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

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 3 November 2025

⏱️ 112 minutes

🔗️ Recording | iTunes | RSS

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Summary

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Sally Greenwald is an OB-GYN who specializes in women's sexual health from a hormonal and physiologic perspective, with expertise spanning desire, arousal, pelvic floor function, contraception, and menopause care. In this episode, she explains why sexual health is a vital component of overall well-being, exploring topics such as the drivers of desire, the anatomy of sexual function, myths and realities around orgasm, and the role of hormones in perimenopause and menopause. She also covers vaginal and pelvic health, pain with sex, evidence-based therapies for low desire and arousal, how contraception and medications can affect sexual function, and practical strategies for enhancing sexual satisfaction and maintaining intimacy across life stages. This episode offers a comprehensive, evidence-based discussion with immediate real-world relevance for women as well as for men who want to better understand their partners.

We discuss:

How sexual health influences physical health, emotional well-being, and relationships [3:15];
Understanding the physiology of the female orgasm, sexual comfort and satisfaction, and the disparity between men and women [12:45];
Foreplay, the science of desire, and methods to help women cultivate arousal and connection [19:00];
The physiology and sources of female lubrication, the role of clitoral nerve anatomy in pleasure, and the use of lubricants and vibrators to enhance comfort and sexual health [23:45];
Understanding female anatomy and what is needed for orgasm [31:15];
Understanding sexual desire, how to cultivate it, the role of hormones, and testosterone therapy in women [41:15];
Personalizing perimenopause care: how desire for ovulation guides the choice between contraception and menopausal hormone therapy [49:30];
Considerations for choosing contraceptives and hormonal therapies during perimenopause [59:45];
Factors negatively affecting desire, and why female libido persists with age and fluctuates across the menstrual cycle [1:11:00];
How sexual trauma and physical pain can affect sexual health, and evidence-based strategies for recovery [1:15:15];
Vaginal care routine: lubricants, moisturizers, topical hormones, and other approaches for vaginal health [1:19:15];
Tips for sexually satisfying your female partner [1:25:45];
The pharmacology of arousal: various treatments for low sexual desire in women [1:30:30];
Sex during and after pregnancy: impact on arousal, safety of sex, and how to manage postpartum recovery and pain [1:37:45];
How Sally would redesign sex education [1:42:15];
Sally's optimism about a new era in women's sexual health [1:49:00]; and
More.

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Transcript

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0:00.0	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.
0:24.1	Our goal is to provide the best content in health and wellness, and we've established a great team of
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0:57.4	If you want to learn more about the benefits of our premium membership,
1:02.1	head over to peteratia m.com forward slash subscribe.
1:07.0	My guest this week is Dr. Sally Greenwald.
1:12.7	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,
1:19.2	contraception, menopause, and perimenopause care, and evidence-based strategies to improve sexual
1:25.6	well-being. In this episode, we discuss why sexual health
1:29.6	is a core part of overall health and life quality for both men and women, a practical framework
1:35.9	for desire, the accelerator and break model, and how patterns change across life, anatomy
1:42.1	for sexual function, the clitoral complex and vaginal anatomy,
1:46.1	and why understanding it matters, both for men and women. Orgasm, realities, and myths,
1:51.8	and varied pathways to orgasm beyond penetrative sex, vaginal tissue health, lubrication,
1:58.1	moisturizers, and when local estrogen is helpful, pain with sex, the common
2:02.5	causes, evaluation, and a multidisciplinary approach to treating it, parimenopause and menopause,
2:08.4	symptom patterns and the roles of estradiol, progesterone, progestins, and testosterone,
2:14.3	contraception across the reproductive years, and how different methods interact with
	...

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