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E211
October 16, 2026
Menopause, Hormones and Women’s Sexual Health with Dr. Rachel Rubin; Listen Again
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In this episode of unPAUSED, Dr. Mary Claire Haver brings back her conversation from earlier this year with Dr. Rachel Rubin, a board certified urologist and sexual medicine specialist at Georgetown University and a contributor to the 2025 American Urological Association guidelines on genitourinary syndrome of menopause (GSM). The conversation opens with why so many women never get help for female sexual dysfunction, when only three fellowship programs train doctors in women’s sexual health compared with 27 for men.

Dr. Rubin walks through the full anatomy of the clitoris, why most women will never orgasm from penetration alone, and why painful sex is never normal. One overlooked source of vulvar pain is the vestibule, a rim of tissue around the urethra packed with estrogen and testosterone receptors. When these hormones drop, it can make sex, tampons, and pelvic exams hurt, a condition often called vestibulodynia. She explains why GSM, once called vaginal atrophy, is a serious urologic condition rather than simple vaginal dryness. She also explains why vaginal estrogen can prevent more than half of urinary tract infections while lubricant does nothing to stop them.

The two doctors also cover how SSRIs, birth control pills, and GLP1 medications can affect libido and orgasm, and why two FDA approved medications for hypoactive sexual desire disorder remain largely unknown. Dr. Rubin closes with her menu of hormone options, from systemic estrogen, progesterone, and testosterone for women to local vaginal hormones, and why the goal of HRT is helping a woman feel like herself again. For any woman dealing with painful sex, low libido, or recurrent UTIs in perimenopause and menopause, this conversation is a reminder that pleasure matters. 

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Chapters

00:00:00 – Why doctors aren't trained in women's sexual health
00:02:36 – Why women's sexual health is overlooked in medicine
00:04:49 – Understanding clitoral anatomy and female pleasure
00:08:53 – How hysterectomies can affect sexual function
00:13:19 – Why painful sex goes undiagnosed
00:15:22 – The tissue, nerve, and muscle causes of pelvic pain
00:20:29 – How hormonal changes affect vaginal and urinary health
00:24:08 – What happens to the clitoris and labia as hormones decline
00:27:07 – Why vaginal estrogen matters for preventing UTIs
00:30:15 – Vaginal DHEA versus estrogen
00:32:41 – How antidepressants affect libido and orgasm
00:35:10 – Birth control and its potential sexual side effects
00:38:14 – Acne medications and GLP-1 sexual side effects
00:40:39 – FDA-approved treatments for low libido
00:43:05 – Testosterone and feeling like yourself again
00:45:52 – Finding the right hormone treatment for your body
00:50:28 – How to reclaim your sexual pleasure

About the guest

Dr. Rachel Rubin

Dr. Rachel S. Rubin, MD is a board-certified urologist and nationally recognized expert in sexual medicine. She is one of the few physicians fellowship-trained in both female and male sexual health and serves as an assistant clinical professor of urology at Georgetown University. Dr. Rubin is the former education chair and current Director-at-Large for the International Society for the Study of Women’s Sexual Health (ISSWSH), and she serves on the editorial board for the Journal of Sexual Medicine and the Video Journal of Sexual Medicine (VJSM).  She contributed to the 2025 AUA GSM guidelines and is deeply involved in research, education, and advocacy to improve access to evidence-based care. She is the founder of the Sexual Medicine Research Team, a collaborative effort dedicated to advancing clinical research in sexual medicine; serves as an associate editor of the journal Sexual Medicine Reviews; and hosts a popular video series, "Sex Matters," on Medscape.