the

truth is, we haven't talked about

hormones enough to actually start

looking at this to figure out what is

important and what is hormonally

important.

>> So, when you start to lose progesterone,

when you arrive at perimenopause, what

are the symptoms you feel? Are they

different symptoms to decline in

estrogen?

>> So, it's hard to know for sure, but some

people think that as the progesterone,

so your sleep starts to get a little

crazy, anxiety starts to go up. And so,

some people will start with progesterone

as a support for

you know sort of perimenopausal hormone

therapy but estrogen can also help with

many of those symptoms. So it's not a

one size fits all of whether we give

people everybody gets progesterone or

everybody gets estrogen. Sometimes

people just get testosterone because

remember that falls in your 30s you know

so there's sometimes where we

do all three and there's sometimes where

we do just one or two. Now it's a very

evolving conversation because most of

the book answers most of the guidelines

really talk about menopause and how we

treat people in this menopause when

you're flatlined. Remember that

castration event where everything's zero

and then we add back hormones. So now

we're starting to talk about

perimenopause as a place to to start

giving women hormones and that's a a

very important and evolving conversation

that is happening.

>> And so this conversation that's

sort of raging on about HRT

about safety about what age you should

take it who should take it what form you

should take it in. What's your

perspective on that and what do women

need to know about that?

>> Yeah so so it's important because

>> is HRT?

>> Yeah it's a great question. So hormone

replacement therapy which is a term that

we used to use for hormones in

menopause. It has a bunch of different

names and everyone tries to change the

marketing around it but hormone therapy

in general is this idea of giving back

hormones when you have hot flashes night

sweats osteoporosis you know sort of

this over 50 crowd that has this

declining estrogen and progesterone

levels. And so typically classic hormone

therapy is estrogen and progesterone.

Now again taking just estrogen estrogen

grows things it helps your bone health

it helps your hair skin and nails it

helps you not have hot flashes it helps

you sleep. It can also grow the lining

of the uterus and so if it gets thicker

thicker thicker there is worry over

years that leads to endometrial or

uterine cancer. So endometrium is the

lining of the uterus so here I can okay

so this is a this is a vagina and then

at the the vagina's like a socket. The

very end of the socket is a tiny hole

and that hole is the the pinpoint

opening of the cervix and that hole if

you go through that tiny tiny hole, it

gets to the uterus and the uterus is a

cavity where we hold babies

where the lining comes out. That's what

period blood is is the lining of the

uterus here which we'll call the

endometrial lining. So progesterone is

very important for this lining here. If

the the lining of the uterus gets too

thick with just estrogen, that can lead

to problems, but if you match it with

progesterone, those problems go away.

>> Right. So so if you just gave someone

estrogen, then the linings of the uterus

would get so thick that that would cause

a problem, but if you give it to both

hormones together, it sort of balances

itself.

>> them out and so that's why you'll hear

hormone therapy talked about estrogen

and progesterone just like the birth

control pill your partner was on was an

estrogen and a progestin. There was a

combination.

>> Okay, got you.

>> And also the history is kind of

important here of why your mothers and

grandmothers weren't given access to

this medication and the stigma behind

it. In the late 90s, a lot of people

were on hormone replacement therapies

and they were seeing benefits. They

actually were all these observational

studies that showed wow, the heart

disease is less and like

>> During menopause.

>> during menopause and a billion dollars

went into the NIH to study this in women

and they did they that was called the

Women's Health Initiative. It was

thousands and thousands of people age 50

to 79. They gave a hormone pill like a

birth control pill almost to all of

these women and they followed them and

they stopped the study early in the

early 2000s and they did a press

conference and at this press conference

they said we're shutting down the the

study early. Hormone therapy causes

cardiovascular disease and breast

cancer. And overnight, a multi-billion

dollar industry went to nothing.

Everyone was told throw your hormones in

the garbage. This is dangerous. What was

crazy is those people who were

prescribing hormone therapy were looking

around saying, "I don't understand. My

patients aren't dying of heart disease.

They're not getting extra breast

cancers. Like, this doesn't make any

sense." And when people actually looked

at the study, it didn't say any of those

things. It was wild how misinterpreted

this study was. In fact, the same

authors of this study back in the early

2000s published this year, in 2025

actually, that below age 70 that type of

hormone therapy, which we don't really

use anymore, has no increased risk of

cardiovascular disease or stroke. And

yet now you have a generation of doctors

who weren't taught how to do this. Only

1.7% of women have are getting

prescriptions for hormone therapy who

who should be offered prescriptions. So,

it is a disaster.

>> Only 1.7%?

>> Only 1.7%.

>> Oh, really? Hmm. Wow.

>> And so, hormone therapy is not something

that I'm saying every woman must have,

but every woman should have access to

the toolbox. I like to think about

hormone therapy is really four buckets

that we talk about. Hormone therapy is

whole body estrogen, which helps with

hot flashes, night sweats,

uh bone loss, progesterone, whole body

progesterone therapy, which protects the

uterus and is this yin yang, especially

if you have a uterus, but it helps with

sleep, and it can help with anxiety

reduction in many of our patients, not

everybody, but a lot of them. The third

thing is testosterone, which we talked

about, which can help with libido. Um

that's what we have the most evidence

for. And then the fourth thing is

vaginal hormones. Now, vaginal hormones

are microdoses of estrogen or what we

call DHEA vaginally, that supports the

bladder and the vagina. So, it helps

with pain with sex, dryness, urinary

frequency, urinary urgency, leakage, and

it prevents urinary tract infections

massively. It is safe for your great

grandmother in the nursing home. It is

safe for your wife who's breastfeeding.

So, if you know anyone in your life who

is a woman, who's having urinary

frequency, urgency, leakage, urinary

tract infections, pain with sex,

dryness, there is a magical solution

that is safe for everybody on Earth um

that is microdosing these hormones

vaginally.

>> At any age?

>> At any age at all. In fact, even more

important for people who are older

because they are dying of urinary tract

infections. So, it's it's it's one thing

when a young person gets a urinary tract

infection and they go to the urgent care

and they get an antibiotic. Even they

deserve prevention and this is prevents

uh those problems in those people, too.

>> Again, what is this?

>> So, vaginal hormones. So, this is a

really important topic. It's called

genitourinary syndrome of menopause or

GSM. Say GSM loudly for your listeners.

>> GSM.

>> GSM, genitourinary syndrome of

menopause. Genital, urinary, syndrome of

menopause. But, really, it's kind of a

dumb name because it's any hormonal

changes in your body can affect the

bladder and the genitals.

>> So, UTI. What is a UTI? And what's

what's causing a UTI? U- urinary tract

infection.

>> Yeah, very good. So, urinary tract

infections are when there is bacteria in

the bladder and it can be a lot of uh of

bad bacteria that can grow and create uh

inflammation. It causes bladder pain,

pain with urination. It feels like razor

blades. Um but, it can also go into your

bloodstream and cause fevers and chills

and cause kidney infections. It can

cause something called urosepsis where

you have to go to the intensive care

unit and need uh antibiotics through an

IV and it can kill you if you have an

infection go through your whole body.

And this gets worse and worse as you get

older.

>> Why is there a link between hormones and

UTIs?

>> Yeah, because what happens is the vagina

is supposed to be acidic and healthy and

hormones help keep it. It is the

hormones, the estrogen and the

testosterone, that keep healthy bacteria

growing in the vagina and suppress or

lower the bad bacteria.

>> So, there really is a vagina microbiome.

>> There is and There's There's no

probiotic on Earth that is proven to do

what the vagina needs quite like

hormones. Hormones make the tissue go

from uh not acidic to quite acidic, and

it is that acidic environment that

protects it from infection. And so,

perimenopause and menopause or other

situations happen, and it changes that

microbiome, so the good bacteria are are

lower and the bad bacteria start to

grow, which can increase your risk of

infections. And sex Right, sex is a

contact sport. So, uh you're bringing

the outside environment into the inside

environment. Uh ejaculate is also not

acidic, and that can change the

microbiome as well. And so, we know

women who are sexually active also have

an increased risk of urinary tract

infections. So again, like a plant

needing water, vaginal hormones help

support the vagina and the bladder to

maintain that acidic environment. And

research has been clear since the 1990s

that using vaginal hormones prevent

UTIs, urinary tract infections, by more

than half.

>> So, what have we got here in front of

me?

>> All right. So, there's a bunch of

different ways you can give yourself

vaginal hormones. The most common way is

a cream. Now, this cream is uh $14 on

Mark Cuban's pharmacy, and it lasts

about 2 and 1/2 months. Now, this cream

that comes with an applicator, which you

don't ever have to use if you don't want

to, but what you can do is you want to

use 1 g of this cream. So, this amount

is 1 g of this cream. We'll put it on

this paper here to show you. 1 g of this

cream rubbed into the vagina. So, you

take it You can take it on your fingers

and rub it into the walls like you If

you put sunscreen on your face, you

don't glob it on and walk out the door.

You rub it in, so it doesn't look all

white and filmy. So, you put it in You

take it with your finger and you put it

in the vagina and you rub it into the

walls of the vagina you can rub it on

the outer this area as well at the

opening.

>> Let me try it. I don't have a vagina but

So you take the this what what is this

cream called?

>> It's estradiol cream.

>> Estradiol take it on your finger you rub

it inside the walls of the vagina like

this.

>> rub it in like you would rub sunscreen

on your face and if you do that twice a

week you can prevent death from urinary

tract infections. You can help with

urinary frequency, urinary urgency,

leakage, you make sex not painful and

dry, it helps with arousal and orgasm.

It's literally better than Viagra and

this is over the counter in the UK. In

the United States you need a

prescription um but it's as little as

$14 if you use Mark Cuban's online

website it should be covered by your

insurance. Now some women hate creams

and so we have things that are not as

messy as what you're showing right there

and we have little tablet inserts. So

here is a it comes with an applicator

and so what a woman does is put this in

her vagina and press a button

and this little tablet so instead of a

cream you could just put this little

tablet in twice a week and that does the

same thing as the cream.

>> Ah okay.

>> Okay so it's a little less messy so

people tend to like the creams better.

Now if you really don't want to do

anything twice a week this is a ring

that goes in the vagina and it can stay

in there for 3 months. Now this it's

sort of like a tampon you can kind of

put it in the vagina and the vagina does

not feel it. By the way the vagina is

not very sensitive in terms of

nerve endings and so when women put

tampons in they don't feel them. When

you put this ring in that you wouldn't

feel it either and it would stay in for

3 months at a time.

>> It's quite it's quite quite a big ring.

>> Vagina can hold like a bowling ball of a

baby can come out of a vagina so it can

actually withstand quite a lot of

volume.

>> And there's a chemical inside this ring

that's going to diffuse

>> Estradiol that slowly diffuses estrogen

for the ring. So that's nice for women

who have dementia, who have very bad

dexterity with their fingers, they're in

a nursing home, uh for someone who's on

the go and they can't remember something

twice a week. So, our ADHD patients like

things like that. And so, there's just

different It's all the same stuff. It's

just in different formulations. Now, the

one different one, this is something

called DHEA. Now, DHEA is the precursor

hormone to estrogen and testosterone.

And remember I said the vulva, the

vagina, the bladder need testosterone,

too. It So, this is a a chemical that

converts into estrogen and testosterone.

And so, DHEA is a supplement you can

buy, you know, sort of in the in the

supplement aisle, but if you put it

locally in the vagina, this is an

FDA-approved product. It's called

Intrarosa. And if you just put this in

the vagina, uh uh it's meant for every

night, but you can do it twice a week.

Um it it melts at bedtime. When you wake

up, and it prevents UTIs. It helps with

pain with sex.

>> And just to be clear again, so you think

a lot of people should be taking these

these things?

>> believe it's preventative. So, I think

And we wrote guidelines by the American

Urological Association uh why this is so

important, how to do it. So many women

have symptoms of urinary frequency,

urgency, leakage, uh urinary tract

infections, pain with sex, dryness. And

this is a safe option for all of those

women. Does that make sense?

>> It does make sense. And one of the

things that doctors sometimes tell their

patients to take to help with the UTI

situation is that?

>> Okay, this is a disaster. So,

women get urinary tract infections a

lot. And so, what do we tell women? Pee

after sex. Wipe from front to back.

Like, that's not data-driven, by the

way. That's all a folk folk tale. Like,

that's that's folklore. There is some

data that cranberry pills can help uh

with preventing UTIs, but the uh amount

that you'd have to drink is uh very

sugary and diabetes-inducing and won't

taste that good. And so, there they do

make pills, but it's a small These

things are small things that help.

Drinking lots of water can help, but

vaginal hormones, vaginal estrogen or

vaginal DHEA, which we just showed a

bunch of, prevent UTIs by more than

half. They don't just prevent UTIs, they

help with urinary frequency, urgency,

leakage, pain with sex. They help your

arousal, they help your orgasm, and

they're safe for every age with every

medical problem. If you've had cancer,

blood clot, stroke, any problems at all,

vaginal hormones are safe and could save

your life. And so this is such an

important topic.

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Thank you so much.

My my partner's 33 years old now. She's

not yet in the perimenopause stage. At

what point does someone start taking

HRT? Is it when they're in

the menopause stage, which is defined as

12 consecutive months without your

period? Is it when they're

postmenopausal? Is it in perimenopause?

>> Yeah, this is a very important question

cuz it's not a one-size-fits-all. At

this age, start this medicine. It's

really when people start having

symptoms. And so I'll give you an

example. So say your partner um

gets pregnant, okay? You decide to have

a baby. Her estrogen is going to go to

10,000 uh for 9 months. It's going to be

super super high. And the day she gives

birth, it's going to crash to zero. So

you go from super high hormones down to

zero. And if she chooses to breastfeed

or pump or or do any of that, they stay

extremely low in the menopausal range

for the entire time you're

breastfeeding. So when you are

breastfeeding or pumping or doing

anything uh and your periods don't come

back, you're basically menopausal.

>> And what are the symptoms then? So if

you just had a baby, you're

breastfeeding.

>> have hot flashes, she may have night

sweats, she may, you have urinary

frequency, urgency, leakage. There's all

sorts of symptoms that come come with

that.

>> Libido changes as well.

>> Libido definitely changes, pain with sex

goes up. And so we call this the

genitourinary syndrome of lactation. And

so there's all sorts of hormonal changes

that can happen at that time. So we see

a big need for vaginal hormones in this

patient population. It's safe for the

breast milk, it's safe for the baby, it

doesn't cause any problems, but it can

really help with all of those symptoms.

Now say she is done having babies and

now she's 30 8 39 40 and she is doing

fine and she has regular periods and she

has no symptoms and no problem. She may

not need anything at all. But what if

she starts getting a lot of urinary

tract infections or having dry scratchy

painful sex or her libido just doesn't

feel it sort of feels like back it when

it did on birth control pills. That may

be an indication where she may benefit

from whether it's testosterone or

vaginal hormones or some kind of

combination. What if she's 43 and her

sleep starts to get really bad and that

may be an indication for progesterone. I

have a patient who was

having hot flashes and night sweats and

brain fog and fatigue. I see her and she

says I will not take hormone therapy.

It's not safe. My mother told me it

causes cancer. At no point am I going to

do this. I said, okay. We had a long

conversation. I shared data and papers

and we did a shared we just worked with

each other and I wasn't pushing anything

on her, but ultimately she started with

vaginal hormones. Her orgasms come back.

Her arousal gets back and she comes back

to see me and says, "Rubin, what are you

doing here? I'm feeling much better.

Like this is you've given me my life

again. I'm not peeing in the middle of

the night so I'm sleeping better. I

don't have as much dryness. Sex is no

longer painful. I haven't had a UTI in

months. What else do you got?" Well, she

was still suffering with hot flashes and

night sweats. She had a bone density

scan which showed osteopenia and she was

worried about osteoporosis cuz her

mother died of osteoporosis fractures.

Well, if she did whole body estrogen,

she would prevent her risk of a of a

fracture. She would make her hot flashes

and night sweats go away, which would

have benefit on how she sleeps, and

ultimately probably benefit on her whole

vascular system. And so, she started

estrogen, and cuz she had a uterus, she

took progesterone at night, and she

said, "Well, my libido is still a bit

low." We looked at her testosterone. We

said, "Testosterone will likely help

with your libido, but it's going to take

4 to 6 months." So, 4 to 6 months, she

comes back to see me. Not only is her

libido so much better, but she feels

that she has the cognitive ability to

enroll in law school. Like, this woman

literally decides that she wants to

change the trajectory of her career and

enrolls in law school, and her brain is

working in like ways she hasn't seen it

in so long, and she is competing against

22-year-olds in law school. And when I

tell you she finished at the top of her

class, she finished at the top of her

class, whereas she said, "I would have

never even considered this opportunity

uh if I hadn't been doing all of these

things." So, in

>> And what age is she?

>> She's in Now, she's in her 60s.

And so, that's why I'm so loud about

these things, because what other organ

in medicine do we let fail completely

before we like do something about it. We

don't make you go blind completely

before we give you eyeglasses. We don't

let your kidneys run out completely

before we give you dialysis or

medications to help your kidneys along.

We don't let you go into full liver

failure before you get the transplant.

Like, this idea of your ovaries have to

fail, and you have to suffer for 12

months before someone intervenes is

insanity.

>> But for some women, they do start HRT

during the perimenopausal phase.

>> Yeah.

>> And for some, they start it during

menopausal postmenopausal stage.

>> Correct.

>> And it's all depending on you how you're

feeling.

>> It's all depending on how you're feeling

and what you want, what your objectives

are.

>> Okay. But it's never too early to start

necessarily.

>> not necessarily. Like, so again, we give

birth control all the time to people in

their reproductive years. Birth control

is just high-dose fake hormone therapy,

right? So, we're giving women hormone

therapy as young as in their teens,

right? To help with different things in

birth control. But, so if you think of

it as all of it is some form of hormone

therapy, it just depends are we using

the natural form of hormone therapy or

we using the synthetic hormone hormone

therapy? We have to get comfortable with

hormones at all ages. And the thing that

we see most commonly, Steven, is sort of

what we call NFLM, not feeling like

myself. I love that statement because

women are coming to the doctor every day

saying NFLM, I'm not feeling like

myself, and they're getting dismissed.

And the truth is there are often

hormonal reasons why you may not be

feeling like yourself. So, for some

people it might be musculoskeletal pain,

so we see plantar fasciitis and frozen

shoulder, and we think of as those

having underlying hormonal causes as

well. So, there's published data that

less than 9% of Medicare patients are

getting prescriptions for this.

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.

I don't know about you, but dryness

People are not having sex anymore

because of the pain, the dryness, the

irritation when it's fixable.

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You said um earlier that one of the

questions people come to you about is

pain during sex. Why are are women

experiencing pain during sex? What is

What is What is going on there

physiologically?

>> Yeah, pain with sex is actually not rare

at all. There are some published reports

that up to 75% of women will say at some

point in their life sex is painful.

>> So, a really dumb question here.

Sex is not supposed to be painful.

>> Sex is not supposed to be painful. If

sex is painful, you need to figure out

why it's You deserve a diagnosis. You

deserve an answer. You deserve to

understand exactly why sex is painful.

You could have a problem with the

tissue. So, you could have a skin

problem, which as we know the tissue of

the vulva is very hormonally sensitive.

So, that tissue could be impacted by

hormones. It's skin. So, people can get

eczema. They can get autoimmune skin

conditions. So, you may have a skin

condition. You may have problem with

your muscles. So, remember the vagina

and the vulva are surrounded by these

big pelvic floor muscles. And just like

you can get tight muscles in your neck

and in your back, you can get tight

muscles in your pelvis. We also know

there's nerves that are involved in this

area. So, if you have a back problem and

you feel it running down your leg,

right? That's called sciatica or sciatic

pain, you can have a back problem that

actually causes you to have pelvic pain.

So, we see people with penis pain or

vulva pain because of problems in their

spines. If you have scar tissue inside

your body from endometriosis, that's

pushing and scarring this tissue from

the inside, you may have pain with sex.

And so, there are many different things

that can cause pain with sex. But

remember I said your OBGYN got almost no

training in this.

>> So, if if I'm currently experiencing

pain during sex as a woman,

what advice would you give them? What

should they do?

>> Yeah, so I would really try to see

someone who has an active interest in

this. See a specialized gynecologist or

a specialized urologist who has an

interest in pelvic pain. And you may

need a couple of opinions. Just like if

you go to the first plumber, you want to

get a couple quotes on well, who's going

to do the best job? It's okay to see a

few different people for this problem.

>> And in terms of prevalence, up to 75% of

women as you say will experience painful

intercourse at some point in their

lives. Between 10 and 20% of US women

suffer from persistent chronic pain

during sex. And during menopause, it

climbs drastically

with estimates ranging to 20 to almost

half of women

having pain during sex.

>> And that probably doesn't even add to

the people who stopped having sex

because either they don't have a partner

or because they it's too painful to even

consider it. And I think it's important

to know that hormones play a fundamental

role here. Not a like a not it's not the

whole story, but it's a huge part of it.

>> In different seasons of life, if

if a woman wanted to have the best sex

of her life, what are the fundamental

things you'd aim at to make sure she can

have the best sex of her life?

>> Yeah, so as you know, this is Diary of a

CEO. So I love how you you love the

health topics, but obviously financial

literacy is really important to for you

to help people because for some reason

people stink about talking about money

and talking about sex, and yet we all

want to be really great at both, right?

We all want a lot of money and we all

want to have great sex, and yet people

stink at talking about it. They they

don't know the fundamentals, they don't

know the basics. And so I actually use

financial literacy sort of as a as a

framework in how we talk about good sex.

And so you've got your savings account

and your you know, your your checking

account. Those are the those are the

basics. Everyone needs money in their

checking and savings account, right?

That's what everybody needs. So that's

going to be your education, your

nutrition, your exercise, your sleep,

your your your communication, uh safety.

Like are you safe in your relationship?

Like the basics. Are you doing the basic

things you need to have great sex? You

know, communication is probably the most

important thing. Can you talk about it?

Can you use words? Um can you explore?

Can you ask questions? So so that's

really important for great sex. Then

there's the 401k, right? The 401k is

something that we all want and should

have access to, right? It's important

for compounding growth and long-term

support of your financial life. Think

about hormones. Think about going to a

doctor who's going to make sure that

everything is optimized the way that it

should be. Your your pelvic muscles are

in good condition. Your mental health is

in good Do you know do you have Do you

need a sex therapist? Do you want to

bring toys into the bedroom and devices

to have even more fun? That's kind of

like the really important. Not everybody

has access to it. Not everyone's going

to do it, but I think it's really,

really important for everyone to talk

about. Then there's like crypto. Okay,

so crypto, that's not to say don't do

crypto. Like don't put all your money in

crypto. Don't do everything and don't

start with crypto. So that's going to be

when you're watching, you're scrolling

Instagram and you see these ads for do

this injection, do this, you know,

cosmetic procedure, do this supplement

that's going to make sex great again. Uh

the truth is if it looks too good to be

true on TV and in the ads like it

probably isn't going to fix what if if

other things are are are struggling. So

I think great sex is within everybody's

reach, but I think your great sex is

different than other people's great sex.

>> So let's go through these slowly and one

one at a time. I kind of broke it down

into three categories, which is there's

biological and physical blockers to

great sex, which are some of the things

we talked about, um hormone crashes,

etc. You mentioned the pelvic floor.

How is an issue with your pelvic floor

going to impact your sex? And what is

the pelvic floor? Why would you have an

issue with it? What do you see in

patients?

>> Yeah, so everyone has a pelvis has a

pelvic floor. So men have a pelvic

floor, women have a pelvic floor. It

just means the bones of your pelvis, so

your hips, right? And your pelvis bone,

your butt bones, all of this is this big

bony structure that holds all of your

organs in place. And your genitals are

attached to this pelvic floor. And the

pelvic floor is surrounded by thick big

muscles. So if we look at the inside of

the pelvic floor, it's these big thick

muscles. And muscles are just like your

biceps, right? Like muscles are

something that contract and relax and

there can be problems with muscles,

right? just like if you work out too

much and you've got a sore trap and you

got to go get it massaged and and or you

got to do physical therapy cuz your

shoulder is hurting. A lot can go wrong

with the pelvic floor. And so, sex is a

contact sport. So, if you're going to

get erections, if you're going to have

an orgasm, if you're going to allow for

penetration to happen, you have to have

healthy muscles because you're asking

your muscles to contract and relax in a

sexual way. And so, as blood is flowing

through the area, blood is going to

engorge the clitoris and it's going to

get bigger and erect, it's going to

engorge the penis, it's going to get

bigger and erect. These muscles are

going to have to relax so that you can

have penetration cuz if they're too

tight, tight muscles are painful,

they're sore, they're they're they burn.

And so, penetration can happen if you're

relaxed, but then orgasm is a series of

muscle contractions which equates to

pleasure and release, which is all has

to do with the nerves and the muscles.

Does Does that make sense?

>> I'm trying to understand how the pelvic

floor would would give me bad sex and

how I would know if the pelvic floor is

the reason I'm currently having bad sex.

>> Yeah, so if if sex hurts, so if the

muscles are too tight and you can't have

penetration but you want it, yeah, that

can be bad sex. If orgasm is painful,

weak, or impossible, it could have to do

with the muscles. It's not always the

muscles, but it could have to do with

the muscles of the pelvic floor. If

arousal, your ability to engorge and

lubricate are diminished or less, that

could be due to pelvic floor cuz you're

not getting enough blood flow to the

area. And so, there are multiple

different ways and if you're not feeling

your genitals, you watch something sexy

on TV and then you feel it in your

genitals or you see someone attractive

walking down the street and you feel it

in your genitals, there's this brain

genital connection. And sometimes that

you So, you have to have perfect wiring

and of your nerves, your hormones, and

your muscles, and so that could have be

affected by your pelvic floor. Now, we

do a lot to mess up our pelvic floor, by

the way. People do surgery, people have

babies, uh people um muscle uh health

changes for many reasons, and so when

you have problems, there may be

biological reasons to these problems.

>> Should we be going to the gym and like

doing pelvic floor exercises to improve

our sex lives?

>> You typically don't do them at the gym.

There are typically trained physical

therapists who help you know what's

going on with your pelvic floor. So for

some people it's to strengthen it and to

do like almost contractions, we call

them Kegel exercises, but for many

people it's just learn the coordination.

>> And you can go and get an exam.

>> You can go get an exam and work with a

pelvic floor physical therapist.

>> So some women, uh cuz we sometimes have

them writing with questions, talk about

the fact that they're they're not having

orgasms. Is that normal or is that not

normal as it relates to um sexual

contact?

>> So about 20% of women will say that they

can't have an orgasm. And the real

question, I'm I'm fascinated by this

data because not 20 20% of men do not

have orgasm problems. And so again, if

we go back to the financial literacy

equation, we have a pay gap in this

country, right? Women are not paid as

much as men. Well, women are not

orgasming as much as men. And so the

data's very clear there. And I think the

majority of problem is education. Women

think that orgasm comes from

penetration. Surely if the in and out

penetration is happening, I should be

able to have an orgasm. And the truth is

that's not how most women orgasm. Some

can, but the reason why women don't

orgasm from penetration is cuz the

clitoris is up here. So the clitoris is

how women orgasm, right? Penetration is

not how most women orgasm. Just like if

you rub your thigh over and over again,

you're not going to have an orgasm. Now

you could keep rubbing your thigh for

the whole duration of this podcast, you

still won't have an orgasm cuz it's

close to your penis, but it's not

actually your penis, which is where men

have orgasms from. And so the clitoris,

if you follow those labia minora, those

inner wings, you get to the hood of the

clitoris or a foreskin, we call it a

prepuce, and that, if you pull it back,

you see what is the tip of the head of

the clitoris, but that's just the tip of

the iceberg. The clitoris is this huge

structure.

My necklace is, of course, like a gold

clitoris. Um the this a huge structure

that goes all the way down to your butt

bones. It's a penis. Under the

microscope, it looks like a penis. It is

made up of the same tissue as a penis.

It works exactly the way a penis does.

It's just that we have a whole field of

medicine devoted to the male penis. I'm

a urologist. And no one is even taught

how to examine a clitoris or where it

is. So, if the penis is going in here or

a toy or a finger or a device, that is

not activating the the clitoris, which

is a mostly internal structure.

>> There's something called a clitoral

adhesion, which people don't know about

as well, which I've heard you talk about

before.

>> Yeah.

>> What is that? And how many people suffer

with that?

>> Yeah, so the clitoris has this hood to

it, okay? And about 23% of the time, the

hood can get stuck to the head. So, for

example, I'm wearing a sleeve here. So,

you should be able to pull back the hood

of the clitoris to see the whole head.

It looks like a mushroom. You know how

penises have like that almost like a

mushroom rim rim around it. So, the

clitoris should have that, too. But

about 23% of the time it gets stuck. So,

you actually cannot see the full head of

the clitoris. It's called a clitoral

adhesion. And so, you should be able to

pull it back, but in about a quarter of

the time you cannot. And we published

data that if you remove these adhesions

in an office-based very simple

procedure, we saw improvements in

orgasm, arousal, and satisfaction up to

60 to 70%.

>> Wait. So, so one

five women

>> Yeah.

>> have a clitoral adhesion. And when

solved, it improves their sexual

satisfaction by up to 60%.

>> Yes, but no one's examined any woman in

your life. No one has ever examined

their clitoris, ever. In any exam, in

any doctor's visit, and nobody's asking

women about their orgasm, about their

satisfaction. Where like they come in

with pain or they come in with libido

issues, but no one is examining this

part of the body. And so, it's this

question of is it cuz we haven't or cuz

we shouldn't? It's cuz we haven't. We

haven't We have never done this before.

>> You pulled up the sex toys though. I

think we were talking about orgasm gaps.

>> So, again, when you were talking about

orgasm and how women experience

pleasure, it's all buried inside the

body. So, if your penis was entirely

inside your body, say you gained 500 lb,

okay? And your your belly was so big you

couldn't hold on to your penis to to do

what it takes to have an How would you

orgasm?

>> Uh probably I don't know.

>> The vibrator industry would be a

gazillion dollar industry instead of

just a billion dollar industry because

vibration can help activate this blood

flow. And so, for women, vibration on

the outside can be extremely helpful cuz

remember the clitoris is kind of around

this area. And so, by putting vibrators

on the outside Now, inside, you can also

have pleasure, but not everyone

experiences pleasure the same way. And

so, understanding devices and trying

different things is really really

important.

>> I don't know. Oh, here we go. Okay, so

this is vibrating now.

>> So, this one This kind of device is

interesting because it is a wand that

can help just like with trigger points.

So, if you have pain in in these

muscles, this can go inside, vibrate to

help with engorgement, but can also get

rid of some of the tension in some of

those muscles.

>> As men, what are we getting wrong in

heterosexual relationships when we're

trying to arouse our partners um both of

the context of using sex toys, but also

without sex toys? What is it that we

just don't understand?

>> I think that men

are constantly asking about they want

their penises bigger, harder,

straighter, girthier, uh lasting longer,

and none of that has anything to do with

how women experience pleasure and and

satisfaction in the bedroom. And so, the

question needs to be how do women

experience pleasure? What is their

anatomy like? How can we activate the

clitoris, the arousal response? What are

the brain things that we need to do to

make women interested, right? What what

gets women excited cuz it's different

than what gets men excited. And your

part every partner's different in terms

of what gets them excited. And I would

love to see more curiosity. I wish

everyone was were as curious as you

about what do we need to learn about

women and how they behave and how they

act and what they want.

>> Yeah, so you need

>> I'd like to implement it tonight.

>> Communication, right? It's that question

and also understanding that your partner

never got told any of these things. And

so this is where watching this podcast

together could be really helpful to say,

"Did you know that? Was it What do you

like? Do you know? Like can we look at

your clitoris together? Like do you know

what these body parts are called? Where

is it that you experience pleasure?" Cuz

some people find direct stimulation of

their clitoris is too sensitive. Cuz we

know the clitoris has like 10,000 nerve

endings. So going directly over the

clitoris can sometimes be too much. Some

partners love it. Some partners want

more stimulation on just the outside

here. Some people need vibration. So

that's another big problem.

>> I can So she's going to orgasm at some

point if this is sufficiently

stimulated.

>> there's sort of a build-up and release

of pleasure, right? That's orgasm. And

again, that is often not happening

during penetration.

>> And once she experiences that, what

happens immediately after for her? Cuz I

know from a man's perspective, if I

orgasm, there's some kind of like

decline in arousal and I don't want you

to touch it again.

>> That's very similar in women.

>> Okay, so it's the same thing.

>> Except women can bounce back faster. Not

all of them, but but but women can have

multiple orgasms.

>> So she orgasms, it's very very

sensitive, she doesn't want me to touch

it for a while.

>> Yeah.

>> And then she could she potentially could

bounce back faster.

>> She could potentially. Some people do,

some people don't, but that's the

conversation of is this something that

is pleasurable? Is this something to try

again? Is multiple orgasms something

that you want to have or try to have?

When does penetration happen during the

dance? Because often times men orgasm

and then they're done, they all over, go

to sleep, whatever it is. Is the orgasm

happening after your orgasm, before your

orgasm? Is it happening before and after

your orgasm? Like are there cuz that

could be a nice way to sandwich it of

like there is, you know, giving the the

sensitive tissue some time to rest, then

your orgasm happens and then you

potentially go for round two.

>> So, if the

sensitive pleasurable part is on the

outside here on the clitoris, then what

do they get from penetrative sex if the

this one of main event is here in the

clitoris?

>> Many times nothing. Many times

[clears throat] connection. Many times

uh sort of this need for closeness and

pleasure. Many times there are women who

have extra nerve endings sort of inside

the vagina on the top of the vagina and

the cervix. So, there are women who love

penetration, but many women get the main

event from the clitoris and so it's part

of the whole menu as opposed to

penetration is the whole story. And I

think every woman's body is different

and so kind of making these broad

statements of every partner likes this,

but many women are asking for

penetration mainly because they're like,

"Okay, that's when you have your orgasm

it's done and then I can go to bed, I

can read my book, I can do all these

other things." But the pleasure often

comes from that clitoral stimulation.

Now, some women can orgasm from penetra-

I have a theory. It's a really

interesting theory that maybe your

listeners can prove with science or help

me prove with science.

So, you know how there's men who

prematurely ejaculate? Like who

ejaculate very quickly?

>> Yeah.

>> There are men who orgasm in a minute or

less.

That's probably [clears throat] 8% of

men, okay? So, if we think men and

women's bodies are very similar, could

we argue that 8% of women will orgasm

within a minute or less?

Theoretically, it makes sense, right? I

think those are the women who orgasm

with penetration. They're so sensitive,

their nerves are so sensitive that

penetration's very pleasurable and then

they have this magical orgasm and they

do it very quickly. So, it's good in a