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For too long, women’s health has been shrouded in silence, dismissed as "just a part of getting older," or sidelined by medical curricula that prioritize reproductive biology over sexual health. Dr. Rachel Rubin, a board-certified urologist and leading expert in sexual medicine, is changing that narrative. Whether you are navigating puberty, pregnancy, perimenopause, or beyond, understanding your body’s hormonal landscape is not just about comfort—it is a critical necessity for your long-term health and quality of life.
Key Takeaways
- Hormones are foundational: Estrogen, progesterone, and testosterone are essential for the health of tissues throughout the entire body, including the bladder and genitals.
- The UTI connection: Many chronic urinary tract infections (UTIs) are linked to hormone fluctuations and the resulting changes in the vaginal microbiome; vaginal hormones are a highly effective, safe, and inexpensive preventative measure.
- The "GSM" reality: Genital Urinary Syndrome of Menopause (GSM) encompasses dryness, pain with sex, frequency, and urgency—all of which are treatable with localized hormonal therapy.
- Advocate for yourself: Because many medical professionals have not been adequately trained in sexual medicine, it is vital to assemble your own "pit crew" and seek out practitioners who understand the role of hormones in your overall well-being.
The Overlooked Role of Hormones in Urinary Health
There is a persistent myth that urinary tract infections are solely caused by external bacteria or sexual activity. However, Dr. Rubin explains that hormonal health is a massive, overlooked piece of the puzzle. When hormone levels fluctuate—due to birth control, breastfeeding, or menopause—the tissues of the vagina and bladder can lose their healthy, acidic environment. This shift allows for the growth of harmful bacteria and significantly increases the risk of recurrent UTIs.
What is GSM?
Genital Urinary Syndrome of Menopause (GSM) is the medical term for the changes that occur in the vulva, vagina, and bladder when hormone levels drop. This isn't just about "dryness." It includes chronic irritation, painful intercourse, urgency, and frequent leakage. By using micro-dosed vaginal hormones, women can restore the health of these tissues, effectively preventing recurrent infections and improving quality of life.
"Using vaginal hormones prevent urinary tract infections by more than half." — Dr. Rachel Rubin
Breaking the Stigma: Vagina and Estrogen
Dr. Rubin notes that despite having effective treatments since the 1970s, many women are still suffering because the words "vagina" and "estrogen" have historically been treated as taboo. Furthermore, outdated warning labels—which claimed these treatments caused stroke, blood clots, or dementia—created unnecessary hysteria that prevented millions of women from accessing life-saving care. As of early 2026, the FDA has removed these inaccurate labels, yet the work of educating both patients and doctors continues.
Understanding Anatomy: The Clitoris and Beyond
One of the most profound revelations from Dr. Rubin’s work is the prevalence of clitoral adhesions, a condition where the hood of the clitoris becomes stuck, causing pain, irritation, or an inability to experience full sexual pleasure. Alarmingly, research shows that 23% of women in her clinic experience this, yet it is rarely discussed or checked during routine medical exams.
Why Anatomy Education Matters
Because the clitoris and the penis share the same biological tissue, it is logical that they require similar care and attention. By using a mirror and understanding your own anatomy, you gain the agency to identify when something isn't right. Whether it is a clitoral adhesion or issues with the vulvar vestibule—a delicate area often mistaken for a UTI site—having the language to describe your symptoms is the first step toward getting the right treatment.
Building Your Own Medical "Pit Crew"
The current medical system often limits appointments to a brief 10-minute window, which is rarely enough time for a provider to address complex hormonal or sexual health concerns. Dr. Rubin emphasizes that patients must become the CEO of their own health team.
Tips for Your Next Appointment
- Come prepared: Bring a list of your symptoms and do not let them be dismissed as "just part of aging."
- Ask the hard questions: If your doctor is unsure about hormonal treatments, ask: "Are you the right person to help me with these specific issues, or can you refer me to someone who is?"
- Seek specialists: Look for practitioners who have taken additional training in sexual medicine or are members of societies dedicated to women’s health.
"I have never fixed a patient by myself. The patients who do the best are the ones who have a team and they are the center of the team." — Dr. Rachel Rubin
The Power of Testosterone for Women
The conversation around testosterone for women is often clouded by political bias and outdated science. Dr. Rubin clarifies that testosterone is a human hormone, not a gendered one. For women, levels begin to drop in their 30s, often leading to fatigue, low libido, and changes in mood. While there is no current FDA-approved testosterone product specifically for women in the U.S., global consensus supports its safety and efficacy. When dosed correctly, it can be the "missing link" for women who feel they have lost their sense of self.
Conclusion
Your quality of life is not something to be compromised, and "gritting and bearing it" is not a medical strategy. By educating yourself on the biological reality of your hormones, you are reclaiming your health and your future. As Dr. Rubin reminds us, you deserve a medical team that supports your well-being, validates your experiences, and provides you with the tools to thrive. Take the initiative to learn, speak up, and advocate for the care that will allow you to live your best life.
