Are you in your 40s or 50s and wondering why sex feels different—less pleasurable, more painful, or just off? You’re not alone. In this must-hear episode, Dr. Rachel Rubin, a leading urologist and sexual health expert, breaks down the real reasons behind low libido, vaginal dryness, painful sex, and hormonal changes during perimenopause and menopause.

We uncover the truth about vaginal estrogen, testosterone therapy, clitoral changes, and why so many women suffer in silence. If sex feels different—or you just don’t feel like yourself anymore—this episode is for you.

Topics covered:

• What Genitourinary Syndrome of Menopause (GSM) really means
• Why vaginal hormones are safe—even for breast cancer survivors
• Clitoral shrinkage & labia resorption explained
• The case for testosterone in women’s health
• Why vaginal estrogen can save lives (not just improve sex)
• The silent epidemic of untreated postpartum sexual dysfunction

📌 If you’re a woman in midlife—or a partner, clinician, or advocate—this is the sexual health conversation you didn’t know you needed.

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Disclaimer: This podcast and any information, advice, opinions or statements within it do not constitute medical, health care or other professional advice. Information is provided for educational and entertainment purposes only.

00:00 - Intro: What This Episode Covers
00:00:14 - Meet Our Hormone Health Expert
00:01:14 - Sexual Health Changes in Midlife
00:02:38 - Hormonal Shifts That Affect Libido
00:03:46 - Common Sexual Health Questions Answered
00:04:55 - Vaginal Discomfort After 40 Explained
00:06:56 - Myths About Vaginal Hormone Therapy
00:08:06 - Why Vaginal Hormones Are Often Needed
00:11:52 - The Cost of Recurrent UTIs
00:13:24 - Types of Vaginal Hormone Treatments
00:15:11 - Why Not to Stop Therapy Early
00:22:56 - Testosterone’s Role in Women’s Health
00:25:30 - The Research Gap on Testosterone
00:30:35 - What Is GUSL in Lactation?
00:34:19 - Sexual Health Advocacy and Research
00:35:22 - Menopause and Labia Minora Changes
00:39:44 - Understanding Clitoral Changes With Age
00:41:10 - Clitoral Adhesions: What Women Should Know
00:44:08 - Gaps in Sexual Wellbeing Education
00:46:27 - Sex and Midlife Relationship Dynamics
00:50:43 - Misconceptions About Hormone Therapies
00:57:20 - Best Vaginal Lubes and Devices
01:02:04 - Advice for My Younger Self

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