Rubin argues that education is a major contributor to the orgasm gap because many people expect penetration alone to produce orgasm. She explains that the clitoris is a large, partly internal erectile structure and says most women need clitoral stimulation, while also acknowledging individual differences in pleasure and penetration.

Rubin says about 20% of women report being unable to orgasm
She identifies the clitoris rather than the vaginal canal as the primary orgasm organ for most women
The visible glans is only part of a larger internal clitoral structure
Penetration can still provide pleasure, connection, or orgasm for some women
Devices, hands, and different forms of external stimulation may help some people
Partners should ask what an individual enjoys rather than apply a universal technique

“Penetration is not how most women orgasm.”
Dr. Rachel Rubin · 57:00

“the clitoris is this huge structure”
Dr. Rachel Rubin · 57:30

#clitoris#orgasm#penetration#sex-education

Hot Take· 1

Hot Take03:00

Rubin Says Doctors Were Never Trained for Many Sexual-Health Questions

Rubin argues that gaps in medical-school and residency training leave many clinicians unprepared to answer questions about hormones, the clitoris, libido, orgasm, and sexual pain. She also says short appointments can encourage overconfident refusals where a clinician should acknowledge limited expertise or refer onward.

Rubin says her own medical training did not cover much of this field
She distinguishes a clinician's good intentions from adequate specialist training
She claims the 2026 OB/GYN training checklist does not include the word clitoris
Research dissemination does not automatically teach clinicians how to prescribe
Patients may need a clinician who has pursued additional sexual-health training

“We don't teach it in medical schools, we don't teach it in residencies.”
Dr. Rachel Rubin · 04:00

“The word clitoris today in 2026 does not exist in the checklist for what an OB/GYN has to learn”
Dr. Rachel Rubin · 07:30

#medical-training#womens-health#sexual-health#advocacy

Explainer· 4

Explainer14:00

How Rubin Explains a Possible Birth-Control and Libido Link

Rubin explains that combined birth-control pills suppress ovulation and ovarian hormone production while replacing estrogen and progestin, not testosterone. She says lower testosterone may contribute to low libido or painful sex in a subset of users, while stressing that birth control has important benefits and that one person's experience does not establish causation.

Rubin says combined pills use estrogen and progestin to suppress ovulation
She explains that suppressed ovaries make less of their own estrogen, progesterone, and testosterone
The pill does not replace testosterone in her account
Rubin describes sexual side effects as possible rather than universal
Bartlett reports a personal correlation in his partner but explicitly says the cause is unknown
Alternative contraceptive options should be discussed with a qualified clinician

“birth control is wonderful, but there are side effects to birth control just like there's side effects to any medication”
Dr. Rachel Rubin · 14:30

“we don't know whether it was the birth control, whether it was something else”
Steven Bartlett · 15:00

#birth-control#libido#testosterone#contraception

Explainer20:30

The Menstrual Cycle as an Estrogen-and-Progesterone Sequence

Rubin walks through the cycle as a sequence: estrogen and progesterone are low during menstruation, estrogen rises before ovulation, and the post-ovulation follicular structure produces progesterone. If fertilization does not occur, progesterone falls and the uterine lining sheds. This is a simplified educational account, not a diagnostic interpretation of an individual's hormone test.

Rubin places the lowest estrogen and progesterone levels around menstruation
She says estrogen rises as a follicle develops before ovulation
Progesterone rises after ovulation in her explanation
The later fall in hormones precedes shedding of the uterine lining
She says testosterone is not usually shown on the standard teaching graph
Painful, irregular, or unusually heavy periods deserve appropriate clinical discussion

“First half of the cycle no progesterone.”
Dr. Rachel Rubin · 21:30

“they both fall and you have a period”
Dr. Rachel Rubin · 21:30

#menstrual-cycle#estrogen#progesterone#ovulation

Explainer58:00

The Underexamined Clitoral Adhesion Rubin Says Can Affect Pleasure

Rubin describes a clitoral adhesion as the hood becoming stuck to the glans so it cannot retract normally. She reports a prevalence of about 23% and says her team's published office-procedure data found improvements in orgasm, arousal, and satisfaction, but the transcript does not provide the study design or enough evidence to generalize the result.

Rubin says the clitoral hood should normally retract to reveal the full glans
She reports adhesions in roughly 23% of the population studied
She describes a simple office-based procedure to release adhesions
Rubin reports improvements of 60% to 70% in selected outcomes after the procedure
The episode does not state sample size, comparator, follow-up period, or adverse effects
Persistent symptoms require qualified examination rather than self-treatment

“It's called a clitoral adhesion.”
Dr. Rachel Rubin · 58:30

“we saw improvements in orgasm, arousal, and satisfaction up to 60 to 70%”
Dr. Rachel Rubin · 58:30

#clitoral-adhesion#arousal#orgasm#clinical-evidence

Explainer1:13:00

Responsive Arousal Can Begin After Sexual Activity Starts

Rubin distinguishes spontaneous desire from responsive desire: some people feel ready before sexual activity, while others become interested after enjoyable contact begins. Bartlett reads sex-specific percentages from a report and Rubin calls them accurate, but the episode does not identify the report, so the figures should be treated as a host-cited claim rather than independently established here.

Spontaneous arousal is present before sexual activity begins
Responsive arousal develops after pleasurable activity starts
Rubin compares responsive desire with not wanting to exercise until after beginning
Bartlett cites men as more often spontaneous and women as more often responsive or mixed
The source and methodology for those percentages are not given
Uninteresting or repetitive sex can resemble low libido without proving a biological disorder

“I want to have sex because we've started having sex and we've started that process and now I can get into it.”
Dr. Rachel Rubin · 1:13:00

“is that really low libido at all”
Dr. Rachel Rubin · 1:13:30

#arousal#responsive-desire#libido#sex-education

Story· 2

Story09:30

Why Rubin Gives Patients a Mirror During Pelvic Exams

Rubin says she bought simple mirrors for her practice so patients can see and name their own anatomy during an examination. Her broader point is that clinical modesty practices can unintentionally hide the body from the patient, while accurate language can support questions and self-advocacy.

A sheet and examination position can keep genital anatomy out of the patient's view
Rubin identifies the labia, clitoris, urethra, and other structures during the exam
She presents anatomical language as a foundation for informed questions
The method teaches during care rather than assuming prior sex education

“I bought two mirrors on Amazon and I give women a mirror”
Dr. Rachel Rubin · 10:00

“it's that basic ability to give women language”
Dr. Rachel Rubin · 10:30

#anatomy#patient-education#pelvic-exam#self-advocacy

Story27:30

Rubin's Account of How One HRT Study Changed Prescribing

Rubin recounts how the Women's Health Initiative was stopped early and publicly associated with cardiovascular disease and breast cancer, after which hormone prescribing collapsed. She argues that the findings were widely misinterpreted and cites a 2025 publication by the study's authors, but the episode does not present the papers in enough detail to independently adjudicate those medical claims.

Rubin describes the Women's Health Initiative as a large NIH-funded study of women aged 50 to 79
She says an early press conference drove an abrupt change in prescribing
Rubin claims later analysis did not support the broad public interpretation
She cites a 2025 publication about cardiovascular and stroke risk below age 70
The transcript does not provide study titles, effect sizes, treatment formulations, or subgroup details
Her larger claim is that the episode created a generation-wide training and access gap

“They did a press conference and at this press conference they said we're shutting down the study early.”
Dr. Rachel Rubin · 28:30

“It was wild how misinterpreted this study was.”
Dr. Rachel Rubin · 29:00

#hrt#womens-health-initiative#risk-communication#medical-history

Q&A· 1

Q&A1:05:00

Rubin Rejects a Simple Good-or-Bad Verdict on Pornography

Rubin says pornography's effect depends on how it is used and on the couple's agreements, rather than being universally good or bad. Bartlett cites research claims linking solo use with lower satisfaction, deception, unrealistic expectations, and sexual difficulties; Rubin agrees that secrecy, rigid dependence, or use that displaces human intimacy can be problems.

Rubin distinguishes erotic media itself from compulsive or relationship-damaging patterns
She says some couples watch together or negotiate solo use around different libidos
Bartlett attributes negative associations to a group of studies and a meta-analysis
His cited mechanisms include deception, unrealistic expectations, and desensitization
Rubin emphasizes that hiding use can damage trust
Reliance on one stimulus or method may not transfer well to partnered sex

“I don't think we can say blanketly it's good or bad, right or wrong.”
Dr. Rachel Rubin · 1:09:00

“Again, it was that deception. It's the hiding.”
Dr. Rachel Rubin · 1:10:00

#pornography#trust#relationships#sexual-satisfaction

Tool· 1

Tool1:28:30

Rubin's Quarterly Partner Day Creates Space Without Demanding Sex

Rubin challenges the idea that worthwhile sex must be spontaneous and notes that dating already involves scheduling time with erotic potential. For busy couples, she suggests blocking one Friday each quarter as a partner day for walking, talking, bathing, massage, or other connection, without making intercourse a required outcome.

Overscheduling, poor sleep, children, and lack of privacy can crowd out intimacy
Dating often schedules the time and anticipation that later seems spontaneous
A partner day creates protected space rather than a performance deadline
The activity can be nonsexual and still restore connection
Rubin frames the quarterly day as an addition, not the couple's only intimate time
The plan should fit a time when both partners can participate willingly

“we were always scheduling sex and it was very erotic and fun when you're in your dating life”
Dr. Rachel Rubin · 1:29:30

“one Friday a quarter, you and your spouse can literally block your calendars”
Dr. Rachel Rubin · 1:31:00

#planned-intimacy#relationships#stress#quality-time

Takeaway· 2

Takeaway1:32:00

Apply the Compassion You Give a Friend to Your Own Sexual Worth

Rubin says many patients reserve kindness for friends while treating their own weight or appearance as a prerequisite for intimacy. She argues that education, communication, and a shift from thinness toward strength can challenge that internal double standard, without claiming mindset alone resolves every sexual-health problem.

Rubin sees body-image concerns as a frequent barrier to comfortable intimacy
People may believe a friend deserves pleasure at any size while denying it to themselves
She prefers directing energy toward strength rather than thinness
Self-compassion can change the narrative around being seen naked
Biological, relational, and psychological factors may still require separate attention

“Your best friend deserves great orgasms, great sex, no matter what they look like, no matter what they weigh.”
Dr. Rachel Rubin · 1:32:30

“when we think of ourselves, 'Oh, I can't be naked with this person.'”
Dr. Rachel Rubin · 1:32:30

#body-image#self-compassion#intimacy#self-esteem

Takeaway1:33:30

A Biological Explanation Can Replace Rejection With Support

Rubin argues that partners often interpret pain or medication-related libido changes as evidence of poor attraction or failed love. Understanding a plausible physiological contributor does not erase the relationship impact, but it can turn blame into empathy and guide the couple toward appropriate clinical or therapeutic support.

Pain can make sexual contact aversive without reflecting a partner's desirability
Some medicines can affect libido or sexual function
A partner may misread those effects as rejection
Rubin says partners can sometimes benefit from joining biological-health conversations
Education can make the problem shared rather than personal
A biological explanation still requires qualified assessment and honest communication

“she doesn't want to have sex with you not because you're bad at sex”
Dr. Rachel Rubin · 1:34:30

“understanding your partner's biology and your own biology is quite important”
Dr. Rachel Rubin · 1:35:30

#physiology#empathy#relationships#libido

Frameworks in this episode

The Four-Bucket Hormone Therapy Toolbox

The Great-Sex Financial Portfolio

The Intimacy After-Action Review

The Medication Informed-Consent Check

The Tissue-Muscle-Nerve Pain Map

Insights & moments

⚡Myth Buster· 1

Why Penetration Alone Does Not Produce Most Women's Orgasms

◆Hot Take· 1