Female sexual health and pleasure have become increasingly prominent areas of focus within the medical and wellness industries, with a growing number of women seeking specialized treatments and expert guidance to enhance their intimate wellbeing. Leading this trend is Dr. Sally Greenwald, a California-based gynecologist known for her concierge practice serving an elite clientele, including high-profile figures from Silicon Valley.
Dr. Greenwald, who has gained recognition as a pioneer in what she describes as extending a woman’s “sexspan”—the period during which a woman enjoys sexual pleasure—charges fees that can reach up to $10,000 annually. Her patient list reportedly includes prominent women such as Priscilla Chan Zuckerberg and Sheryl Sandberg. Greenwald emphasizes that sexual satisfaction is not merely a luxury but an essential component of overall health and happiness, linking a fulfilling sex life to better sleep, enhanced emotional connection, and physical wellbeing.
According to Greenwald’s clinical experience and research, only a small fraction—around 5 percent—of women report experiencing optimal sexual pleasure. Many women face challenges such as diminished desire, pain during intercourse, and difficulty achieving orgasm. She highlights a persistent disparity in orgasm rates: while approximately 95 percent of heterosexual men regularly orgasm during sex, only about 65 percent of heterosexual women do, with lesbian women reporting higher rates at around 86 percent.
Greenwald’s approach includes the use of menopause hormone therapy (MHT), a term she prefers over hormone replacement therapy, which she argues suggests a pathological condition rather than a natural biological transition. Her treatment philosophy focuses on helping women navigate menopause with resilience and agency rather than fighting against it. She notes that testosterone levels generally remain stable unless a woman’s ovaries are removed, and that addressing hormonal changes can be part of a proactive strategy to maintain sexual health.
Beyond hormone therapy, Greenwald advocates for practical lifestyle adjustments and sexual health practices, recommending silicone-based lubricants as a routine product comparable to sunscreen and endorsing the use of vibrators, including devices like the "magic wand" massager, especially for postmenopausal women. She also stresses that sexual desire requires effort and intentionality, encouraging couples to prioritize time for intimacy despite modern distractions such as smartphones, which she identifies as contributing to a global decline in sexual activity.
Despite her enthusiasm for various treatments, Greenwald acknowledges the limited scientific evidence underlying many recent therapies promoted in female intimate health, noting the field’s longstanding under-research status. While she supports further study, she advises patients to weigh potential benefits against risks and decide according to their values.
In parallel, sex educator Emily Nagoski, author of "Come as You Are" and its sequel "Come Together," has contributed to recent conversations around sexual wellbeing, emphasizing the importance of understanding sex as a skill that can be developed and improved rather than an innate ability.
The rising attention to female pleasure reflects broader cultural shifts toward recognizing sexual health as integral to overall wellness. While treatments and approaches vary widely, experts like Greenwald and Nagoski advocate for more open, evidence-informed discussions aimed at helping women reclaim control and satisfaction in their sexual lives.