Women's sexual health: desire, arousal, and orgasms, navigating perimenopause, and enhancing satisfaction | Sally Greenwald, M.D., M.P.H.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Dr. Sally Greenwald. Sally is an OBGYN who specializes in women's sexual health from a hormonal and physiologic perspective with a clinical focus that spans desire, arousal, pelvic floor function, contraception, menopause and perimenopause care and evidence-based strategies to improve sexual well-being. In this episode, we discuss why sexual health is a core part of overall health and life quality for both men and women, a practical framework for desire, the accelerator and brake model and how patterns change across life, anatomy for sexual function, the clitoral complex and vaginal anatomy and why understanding it matters both for men and women, orgasm realities and myths and varied pathways to orgasm beyond penetrative sex, vaginal tissue health, lubrication, moisturizers and when local estrogen is helpful, pain with sex, the common causes, evaluation and a multidisciplinary approach to treating it, perimenopause and menopause, symptom patterns and the roles of estradiol, progesterone, progestins and testosterone, contraception across the reproductive years and how different methods interact with hormones and sexual function, medications and adjuncts for low desire or arousal, including the FDA approved options and the realistic expectations around them, the use of vibrators and other devices as therapeutic tools both solo and with partners, when medications and substances help or hinder arousal and orgasm, such as cannabis, THC, SSRIs and practical strategies for use, pregnancy and postpartum sexual health considerations, and safer sex practices and STI screening, plus communication and sexual health education around how to talk to your kids about sex. This podcast will have an immediate and obvious application and interest to women, but I can tell you guys, if you're listening, this is something you will want to understand greatly. I learned an enormous amount during this interview with Sally. And if you want to understand your partners better, this is definitely the podcast for you. So without further delay, please enjoy my conversation with Dr. Sally Greenwald.
Sally, thank you so much for coming out to Austin.

**Sally Greenwald** (3:28)
Thank you for having me.

**Peter Attia** (3:29)
This is a topic that on the surface might seem somewhat directed towards 50 percent of the population, but I think it's safe to say it's probably going to be directed towards 100 percent of the population. So you have a practice, you're an OBGYN, but your focus is not just on maybe the standard OBGYN things, but really around women's sexual health. Is that a fair assessment?

**Sally Greenwald** (3:52)
That would be a fair assessment, yes. From a hormonal and physiologic perspective, yes.

**Peter Attia** (3:57)
Awesome. Well, by way of background, we were introduced through a mutual friend slash patient who had listened to the Rachel Rubin podcast that I did recently, was super impressed by it and said, you have got to speak with Sally and one thing led to another, and we are now speaking. So, let's start by helping people understand why would a podcast that focuses on health, longevity, all of these things that pertain to living longer and better, why would sex be an important part of that discussion?

**Sally Greenwald** (4:33)
Well, I'm having a hard time understanding how sex couldn't be a part of that conversation. First of all, this is a performance-driven podcast. And so, for the 50% of your listeners who are male, if you want to improve your performance, I'm going to give you facts and anatomical descriptions and describe some pathophysiology so that you can improve your performance. Clearly, sexual health is health. And when you look at your longevity levers and you think about your centenarian decathlon and what you wanna do when you're 100, for many people, this is on the list. And I wanna talk about how to structure your life and get you ready to do that. I also think that there's probably a small group of listeners, similar to myself, who always thought that The Drive was supposed to be about Sex Drive and that you just had a branding error when you named it The Drive. So for those people as well, we're finally gonna talk about the drive that you actually care about, which is Sex Drive.