Systemic Options: Ospemifene and Risk Considerations

In this episode Dr. Mary Claire Haver is joined by Dr. Rachel Rubin, a board-certified urologist and nationally recognized expert in sexual medicine, fellowship trained in both female and male sexual health. As assistant clinical professor of urology at Georgetown University and former education chair of the International Society for the Study of Women's Sexual Health, she brings unique insight into the stark disparities in how sexual dysfunction is treated across genders. Dr. Rubin founded the Sexual Medicine Research Team, and her advocacy work has been instrumental in changing FDA labeling on hormone therapy and advancing the American Urological Association Guidelines on genital urinary syndrome of menopause.

During the conversation, Dr. Haver and Dr. Rubin explore the intersection of menopause, hormones and women's sexual health, revealing why most doctors, including OB-GYNs, receive virtually no training in sexual health despite sexual dysfunction affecting millions of women. Dr. Rubin explains how men's sexual health benefits from 27 fellowship programs while women's sexual health has only three, and why erectile dysfunction research receives billions while female orgasm research gets nothing from the NIH. She breaks down the complete anatomy of the clitoris that most medical professionals never learned, explaining why understanding this matters for surgical outcomes, pleasure, and treating conditions like vulvar vestibule pain that affects penetration, tampon use, and pelvic exams. Dr. Rubin discusses how the vulvar vestibule, the hormone sensitive tissue surrounding the urethra, becomes a source of pain for many women during perimenopause, on birth control pills, or postpartum due to low estrogen and testosterone.

Guest links:

Dr. Rachel Rubin (Instagram)

Dr. Rachel Rubin (YouTube)

Dr. Rachel Rubin (Website)

Dr. Rachel Rubin (LinkedIn)

Dr. Rachel Rubin (Facebook)

Dr. Rachel Rubin (X)

Books

“Vagina Obscura: An Anatomical Voyage Hardcover,” by Rachel E. Gross

Articles

Sexual function after hysterectomy according to surgical indication: a prospective cohort study (Sexual Health)

The human cervix: Comprehensive review of innervation and clinical significance (Clinical Anatomy)

Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves (Brain Research)

The Impact of Glucagon-like Peptide-1 Receptor Agonists on Erectile Function: Friend or Foe? (Biomolecules)

Effect of Saw Palmetto Extract on Erectile Dysfunction and Libido in Patients with Lower Urinary Tract Symptoms Because of Benign Prostatic Obstruction (International Journal of Applied Research on Medicinal Plants)

“Not feeling like myself” in perimenopause — what does it mean? Observations from the Women Living Better survey (Menopause)

Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements (Journal of Menopausal Medicine)

Menopausal Hormone Therapy and Cardiovascular Diseases in Women With Vasomotor Symptoms: A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials (JAMA Internal Medicine)

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