LadyGang - LG QUICKIE: Let’s Talk About Sex Baby

Episode Date: September 29, 2022

Urologist and sexual medicine specialist Dr Rachel Rubin is helping women everywhere understand how their body works, so that they can be the CEO of it. Find how how she’s creating orgasm equality and raising awareness for HSDD. Revive the sex drive you once knew and visit HSDDtreatment.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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It's decided then. I'm going to my Marshalls for a whole new fit and more. And you should too. Score some amazing deals in-store or at marshalls.com. It's time for a quickie. Podcast One presents The Lady Gang. The Hollywood Girl Posse with Lady Gang Quickie. Here's Kelty Knight, Becca Tobin, and Jack Vanek.

Let's make this quick. Hello, hello, hello. Welcome to the Lady Gang Quickie. I am back here with Jack and Kelty and a very special, special guest who's way overqualified to be here with us. But we're going to do our best to raise the bar for you. Kelty, who do we have? Well, I'm very excited about this and I just want to say that I'm choking right now because last week when we were all together,

I asked Jack what drinks she would like at the house. And she said, get me a kombucha. And the Kelty in me was like, how many kombuchas could she drink in one day? So I got four. She drank half, half one. And now there's three full, beautiful $9 air one kombuchas in my fridge. And so I, we've just in between episodes and I'm trying to keep my blood sugar. I'm on a health journey, obviously. And I'm trying to keep blood sugar stable. So I'm having this kombucha with my breakfast and I took a sip and it's so bubbly. I forgot how bubbly kombucha was. You can't chug it Kelsey. Yeah, it's not a diet poke. What does it think it is? You know? Um, so anyway, uh, but I'm lucky because we have a doctor on today. So if anything was really going badly, she could help

me out. And also, uh, I know you're not a dermatologist. Uh, I'm going to introduce you in a second, but I also put my vitamin C cream a little too close to my eyes and it's also been burning all day. So there's a lot going on that I could possibly go to urgent care for, but that's not what we're here today. We're here today to talk about your vaginas and your sex drive and your brains. Um, we've had a couple episodes of this podcast that have absolutely gone off. You ladies listening have loved these conversations because this is truly in the world of lady secrets. This is the thing that we don't talk about with our doctors and we don't talk about with our friends is our sex drive. And when we feel like we might not be having the sex drive

that we want, like, you're not going to call your friend and be like, I feel like my sex drive is low. So we're having those conversations and we want to welcome Dr. Rachel Rubin. She's a board certified urologist and sexual medicine specialist. She's an assistant clinical professor of urology at Georgetown university. She's very, very smart is what that means. She owns her own private practice in the Washington DC area. She's one of only a handful of physician fellowships trained in male and female sexual medicine. She's a clinic, clinic, clinic, clinician, clinician. I didn't even know that was a word, a researcher and vocal educator in the field of sexual medicine. In addition to being the education chair for the international society for the study of women's

sexual health, she also serves as an associate editor for the journal of sexual medicine reviews. This seems like a lot of work, Dr. Rubin. You know, I dreamed as a little girl to become a penis doctor when I grew up. So it was like this thing I always dreamed of. No, it just kind of happens. And this idea of like women's health, it should not all be gynecologists, right? They, we ask them to do too much. And so there's only one fellowship in the entire country that even acknowledges women's sexual health, which is why your doctor never asks you about it. Nobody teaches us. I mean, first of all, let's talk a little bit about your career. What did you really want to be the penis doctor when you grew up? No, you know, I was interested in women's health, but I hated

babies and deliveries. Like I have two, you can have both of them, right? Like I didn't like the delivery process. I didn't want to spend my whole training delivering babies. I liked the gynecology aspect. I liked women's health and I found urology, which was an amazing specialty where I could learn how to operate. I could do surgery, but I could see all genders and we could talk about sexual health issues and quality of life issues. We spent tons of time talking to dudes about their sex lives, about their erections, their orgasm, their ejaculate. We love quality of life when it comes to men, but we never talk about it when it comes to women. Like we never do. So I spend my career, I always say that I'm really trying to like create orgasm equality, right? I want everyone to be able,

we have a pay gap. We also have an orgasm gap that y'all probably talk about. And so how can I help? Because I take care of everyone, which is why it's so fun. Cause I can really help every, whatever sex you want to have, I can help, you know, how can we make it better? How can we make it more fun? And how can we get everyone, um, living their best lives kind of a thing. So what does an appointment with you actually look like when somebody is coming to see you? Like what are people asking and how are you helping them? So it's a really great question. And to the point, you cannot do this kind of medicine in 10-minute doctor visits.

You can't wait for the one-year visit that you get 10 minutes with your gynecologist and she's doing your pap smear, your mammogram. She's asking you about safety and STDs. Like, no, you need a separate visit or you need separate multiple visits if you're working within the insurance model and you're getting 10 minutes only because she's got like, or she or he have like 20 patients after you. And like, they really don't want to sit around talking about your libido. They have important things to do. Women's sexual health is always going to be at the bottom of the totem pole for physicians sort of in that model. So we do it differently. I

started my own practice about seven months ago. It is outside of, it's out of network with insurance. So it's like a lawyer, right? You could go to the fancy lawyer who's going to keep you out of jail, or you could go to the one that the public defender gives you and you hope for the best. And so we take over an hour really just talking initially, right? I want to hear your whole story. You give me a narrative without me interrupting you. Can you imagine going to a doctor and not being interrupted and getting to just say your story and tell me what's going on? Then I go step by step. I find out your past medical history, your surgical history, your allergies, your medications, because all of that matters. Antidepressants can cause sexual side effects. Birth control pills can cause sexual side effects. Surgeries can cause sexual side effects. So I have to really, I always think I'm like a sex detective. I have to understand what's going on with you in order to understand why things aren't working as you would like them to work. I have to ask you about your social history, what you do for a living, how you were raised thinking about sex, your trauma history. All of that matters, of course, because then you have to work with me to figure out what does your quality of life look like. Do you have pain? Do you have libido problems? I ask about orgasm. How do you orgasm? Do you have questions about orgasm? You're three women who have been to doctors in your life. Have you

ever been asked by a doctor if you could have an orgasm? No, never. Not once, right? I've never been asked and I'm a lot older than you are. And so it's important, right? It's medicine, it's biology, it's physiology. It's not all sex therapy. It's not all let's talk about our feelings and how it's some of that. And so we use a term in my world that's called biopsychosocial, right? It's the biology, it's the psychology, and it's kind of a social thing of how we're all raised thinking about these issues. And so I spend an hour really both hearing your story and then developing a plan with you of like, what does this look like? And I do a lot of really nerdy PowerPoint present. I love virtual visits because I can do really nerdy PowerPoint

presentations. I can share my screen with you. I can show you what body parts look like. And then when you come into my office, especially for my female patients, everyone gets a mirror. Okay. They get a mirror and they get a tour of their own vulva. This is your labia majora. This is your labia minora. This is the clitoris. This is what's going on with the clitoris. This is your vulva. This is your vulvar vestibule, which is the part of the body where people who have pain with sex, that's the part where it hurts so much. And many of you have never even heard that word vestibule before. It's this little tissue at the opening of the vulva between the vulva and the vagina, that's actually bladder tissue. It's that bladder tissue that can feel really raw and

irritated. And it's very hormone sensitive tissue. So people, if you have any girlfriends, anyone listening, if you have girlfriends who have pain with sex, right, pain at penetration, they have to see a doctor who understands that and can understand how birth control or breastfeeding or menopause, I know that's a little old for you guys, you know, can affect that tissue. So it's actually bladder tissue, which is urology, right? That's what I do. And so then I teach you about the pelvic floor and how, you know, issues with the pelvic floor can create a medical problems as well. And really I get people to try to understand and educate them because when you understand your body and how it works, then you can be the CEO of it and take a, take charge and say, okay, this is what

I need to do. These are my team members that I need to get involved. And this is how we get better. Does that make sense? Wow. You just blew my mind. It makes so much sense. It's just so wild that we walk around our whole lives with these things, with these parts, and we know nothing about them. Like I could tell you everything about my skincare and what it's doing for my face and the hyperpigmentation and tightening up the blah, blah, blah. I had no idea that there's a thing called the vestibule. Yeah. But now you do, and now you can, and to be honest, like it, it's a body part, right? The, the vulva is a body part and universally women are disgusted by their own bodies and I see them and they say, oh, oh, I'm sorry. It smells. I'm

sorry. I didn't shave. I'm sorry. I'm bleeding. Like all these apologies. I see men 50% of the time. They don't apologize. Right. So all these women come in with this shame. Right. And like, I don't feel shameful about my hand. Right. I feel totally neutral. Like my hand, some of you guys probably have big rocks and stuff like, and then it would have been amazing, but my hand is totally neutral. Why is the vulva this place where you can have orgasm, your partner potentially can have a lot of pleasure human life can be formed and come out of. Right. And yet people are disgusted by it or horrified by it. Like, where did we go wrong in the process where like that happens? So giving that mirror, taking away the sheet where the doctor is like a mechanic hiding under the sheet.

So you don't even know what they're looking at. How does that help? Like I have to educate patients to empower them to understand their body parts. Because again, when you understand how orgasm works, how vaginas work, how vulvas work, then you can go to your partner and say, honey, I heard this crazy story. I heard from this crazy doctor. What if we try X, Y, and Z? Of course I can't orgasm from penetration. My clitoris is not anywhere near my vagina. Or, you know, you can't orgasm from someone touching the inside of your thigh. It's close to your penis, but it's not your actual penis. Guys can understand that. Gals can understand that. And so education is where we empower women to just get better treatment. I love this so much. And one of the things that

we have talked about and we want to talk about today is just that low libido. I think it goes along with what you're saying about shame. And there's a lot of shame for some reason. I guess being a child of the 80s and then growing up in the 90s, the Pam Anderson playboy sex fun girl was out there. And like, if you weren't that girl, or, you know, if you haven't continued to be that girl in your relationships and your marriage, like somehow you have this terrible sex life, you know what I mean? And then, and then on top of that, like, does anyone ever really want to have sex? Like, I think we talk about this all the time and we're like, what is the normal amount of having to talk yourself into having a sex life? So that's, it's that we have these conversations,

Right. People come in and we talk about this. And this is essentially also where the biopsychosocial model comes in, because there is no one size fits all and there is no one perfect sex life. And it's not a quantity versus quality, because if you have a pain with sex and you have sex every day, that's terrible. Right. If you have amazing, wild, incredible, mind blowing sex that lasts for six minutes, but everyone got theirs and everyone's happy and it happens once a month, which would you choose? Right. You're always going to choose that. And so the key is like we actually are poisoned by us not talking about this. You said we never talk about these things. So if you're only living in this Instagram generation where you see what you think other people's sex lives look like, then you create this like this script or this Hollywood movie in your brain. And you're like, well, if I don't look like Angelina Jolie and I don't act like Pamela Anderson, well, then I don't deserve this. sex is mediocre right as opposed to oh my gosh i just had an amazing orgasm my partner just had

an amazing orgasm that was awesome right and so i think we um the idea that only attractive people can have good sex is like the most ridiculous concept in the world and people women especially really believe that oh i don't like the way my belly looks i don't like the way my butt looks so you don't deserve an orgasm like do people with disabilities deserve orgasms like of course Do people with different sizes deserve orgasms? Like, of course we can see it for other people, but we cannot see it for ourselves. And so doing a lot of like, would I say this to my friends, right? Would I tell my friend that she didn't deserve that?

Or she didn't like, or like, would I be as nasty to myself as I am to my friends, right? You would never be that way. And so I think it's a lot of mindset work. That's where the psychosocial stuff comes in. So I love that you talk about this. is I wanted to ask that. I feel like we, with the shame, we can sometimes feel like, well, I, I have a low libido and it must be my fault because I'm not sexy enough. My partner isn't sexy enough. I haven't done enough of the like work to get this dream life happening. And what

you're saying is like, it, it is kind of hormonal or in our brains. Like how does that work? And I know that we talk, we want to talk about HSTD, like what is that and what is it doing in your brain when you're not wanting to have sex. Yeah. So it's very interesting. HSTD, which stands for hypoactive sexual desire disorder. HSTD is a fancy way of saying low. It's a doctor way of saying low libido that you're bothered by, right? If you are, if you have no desire to have an orgasm ever or have any intimacy ever, and it doesn't bother you, you don't have a medical problem. If it bothers your partner, you still don't have a medical problem, right? I don't, I'm not there to treat your partner and what your partner's desires are. I'm there to treat the patient in

front of me. So if a patient comes to me and say, Dr. Rubin, my partner is gorgeous. We have a great relationship. We have so much fun together. The sex we have is fine. I don't have any pain. I don't have any medical problems. Like I just like, I used to be interested. I used to want, and like, I don't want anymore, but I kind of want to want Dr. Rubin. I'm here because I want to want, I want that spark. I want the tinglys. I want the thing that got me excited. Right. And so that takes a conversation of like, OK, well, if you go on vacation, do the tinglys come back? You know, and HSTD is when the tinglys don't come back, whether you're on vacation, whether your partner, you know, is is perfect, like where. So it's really there is a medical condition. And it's it's not like everybody has that because a lot of us have, you know, the gosh, I'm working like crazy.

I got so much stuff to do. Like, you know, it's just not on my priority list. That's not HSTD, right? When you have great vacation sex, it's not, it's not HSTD. So there is a medical condition when you used to want, and you no longer want, but you want to want that as a medical condition. If you are bothered by it, Hey, I've got tons of wrinkles in my forehead people. And there's like four different types of Botox, right? Botulinum toxin that I can put in there if I'm bothered by it. But if I went to a dermatologist and said, Hey, I got all these wrinkles in my forehead, they wouldn't say, Ooh, that's a medical condition. We have to give you all this Botox to treat this medical condition, but you deserve to have no wrinkles in your forehead. If that's what you

want, similar to HSTD. If you want to play around with the biopsychosocial model of treating HSTD, your body, your choice, and what are your choices? Sex therapy is awesome, right? Everyone gets, has better sex when they do sex therapy, when they talk about sex, when they communicate with their partners, when they read sexy novels, when they, you know, watch things that are sexy, like people have better sex. That's always a good answer. Sex therapy. There's great ways to find good sex therapists. There's a sect, which is a sex therapy finder, um, uh, organization psychology today.com. You could just search for sex therapists, put in your zip code and find a sex therapist near you. Sex therapists are incredible. And I think they work best when

you're in a good relationship and you're happy. Don't go when you're on the brink of divorce or break up. And like, this is the thing that it's not going to save you, right? It's all that's when they start talking about everything else. Sex therapy is when everything else is good, but you need to figure out how to communicate about sex because nobody taught you in middle school sex ed class, how to talk about sex. Nobody taught you, nobody taught you how to use the words. Nobody taught you what if something's going wrong? How do you talk about it? How do you like, like, and your partner never learned either. They don't know your buttons. They don't know what works for you if you don't tell them. So sex therapy is very helpful. Get a coach.

there are medical things that we can do that are FDA approved, that are studied with science and evidence that show improvements in libido. So for example, maybe y'all know this, maybe you don't, but antidepressants can be lifesaving for many people, but they can also have side effects. And some of those side effects can be sexual. So antidepressants can sometimes lower your libido or delay your orgasm. I have so many patients who say, oh, I love my antidepressant because I'm not anxious all the time, but it takes forever to have an orgasm, right? So if we believe that there are medications that can hurt your sexual function, well, couldn't the opposite be true, that there are medications that can boost your sexual function? And that's really the idea behind

these medications that are FDA approved for low libido. So we know testosterone in men is a great thing to increase their libidos. We actually also know that testosterone for postmenopausal women also boost their libidos as well. And so we've got testosterone that, that we can use. We also have medications that are non-hormonal that can boost dopamine and get you more interested in sex and they're proved. And this is a very sad truth is women will keep having sex, whether it's good or not. That just made me want to barf. Right. I can provide a bag. Like it's true. And until we demand better from science and medicine and evidence? Because the other reality is people go towards all sorts of pseudoscience, right? Oh, this thing on Instagram that I saw is going to

cure all of my problems if I just look this way or act this way or spend money on X, Y, and Z. And so medicine and science doesn't put resources and money towards what they do for men. I have like 27 testosterone products that I can give to my male patients and zero approved testosterone products for women, zero, right? We use it, but we use it off label. And so that's the patriarchy. That's the frustration. That's the, that's why I get up every morning screaming and yelling and trying to, vulvas, right? To care loudly, right? Like, because we have to demand better and demand more options for people because your quality of life, no one's ever told you this before. your quality of life actually matters, right? It matters. Wow. I never think that the episodes

that are going to like the ones that I'm like expecting to really bring me to church rarely are. And the ones that I'm like, this is going to be a great conversation, blow my mind. Like it really is so crazy. I mean, that's a t-shirt right there. That's a t-shirt. I know. Wow. I don't even know. You know, I was on an antidepressant and a friend of mine, I was talking to I was like what the nobody told me they said your libido would drop but nobody said it would like legitimately be numb like there's a numbness feeling like a physical reaction to this thing and I don't know if it's because mentally that that's keeping you from feeling having sensitivity down there I don't know how that works but she joked and she goes oh yeah

all of my friends and I we call it no sex a pro and I came off of it because it was so depressing And so that to the point is, and so we have a lot of patients with breast cancer, right? And breast cancer therapies and treatments are very caustic to the vulva and to libido and to sexual health. 50% of people on sex, on breast cancer medications go off of them for those reasons. And yet you don't have the oncologist saying, whoa, whoa, whoa, how can we study this to find more therapies that we can add or supplement these life-saving medications? Because they'd rather say, ma'am, your libido is not important. We're keeping you alive. Like you should thank us. And women are pissed, but they don't have many options.

So they go to the snake oil, if you will, because not a lot of doctors are listening and validating and saying like, hey, this is a real thing. you deserve to both live and live, right? Like you deserve to have a life. I love it so much. Dr. Rubin, you are an incredible, like, I just feel like I went to vulva church and it was like very enjoyable. The lady gang. I have one quick question before we wrap up is that on Tik TOK, I've been following this lady who's doing squeeze alongs. Oh my God. I saw her last night and I've been doing them. What's it like? It's like the Kegel muscle squeezes and she'll do it with a song and

she'll be like every day and squeeze along with her for a minute. Is that useful or am I wasting my time? So that's kind of brilliant and very funny. What I will say to that is everyone's pelvic floors are slightly different. If you're someone who has pain down there, like pain with penetration, pain with tampons, then Kegels are the opposite of what you want to do. Your muscles are too tight. If you're someone who leaks urine when you cough, laugh, or sneeze because you've pushed a baby out, then yeah, sometimes those squeeze-alongs can be helpful. What I will say is you're never wrong to have a consultation with a pelvic floor physical therapist because they can make sure you're doing those squeezes correctly. Because there is actually data to show that if I

teach you guys verbally how to do a Kegel exercise, you do it wrong. You kind of suck at it, no offense, but like, because you don't even know what's going on down there. So for you to squeeze, you're actually using, some of you are using your belly muscles. Some of you are using your butt muscles. Some of you are using your pelvic floor muscles. And so having a professional sort of look down there, that can be very helpful. And do you see patients in other places virtually, or do you have to have in person? Yeah, it's a great question. So we, we certainly talk to people, but if I, you know, as a, with my medical license, I can only take care of you and write you medications, you know, when you're here seeing me in the Washington, D.C. area.

I hope one day that changes, that I can have some rich donor, if they're listening, pay for me to have medical licenses in every state in the country, you know, so that we can do more virtual care. Because pandemic has taught us how incredible virtual care can be and how much good we can do by giving people good information. because not everyone needs to see me, but it's also, there's not a lot of me out there. Again, if there's someone very fancy listening, there is one fellowship in the entire country that even acknowledges women's sexual health. Just one. There's 27 for men. We only have one for women. I need a fellowship. I need to train people. I need a way, but that stuff all costs a lot. We need a fancy donor to come in and say, hey, women deserve this. How can we train more people to do menopause care, to do sexual health care, to help people with pelvic pain, because there

really is some education chair of a sexual medicine society called ISWISH, the International Society for the Study of Women's Sexual Health. There's about a thousand members, and that includes sex therapists and physical therapists and doctors of every kind. A thousand. That is not enough, right? That is nothing. And so we have to get the word out. So sexual health is just health. Everything that can go wrong with you can affect your sexual function and your sexual health. And if doctors have no training or ability to talk about it, then patients aren't going to ask about it.

They're going to feel uncomfortable and then they suffer. And that part is just not acceptable. Dr. Rubin is my hero. I know. I can't let you go without asking you a question for my fellow mothers, the women I know who have delivered babies. There's this like crazy thing where your OBGYN will tell you that you can have sex six weeks after, for most people, six weeks after vaginally delivering a baby. And every single woman I know

who has vaginally delivered a baby is furious. And it's like, yes, technically can a penis go inside of me? Yeah. But do I want my OBGYN to tell my husband he shouldn't come near me with a 10 foot pole for a year? I would also like, okay, this is really important actually. And I don't know if we have time for it, but if anyone follows me on social media, which is DR Rachel Rubin, Dr. Rachel Rubin. I have very few followers compared to all of you, but the thing that I talk about most on social media is something called vaginal estrogen. Okay. Vaginal estrogen. Let me give you a little overview very quickly. The vagina has a microbiome. It needs healthy bacteria in it to stay acidic. You want a pH of your vagina four and a half. If it is acidic, it can fight

infection. Okay. So an acidic vagina is a happy vagina. And so there are many things that can change the microbiome of the vagina. Hormones affect this microbiome. So if you're on birth control pills, sometimes that can affect the vaginal microbiome. If you are breastfeeding, you are menopausal pretty much, right? When you're breastfeeding, you don't get your period. So you have no estrogen in your body. When you're pregnant, your estrogen is like 3000. When you're breastfeeding, it's zero. You go from an estrogen from 3000 to zero. You wonder why you have brain fog. You wonder why you have low libido. It's because you're in menopause. And so in menopause, when your estrogen is zero, your vagina has no acidity to be strong and healthy

and lubricate and fight infection. And so using a local vaginal estrogen, which is a little, either a little tablet that you put in the vagina twice a week, or a cream that you put in the vagina twice a week. And women don't always love goopy cream. So I like the little vaginal tablet inserts or a vaginal DHEA product, which can go in every night that gives the microbiome a healthy acidic ecosystem. So it can fight infection. It can lubricate. And so sex isn't painful. And so when after baby, the answer should be right at your six week visit, there should be no conversation of penetration. There should be a piece of paper that says, here's a prescription for pelvic floor physical therapy. And here's a prescription for vaginal estrogen, because this

safe and won't affect your milk supply. Use this. And when you feel ready, and when you decide you're ready to have any intimacy with your partner, you get to decide. That's what needs to happen. And same for all of your mothers and grandmothers. If you know anyone over the age of 45 who has a urinary tract infection, they must be on vaginal estrogen to prevent urinary tract infections. It will save their lives, right? There are lots of grandmas in nursing homes who die of urinary tract infections and vaginal estrogen can save their lives. Oh my God. This is a whole other episode. You have to come back. I'm so honored that you would have me on and I'm so grateful for the platform to be able to talk

about this stuff. And thank you. Thank you so much. You really are doing the Lord's work. Really, really. And if you want to learn more about an FDA approved treatment option, you can visit www.hsddtreatment.com. And of course we'll link everything in the show notes and we will link to Dr. Rubin on Instagram so you can follow her because you're going

to want to alright we weren't here for a long time but we're here for a sexy time sexy time yes we were thanks for listening

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