Dr. Rachel Rubin

So it's skin. It's ectoderm. So it is skin and we're split open. So if you take the median RAFE and you split it, that's your labia minora, which is very hormone sensitive. I'm not on TikTok, but I am trending on TikTok because I talk about the labia minora shrinking and disappearing in menopause and the internet has broken because of it.

So it's skin. It's ectoderm. So it is skin and we're split open. So if you take the median RAFE and you split it, that's your labia minora, which is very hormone sensitive. I'm not on TikTok, but I am trending on TikTok because I talk about the labia minora shrinking and disappearing in menopause and the internet has broken because of it.

So the labia minora is very hormone sensitive tissue that we do not study and we know almost nothing about, but it resorbs in menopause. Inside the labia minora, so if we cut into the median raphe in a man, and we do this when we put in penile implants or we do urethral surgeries, we get to the male urethra. So Peter, your outside of your cheek is skin.

So the labia minora is very hormone sensitive tissue that we do not study and we know almost nothing about, but it resorbs in menopause. Inside the labia minora, so if we cut into the median raphe in a man, and we do this when we put in penile implants or we do urethral surgeries, we get to the male urethra. So Peter, your outside of your cheek is skin.

The inside of your cheek is different tissue. One's more sensitive, one's thicker. So the skin of the median raphe is very different than the skin of the tube of your urethra. You agree? For sure. So if you split open the labia minora, you get to the urethra. And that is the vulvar vestibule.

The inside of your cheek is different tissue. One's more sensitive, one's thicker. So the skin of the median raphe is very different than the skin of the tube of your urethra. You agree? For sure. So if you split open the labia minora, you get to the urethra. And that is the vulvar vestibule.

So the tissue that surrounds the urethra in a woman that goes all the way around, and I will show you nerdy anatomical diagrams when we're done here because I need you to know this. That is the female urethra. It's called the vulvar vestibule. It is made up of endoderms.

So the tissue that surrounds the urethra in a woman that goes all the way around, and I will show you nerdy anatomical diagrams when we're done here because I need you to know this. That is the female urethra. It's called the vulvar vestibule. It is made up of endoderms.

So we think of the cervix as a transition point, but the most important transition point that affects sexual health in a woman is when you go from ectoderm of the labia minora to endoderm of the vulvar vestibule, and then past the hymen is mesoderm. It's fascinating anatomy. Why is this important? It's super compressed.

So we think of the cervix as a transition point, but the most important transition point that affects sexual health in a woman is when you go from ectoderm of the labia minora to endoderm of the vulvar vestibule, and then past the hymen is mesoderm. It's fascinating anatomy. Why is this important? It's super compressed.

It's so important because if you push with a Q-tip on the labia minora, they'll have no pain. If you push them on their vulvar vestibule, they'll say, that's my UTI. That's my interstitial cystitis. That's the pain that I have with sex. It is rich in hormone receptors.

It's so important because if you push with a Q-tip on the labia minora, they'll have no pain. If you push them on their vulvar vestibule, they'll say, that's my UTI. That's my interstitial cystitis. That's the pain that I have with sex. It is rich in hormone receptors.

This is why 50% of women go off their endocrine therapy for breast cancer because they have urinary symptoms, pelvic pain symptoms, and it is all sourced in a body part that no one taught you in medical school. And I did that on purpose because I knew you wouldn't know it. because no one is taught how to examine it.

This is why 50% of women go off their endocrine therapy for breast cancer because they have urinary symptoms, pelvic pain symptoms, and it is all sourced in a body part that no one taught you in medical school. And I did that on purpose because I knew you wouldn't know it. because no one is taught how to examine it.

They put a speculum in and they bypass it completely and they are missing the problem. Back to the DHEA, this tissue has estrogen and testosterone receptors in it. So sometimes estrogen is not enough to help this vulvar vestibule tissue. And so DHEA, there's some data. There's one paper to suggest that DHEA is enough. And this is the one time that I will compound a product for a woman.

They put a speculum in and they bypass it completely and they are missing the problem. Back to the DHEA, this tissue has estrogen and testosterone receptors in it. So sometimes estrogen is not enough to help this vulvar vestibule tissue. And so DHEA, there's some data. There's one paper to suggest that DHEA is enough. And this is the one time that I will compound a product for a woman.

Otherwise, I use FDA-approved products in my practice. And I compound basically the amount of estrogen and estrogen vaginal topical cream, the 0.01%. And I will use a topical testosterone 0.1%. different than the 1% we talked about for libido, but a 0.1%. They rub it topically on this vulvar vestibule. You cure pain with sex. You help these UTI symptoms.

Otherwise, I use FDA-approved products in my practice. And I compound basically the amount of estrogen and estrogen vaginal topical cream, the 0.01%. And I will use a topical testosterone 0.1%. different than the 1% we talked about for libido, but a 0.1%. They rub it topically on this vulvar vestibule. You cure pain with sex. You help these UTI symptoms.

Interstitial cystitis goes away in so many patients. It's miraculous.

Interstitial cystitis goes away in so many patients. It's miraculous.