“Sexual health is health,” Dr. Sally Greenwald tells her patients. A highly sought-after gynecologist serving the élite women of Silicon Valley, for whom optimization of all bodily functions is a top priority, Greenwald has an untraditional approach to her concierge practice. She believes, for instance, that regular orgasms are vital to good health, and encourages quickies even in moments when the urge isn’t there. She counsels women to use cutting-edge hormone therapy to relieve symptoms of perimenopause and menopause, and finds ways to prescribe nonsystemic hormones to women who have had breast cancer, a strategy that is controversial among some oncologists. Her patients are data-driven; they believe in “healthmaxxing” and are willing to pay tens of thousands of dollars to become part of Greenwald’s practice.Melanie Thernstrom, a patient of Dr. Greenwald’s, has written a fascinating piece about the doctor’s methods for this week’s Body Issue. Describing Greenwald, Sheryl Sandberg told Thernstrom, “She’s unafraid to broach topics in ways that other people, I think, have been afraid to do.” I recently chatted with Thernstrom about how to have the sort of sex that Greenwald would approve of, and about her distinctive approach to gynecology.Our conversation has been edited and condensed.What made you want to write about Greenwald?She was actually consulting for my primary-care physician a few years ago, just as she was getting her concierge practice going, and she really changed my life—it felt like I had been cured of menopause. And I felt that she was really raising the standard of care for gynecology. I passed her solutions along to my friends, who would pressure their doctors for the same treatments, and they also had transformative experiences. There are parts of her practice that can easily be reproduced. More generally, I think we should be considering a paradigm shift in the medical treatment for menopause. For a significant portion of women, menopause is actually disabling—I was one of them—and we should be treating it as such.You describe the way she counsels her patients to have as much efficient, five-minute sex as possible, telling them to aim for “super-heteronormative, vanilla, white-picket-fence sex that has data behind it.” What does she say the benefits are?It’s not that it literally has to be five minutes. What her patients told me is that they’d always thought that to have sex they needed to be in a special state of mind—to be feeling romantic toward their partner. But the reality of married life, especially with children—Greenwald has four sons of her own, so she gets it—is that that state of mind is rare. So she tells her patients to ask their partners, “Do you have five minutes?” And to think of that efficient partnered orgasm as something you’re doing for your health: for better quality sleep, stress management, cardiovascular engagement, pelvic-floor maintenance. And, by lowering that barrier, they’ll be having more sex, which benefits the relationship.You note that she also suggests that women should focus on increasing their “sexspan,” rather than merely their life span. What exactly does that mean?Male doctors in Silicon Valley are all mostly thinking about longevity—trying to live as long as possible. But Greenwald talks to her patients about the quality of that life, and how having satisfying sex is part of that. She asks: How many sexually active years do you want to have? Do you want to be having orgasms in your eighties? And she encourages people to take steps to lengthen the number of years that they’ll be sexually active. She wants to prevent the decline that starts when women are in perimenopause and deepens when they’re in their sixties, seventies, and so on.Generally, the standard of medical care, as you point out, does not prioritize women’s experience. One moment in your piece that hammers this home is when you describe Greenwald’s experience as a guest on the podcast “The Drive,” hosted by Peter Attia, the longevity doctor whose own élite patients pay hundreds of thousands of dollars to join his practice—and whose name was in the Epstein files more than seventeen hundred times. (He wrote to Epstein that “pussy is, indeed, low carb.”) Would you say that the kind of misogyny he represents in the medical community is one reason Greenwald’s work is important?Absolutely. And Greenwald really has the power to put women’s issues on the map in a very important way. She takes the position that for most middle-aged women, especially those who have been married for a long time, there is room for massive improvement in their sex lives. She makes a powerful case that there are health benefits to having partnered sex—and regular orgasms, in particular—and that women need to be having more of it. And she has advice, like Fuck-It February, for how to accomplish that.Why is it that Greenwald’s approach to hormone therapy is somewhat controversial among the medical community?We’re in a moment of real transition. It has been thought that hormone-replacement therapy puts women at risk for breast cancer, but newer data suggests that this is not necessarily true, and one form of estrogen seems to be associated with a decrease in breast cancer. Still, many doctors remain reluctant to use it. But she is using it, deciding together with patients when it makes sense for them. That shared-decision-making model is central to her practice.I spent many months reporting this story, interviewing her patients—and I am especially grateful to those who let me sit in on their medical appointments. I was struck by what an intimate relationship Greenwald has with her patients. She sent one woman to a pelvic-floor therapist, and, after her session, the woman had sex with her husband, and then actually texted Greenwald that she’d had an incredible orgasm! She really redefines the boundaries of the doctor-patient relationship.Read or listen to the story »Editor’s PickSerena Williams Returns to WimbledonPhotograph by Cameron Spencer / GettyFor a moment, it looked like the forty-four-year-old would pull off another stunning comeback in the tournament she has won seven times. Then reality sank in, Louisa Thomas writes. 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On this Canada Day, remember: we could have been Canada. 🇨🇦