On a morning in June, Bethesda urologist Rachel Rubin, 39, is pondering where to hang a clock depicting the anatomy of the pelvic floor. “Should this go in my office or in the lobby?” she asks one of her colleagues as she stands in front of shelves full of vibrators, bobbleheads, mugs with quirky sayings referencing reproductive health, and both anatomically correct and smiling cartoony models of the clitoris. A pillow on a chair is embroidered with “give me the estrogen and nobody gets hurt.”
Rubin, who jokingly calls herself “Dr. Rachel Rubin, Sex Detective,” wants people to talk openly about sex, but more importantly she wants them to understand how it uniquely affects each person. She has built a following of more than 62,000 on Instagram for her candid posts about sexual health and is an outspoken advocate against gender disparities in research on sexual and reproductive health and anatomy. A proponent of hormone replacement therapy, she’s often a source in national and international news reports about menopause research, and she regularly speaks on panels about women’s sexual health.
Rubin lives in Chevy Chase with her husband, Michael Gerber (who has written for Bethesda Magazine), and their children, who are 5 and 7. She started her medical career at MedStar Georgetown University Hospital and became interested in how sexual health is seldom discussed during most appointments with doctors.
After deciding to pursue urology, Rubin received a fellowship in 2016 at San Diego Sexual Medicine, a multidisciplinary health care facility at Alvarado Hospital. During the fellowship, which focused on women’s sexual health and changed the trajectory of her career, Rubin took to social media, tweeting about the research her colleagues were doing and trying to explain it to a broader audience. Her online presence took off.
“It’s not just important to do the research, but it is really important to translate the research and describe the research,” Rubin says. “We complain a lot that there’s not enough research, and I agree … we’re very far behind. But we’re not even using the basic research that we do have to help people.”
At her Bethesda practice, Rubin and her colleagues work with patients of all genders and backgrounds to reach their optimal sexual and reproductive health and solve the mysteries of everything from low libido to severe pain. While her social media posts are popular with women going through menopause—a key topic of her content—she has treated children as young as 7, and her oldest patient is 98.
One patient came in with “horrible, horrible” pelvic pain and clitoral pain that she’d experienced for three years, Rubin says. She and her colleagues were able to help with a combination of local hormones, pelvic floor physical therapy and other treatments, but it turned out that an issue in her spine was causing nerve pain.
“Her pain went away with a nerve block and she ultimately had minimally invasive spine surgery. Her pain is completely gone,” Rubin says. “It wasn’t me that was going to cure this person’s pain. But it was me thinking outside the box, working up the parts that I knew how to work up and then using my network and my colleagues to be able to validate this person’s experience and say it’s not normal to have three years of clitoral pain. How can we make this better for you?”
Rubin says most cases aren’t that extreme. She believes urology work can save marriages and that “seeing a specialist is expensive, but it is cheaper than divorce.” Her practice does not accept insurance.
“It could be someone with erectile dysfunction who has reliable erections again and feels great. It can be someone who lost their ability to have an orgasm and we are able to help that happen again, that makes them want to be more intimate with their partner, and that’s super pleasurable to take away someone’s pain,” Rubin says.
Bethesda Magazine spoke to Rubin about her work. The interview has been lightly edited for clarity and length.
When people hear the word urologist, they’re not necessarily thinking about their sexual or gynecological health. How do those things go hand in hand?
Urologists take care of the genitals and urinary tracts. The problem is, we have this idea that OB-GYNs are supposed to take care of everything that goes on with a woman, but they’re not trained to do everything that goes on with a woman, nor should they be responsible for all of these issues. So urologists are really focused often on quality of life issues, issues with urination, issues with sexual health, and we are board certified to take care of men and women. It’s just the misogyny of our society where we are better trained at taking care of men than we are women, which is a huge problem, which is what we’re trying to change.
We deal with issues of libido, arousal, orgasm and pain. And so if you have any of those problems, and many people have those problems … that’s when you invest in coming to see us.
While you can’t diagnose through an Instagram post, do you think your social media encourages people to talk to their doctors about their sexual health?
It helps empower the patients to advocate for themselves and to be able to say, ‘Wait a minute, during this 10-minute visit where I got gaslit and didn’t get taken seriously, maybe this doctor, it’s not their expertise. Maybe I should see someone who actually cares a lot about this.’ The person who has 30 patients a day and is dealing with cancer may not have the interest in your libido and may not have the time to deeply dive into your libido.
When your patients come in, are there things that they are afraid to ask?
It is very scary to come in to the sex doctor and also talk for that amount of time about yourself. Most people have never done that before, but when you connect with someone who genuinely cares and wants to hear it, it really releases a lot of that anxiety. There’s also always the patient who is so afraid that I’m going to tell them this is all in your head, this isn’t real, you’re not experiencing this. I’ve done this for a long time and I’ve never said those words before. Why? Because there’s always biology to help explain what’s happening to the person. Also your brain is a part of your biology, so understanding that is really important.
Menopause isn’t new, but it seems to be something we’re talking more frankly about now. Why is that, and why are some aspects just now being researched?
Menopause is having a little moment right now, and I’m grateful for my social media ‘posse’ because we are bringing awareness loudly. What’s also happening is journalists are becoming perimenopausal and they are writing about it. The New York Times has written about it. The Washington Post has written about it. It’s getting picked up—there are a lot more articles and stories. This is nothing new. But it’s just our ability to have these conversations. There’s a new term, NFLM, it’s ‘Not Feeling Like Myself.’ Women in their late 30s and 40s that are just like wait a minute, all of a sudden I want to go to the allergist and the neurologist and the cardiologist and the orthopedist. All of a sudden I have all these doctors, now what is going on? And you’re not so unlucky that you have 100 things going on. Your body is sort of doing puberty in reverse, and there is a wild fluctuation in the hormones that the ovaries make.
How can people best empower themselves to take charge of their sexual health?
We need education, and it’s important to find the health care professionals who really want to help you. I give people a mirror and I give them a tour of their own genitals, and I say this is your labia majora, this is your labia minora, this is your clitoris, this is your pelvic floor. It is what I love about my job. I have the smartest, most impressive D.C.-area people, and not a single one of them doesn’t learn when we do that together, where I teach them very basic facts about their body parts and how they work. Having that tour is incredibly beneficial so that if something were to hurt, you know where it’s hurting, you can then look and you know.
I think education is so important because sometimes we’re embarrassed. We feel like we have come this far in life and think, ‘I should know this, so I can’t ask that question, oh, I can’t ask my friends this question, that’s too embarrassing.’ That’s where having the trusted sources is so important.
This story appears in the September/October 2024 issue of Bethesda Magazine.
