\n
![](\"https:\/\/www.healthywomen.org\/media-library\/rachel-rubin.jpg?id=67667622&width=980\")
<\/p>\n
\n<\/p>\n
\u201cSexual health is health.\u201d <\/p>\n
That\u2019s the mantra of Rachel Rubin, M.D.<\/a>, a board-certified urologist and sexual medicine specialist on a mission to change the way women think about their bodies and their healthcare. Whether through social media, her YouTube channel or podcast appearances, Rubin seizes any opportunity to push conversations that have long been ignored into the mainstream. <\/p>\n Rubin\u2019s ready for society to start openly discussing everything from vulvas to orgasms and wants women to enter their doctors\u2019 offices prepared to advocate for themselves like never before. It\u2019s important to her that women know where to go for pelvic floor<\/a> pain, that testosterone<\/a> is far from just a male hormone, and that our understanding of hormone therapy<\/a> research has evolved<\/a> far beyond the findings of the 2002 Women\u2019s Health Initiative (WHI) study. <\/p>\n We spoke with Rubin about how to overcome medical gaslighting, why women’s sexual health has been overlooked for so long and how women can better advocate for themselves.<\/p>\n This interview has been lightly edited for clarity and length.<\/em><\/em><\/p>\n HealthyWomen: You’ve spoken openly about medical gaslighting in women’s healthcare. How do women get around this?<\/strong><\/p>\n Rachel Rubin:<\/strong> We’ve all been in that situation where we go to someone with an agenda, and then they\u2019re not hearing us; they’re not interested in our agenda. They have their own agenda, and the interaction doesn’t feel very satisfying.<\/p>\n I think it’s important for everyone to step back and not think about this as good guys and bad guys. There are a few challenges that we have in these situations. Number one, medical appointments right now with insurance are 10 minutes long, and it\u2019s really hard to get everything that you want in your agenda in 10 minutes with your legs up in stirrups.<\/p>\n Number two, I think too often we go to the doctor expecting them to be all-knowing about our history and the topic that we want to talk about. But unfortunately, what we know from data is that your doctor wasn’t taught anything about pelvic pain<\/a>, menopause<\/a> and hormone therapy<\/a> \u2014 perimenopause for that matter \u2014 and even basic examinations of certain female anatomical parts. Even the word clitoris doesn’t exist in what an OB-GYN has to know in medical training.<\/p>\n We\u2019re entering these rooms thinking we’re seeing an electrician, but the person in front of us is a plumber. If you go to the plumber expecting electrical work, even if it’s the smartest plumber in the area, they’re not going to do a great job on your electrical work.<\/p>\n The doctors that we\u2019re seeing, they’re not dumb, they’re not uncaring. They’re overworked, they don’t have enough time with you, and likely they\u2019re the wrong specialist to take care of you. That’s not your fault as the patient, and sometimes my colleagues don’t have the greatest humility to acknowledge any of those challenges. <\/p>\n Before you even go to the appointment, you can look online or call the office and say, “Is this something that this doctor knows a lot about or enjoys taking care of? Do my problems fit within the scope of what this doctor likes to do? Have they done extra training on this topic?”<\/p>\n Many times patients think that if they save all their problems for one annual visit, the doctor will appreciate it, and we’ve done bad marketing on that. Your annual visit has a set amount of things that are to be done. You have to go in and say, “Hey, I’m here for this one issue. Can we make another appointment to talk about another issue?” Sometimes you have to go more than once to get all your needs met because how is someone going to know everything in a 10-minute visit?<\/p>\n HW: Women’s sexual health has historically received far less attention and research than many other areas of medicine. Are you starting to see that change?<\/strong><\/p>\n Rubin:<\/strong> We’ve been calling these things \u201cprivate parts\u201d for as long as time. In fact, the nerve that innervates the penis and the clitoris is called the pudendal nerve, which means \u201cshame\u201d in Latin. So this is not anything new.<\/p>\n We do not teach these things. Our anatomy textbooks don’t have the full anatomy of genitals, and nor do we teach anything about sexual medicine in medical schools, residency training or other curriculums. So why would we expect our doctors to know anything about our sexual health? And yet, sex is biology. Sex is how we reproduce as a species. Sex is really why many of us are here today, and so we have a lot of work to do to increase not just the research but the education around the research.<\/p>\n It is<\/em><\/em> getting better. Social media and many things have created this grassroots momentum of people caring about women\u2019s sexual health. But most people can’t even say the words. Most people don’t know the word \u201cvulva.\u201d They can’t say \u201cclitoris\u201d out loud. The word sex feels like, “Oh, I can’t talk about this,” or it gets banned on social media. Orgasm<\/a> is this word that can’t be said out loud confidently in public spaces, and the question is why? Orgasm<\/a> is something everybody has or wants to have, and we can’t even discuss it. So we\u2019ve got a lot of work to do in this space to even be able to have the language to talk about it.<\/p>\n HW: Testosterone for women has been getting a lot of attention lately. What do you wish more women understood about it?<\/strong><\/p>\n Rubin:<\/strong> The fact that women make testosterone is a huge, innovative idea. We had been historically taught girls make estrogen<\/a>, boys make testosterone, and that was never reality. The ovaries and the adrenal glands make androgens. They make testosterone, and we know that those human hormones help with sexual health, libido, genital health and maybe potentially other things as well. It\u2019s important that we even acknowledge that the basics are true.<\/p>\n Now, we don’t have an FDA-approved testosterone product for women, despite it being approved in Australia, New Zealand, South Africa and the U.K. It is safe enough for their regulatory bodies, and so that’s why we’re doing a lot of advocacy work around making it available to women.<\/p>\n Right now, we prescribe it off-label, like we do many other things off-label. But many clinicians do not know how to write prescriptions or how to counsel patients on it, and so it feels a little bit like the Wild West right now.<\/p>\n HW: Perimenopause and menopause have become much bigger parts of the public conversation. What’s something we\u2019re finally getting right?<\/strong><\/p>\n Rubin:<\/strong> It\u2019s so wonderful to see so many people talking about this, having conversations with their girlfriends, their mothers, their aunts, their sisters. It\u2019s the talk of the town, and it\u2019s so delightful to be a part of that national conversation, to see the news media pick it up, to see social media algorithms go crazy for it, to see Melinda Gates talk about it loudly and proudly and publish in The New York Times<\/em><\/em> about it and put her money where her mouth is. <\/p>\n The challenges are the clinicians. The doctors out there have a lot of work to do to catch up. We\u2019re falling behind because we do not teach this in medical school, residency training or after the fact, and it’s not easy to learn. We have to actually teach people how to write prescriptions, how to counsel patients and how to take care of women\u2019s health. We have a lot of work to do in this space, but it\u2019s really wonderful to see women standing up and saying, “Hey, I don’t feel like myself, and I would like to know what my toolbox looks like to help me feel the best that I possibly can.” I love people demanding quality of life, and I love people advocating for themselves and really trying to figure out, “What do I want to put in my body to make me feel the most like me?”<\/p>\n I’m so happy that women are getting it right that there was misinterpretation of old data from the WHI, bad marketing that happened that made women afraid of many of the treatments surrounding menopause and perimenopause. They’re starting to stand up and say, “Wait a minute, the data didn’t even say that. Why are we so afraid of something that we weren’t supposed to be afraid of?” And they’re asking questions.<\/p>\n Where are we still getting it wrong? I think women think that they only need one doctor, and that one doctor is there to help for every single problem that they have. We don’t have a doctor for men that takes care of all of men’s problems. I’m a urologist. No man comes to see me for his heart health or his brain health or his bone health. They come to see me for their genitals, their prostates, their bladders, their kidneys. And so this concept of women’s health, that we\u2019re not as worthy as a man is of just as many specialists and doctors and people to really look at all of us \u2014 I think we have a lot of work to do in this space.<\/p>\n HW: Social media has become a major source of health information. How has that helped women, and where can it also create confusion?<\/strong><\/p>\n Rubin:<\/strong> Social media is incredible, what it’s been able to do, to be this great equalizer to getting people information from different sources. That being the case, there’s just as much good information as there is bad, and arguably more bad information.<\/p>\n It’s also challenging because nobody controls it. I think that is both a good thing and a challenging thing that we have to work with because we have free speech, and we cannot control what everybody says and how they say it. And in medicine, we have never all agreed on things. We\u2019ve never agreed on the details. That’s why we collaborate. We do things like consensus statements, and we try to form collaboration among many people who disagree. That is the way science has always worked, but we’ve never been in a place where we’re watching it happen minute to minute, live and in real time.<\/p>\n Patients have access to information like never before, which I think is a good thing ultimately, and they can advocate for themselves because not every person wants the same thing. <\/strong>We cannot control people, but we have to provide information so they get to decide what\u2019s right for them, and we do the best that we can. We should call out wrong things when we see them, but we also have to understand that the horse has left the barn, and we\u2019re not going to have full control over this experience.<\/p>\n HW: We often hear about pelvic health only after symptoms develop. What can women do to take a more proactive approach?<\/strong><\/p>\n Rubin:<\/strong> First, know that you have a pelvis and don’t just call it a vagina and know what the body parts’ names are. Also know that body parts change with hormone changes, with age, with childbirth. There are so many things that can affect your pelvic health<\/a>, and it’s not all one thing.<\/p>\n I think this is a good analogy. If you have face pain, there are 10 different doctors you have to figure out. Where in your face? What’s going on? What body part is it? So when we talk about pelvic health, it’s also kind of like saying face pain. Do you need a musculoskeletal person who helps with the bones and the muscles and a rehab specialist? Do you need someone who helps with your sexual organs like your clitoris or your vulva? Do you need someone who helps with your uterus, with your cervix, with your reproductive organs? Do you need help with the hormonal aspect of it, the nerves, the muscles, the arteries?<\/p>\n We all have so many intricate parts of our pelvises, and to just say, “I need pelvic health,” well, who’s the specialist that you need to see, and what part is having the issue?<\/p>\n If you go to a physical therapist when you need a hormone specialist, you’re not going to get your questions answered. The more we become educated about our bodies, we can show up to the right specialist, and we can do our own research before we go into the wrong room for the wrong question and get gaslighted.<\/p>\n HW: Are there racial, geographic or socioeconomic disparities in access to sexual healthcare, menopause care or pelvic health treatment that concern you the most?<\/strong><\/p>\n Rubin:<\/strong> It’s a dumpster fire. Even the rich people are getting garbage care here. Oprah had to see five doctors for her heart palpitations before they figured out it was perimenopause. Melinda Gates just said she saw three doctors before she got a proper hormone prescription for her menopause problems. Halle Berry came out publicly and said she got diagnosed with genital herpes<\/a> when she had the genitourinary syndrome of menopause<\/a>. That’s menopause and hormonal care. Sexual medicine is way worse than that.<\/p>\n So the thought that you’re going to get any good care, no matter how much money you have, is almost near impossible. In a way, this is the most equitable situation we have because the richest of the rich are not getting good sexual health care and are not getting access to the right people.<\/p>\n We don\u2019t have enough fellowships. We don’t have enough funding. We don’t have enough training programs. We don\u2019t have enough people who do this work. So you really think of sexual health almost like a rare cancer that you have to seek out a super specialist, and it may not even be in your state, let alone in your town. And so you have to advocate. If you have a sexual health problem, which is very common, by the way, you have to seek out someone who cares about that as much as you do. And we exist, but there are not many of us. <\/p>\n HW: If every woman woke up tomorrow knowing one thing about her body that she doesn’t know today, what would you want it to be?<\/strong><\/p>\n Rubin:<\/strong> That the clitoris is the pathway to orgasm and pleasure, and it is almost never penetration \u2014 and that if you activate the clitoris through vibration and other joyful ways, you can build a buildup and release of pleasure. Women are capable of multiple orgasms, and joy is possible, but it is not what Hollywood tells us is the pathway to pleasure.<\/p>\n