Something is happening in women’s health care. Perimenopause is finally being discussed openly. Vaginal estradiol has entered mainstream conversation. Testosterone therapy for women is no longer confined to niche clinics or whispered discussions. Across medicine and social media alike, women are asking new questions about tissue health, sexual function, intimacy, discomfort, sensation, and quality of life. And perhaps more importantly, they are no longer accepting silence as an answer.

These conversations are larger than a trend. They reflect a growing recognition that medicine may have left an important part of women’s health structurally underdeveloped, not intentionally, but historically. And what all of these individual conversations are building toward is something medicine has never formally constructed before. A recognized clinical domain for women’s sexual health. One that sits alongside reproduction, disease prevention, and longevity with the same legitimacy, the same research infrastructure, and the same clinical standards medicine has built everywhere else. Not for the few women who find the right specialist. For every woman. In every exam room. Something that changes the lives of grandmothers who suffered in silence, mothers who were told their symptoms were normal, and daughters who will never have to find out alone.

That is a movement. And medicine needs to lead it, not follow it.

There is a question that belongs in every new patient encounter in every OB/GYN office in this country. It takes ten seconds. It changes everything. And most of us were never taught to ask it.

How are you feeling in your own body? Is intimacy a meaningful part of your life?

Sixteen years of practice. Thousands of patients. Residents trained. And not once did that question make it into the room. Not because I didn’t care for the women sitting across from me. Because the examination I was taught, the one being taught right now in residency programs across the country, never included it.

The realization didn’t come from a journal or a conference. It came during a season of personal reinvention. I lost weight. My body changed. And a male testosterone clinic asked questions no physician had ever asked: Was intimacy still meaningful? Was my body working the way it should? Did life feel like it used to?

If no one was asking those questions of women, someone had to start.

That conviction led to a complete professional reinvention. A fellowship under cosmetic gynecology pioneer Dr. Michael Goodman followed. Hundreds of hours of independent surgical education. Teaching internationally across six countries. And everywhere (Dubai, India, Guatemala, Jamaica, Iran, the Philippines) the same silence. Women experiencing real concerns. Medicine offering nothing.

Before leaving for the American College of Obstetricians and Gynecologists (ACOG) annual conference in San Francisco, my patients knew the trip was coming. When I told them I was taking their stories to the largest gathering of OB/GYNs in the country, that their experiences were going to be in that room whether those physicians wanted them there or not, the response was unlike anything I had seen in a clinical encounter before. The only way to describe it is a strange mix between two people belly bumping in excitement and a proud parent sending their kid off to war. They were thrilled. They were scared. They believed something important was about to happen.

That feeling carried into the booth when the dirty looks started. The booth featured a radiofrequency surgical device and its applications in cosmetic gynecology. A piece of medical equipment. The contempt it generated said everything about how far medicine had decided to keep this conversation from the exam room. A male physician in a room of predominantly female colleagues. Colleagues stopping long enough to say: These women don’t need this. They need self love.

My first feeling was doubt. Whether any of this actually mattered to women. Whether the room was right. Then the belly bump came back.

What followed was disappointment, not anger. The contempt came from the same training, the same framework, the same incomplete examination. ACOG governs 30,000 physicians. They set standards. They cannot validate what has not been formally studied. The institutional resistance made sense. The patients who walked into those physicians’ offices the following Monday paid the price for it.

Two patients found their way to my practice after medicine had nothing left to offer them. One was a physician herself. She saw three specialists. Three dismissals. She came in skeptical enough to be almost rude. On her final visit she said quietly, “I couldn’t stand the sight of my own body. Now I look at her every day.” The other was a mother whose body changed after children in ways nobody had warned her about. Told it was normal. After her procedure she said, “I’m back. All the ways back. I mean all THE ways.”

These are not exceptional patients. They are typical ones. The exceptional thing is that they found their way to a conversation medicine should have been having with them for years.

Medicine created the gap. Misogyny sustained it. Women’s sexual health paid the price.

The social media conversation happening right now is women refusing to accept that gap any longer. They are building the movement from the outside because medicine has not yet built the infrastructure from the inside.

We built the gap. We can close it.

This is a call to change your examination, beginning with your next patient encounter. Ask one more question.

What is your sexual function like? How do you feel in your own body? Is intimacy a meaningful part of your life?

The social media cycle will eventually move on to something else. The women sitting in your waiting rooms will not. They will still be there, carrying concerns medicine has not yet built the infrastructure to address. Still waiting for a physician who asks.

The examination was wrong. It can be taught differently. And when it is, grandmothers, mothers, and daughters will all have access to something that changes medicine permanently.

Not a trend. A domain.

Michael Reed is a board-certified obstetrician-gynecologist, certified menopause practitioner, and fellowship-trained cosmetic gynecologic surgeon practicing in Davis, California. He is the founder of the Institute for Restorative and Cosmetic Gynecology and practices under the brand The Cosmetic Gyn.

His clinical focus is cosmetic and functional vulvovaginal surgery and women’s sexual health. Dr. Reed has taught cosmetic gynecology internationally across six countries and has contributed to the medical literature on the field, including a peer-reviewed publication. He shares updates on Instagram and TikTok.