Consider sexual health a core part of overall health, life quality, and a ’longevity lever’ to include in your centenarian decathlon goals, as it impacts sleep, cardiovascular health, and relationships.
Recognize that sexual desire discordance (one partner wanting more, the other less) is a significant risk factor for divorce, and actively work to align on sexual frequency and satisfaction with your partner.
To enable sexual activity in your 80s or 90s, aim for a VO2 max north of 45-50 ml/kg/min in your younger years, as sex requires about 7 METs (VO2 of 25) and you need to be below your maximum.
Understand that women often experience ‘responsive desire’ (arousal leading to desire) rather than spontaneous desire, and actively curate arousal through environment, lubrication, vibrators, and mindfulness.
For women, foreplay lasting greater than 21 minutes significantly increases the likelihood of orgasm (over 90%), and appropriate foreplay reduces pain by allowing the vagina to change angle, width, and length.
For women, use a silicone-based lubricant with a lube shooter 30 minutes prior to intercourse, placing it higher in the vaginal canal, then relax (e.g., read, drink tea, wash face) to cultivate arousal.
Opt for silicone-based lubricants over water-based ones, as many water-based products are hyperosmolar due to additives and can paradoxically dry out the vagina long-term by drawing out water molecules.
Select lubricants with an osmolality close to 300 mOsm/kg (e.g., Uber Lube ~600, Good Clean Love Almost Naked ~280-300), and avoid high osmolality products like Astroglide (~8000) or KY (~4000-6000).
Recognize that friction is not necessary for female orgasm and is strongly associated with micro-tearing and pain during intercourse; women need no friction for pleasure.
Introduce vibrators into your sex life, especially as type A nerve fibers (responding to vibration/deep pressure) age better due to myelin, to help maintain the ability to achieve orgasm.
Understand the full clitoral anatomy, including the tip, vestibule, crura (wishbone structures), and the G-spot (anterior vaginal wall), to discover varied pleasure points and communicate effectively with partners.
Recognize that the clitoral crura can be asymmetric, leading to greater pleasure on one side; explore and identify if you or your partner are a ‘righty’ or ’lefty’ for targeted stimulation.
For women, find the G-spot (anterior vaginal wall, about a third in, using a ‘come hither’ motion) when aroused, and relax through the urge to urinate to potentially achieve orgasm.
Understand that it is normal for 90% of women not to orgasm from penetrative intercourse alone; external clitoral stimulation is often necessary and valid for achieving orgasm.
Women should actively communicate their individual anatomical preferences and desired stimulation techniques to their partners to enhance pleasure and increase the likelihood of orgasm.
Recognize that ‘orgasms beget orgasms,’ meaning the more you have, the easier it becomes to achieve them, training your body’s response to stimuli.
Schedule sex to proactively work on desire, treating it as a prioritized activity, as ‘sex begets sex’ and can increase overall desire.
Engage in a ‘Fuck It February’ protocol by scheduling sex 2-3 times a week for the month to reduce pressure on the initiator and help the less interested partner cultivate responsive desire.
If experiencing hypoactive sexual desire disorder (low sex drive for over six months where you care), discuss testosterone therapy with your doctor, as it is well-studied for this condition in post-menopausal women.
For women, administer testosterone via cream (e.g., compounded or Testim oil in a syringe) on the inner thigh, aiming for a total testosterone level above 20 ng/dL and adjusting based on symptomatic response.
As a perimenopausal woman, determine if you prefer to continue ovulating or not, as this fundamental preference guides the most appropriate hormone therapy decisions for managing symptoms and contraception.
Maintain detailed symptom tracking, including timelines and relation to menstrual bleeds, to provide your doctor with crucial information for personalized hormone therapy decisions.
For perimenopausal women seeking contraception without ovulation, explore newer birth control pills containing 17-beta estradiol (e.g., Natasia) for potential bone and overall health benefits.
If estrogen is contraindicated, consider the drospirinone-only pill (Slynd) to suppress ovulation (98% efficacy), which can also help mitigate water retention and PMS symptoms due to its diuretic component.
To achieve both contraception (via ovulation suppression with Slynd) and menopause hormone therapy benefits (like bone protection), consider combining the drospirinone-only pill with a 17-beta estradiol patch.
For perimenopausal women experiencing heavy menstrual bleeding and needing contraception, Natasia (progestin with estradiol valerate) is an FDA-approved option that also provides hot flash and bone benefits.
For breastfeeding women experiencing vaginal dryness or pain due to low estrogen, use local estrogen cream to maintain vaginal health and moisture, mimicking menopause treatment.
Cancer survivors experiencing vaginal dryness or pain should feel comfortable using local estrogen treatment, as it is considered safe and encouraged for almost all patients in this population.
Consider seeing a pelvic floor physical therapist to improve pelvic floor tone (leading to better quality orgasms) or to address hypertonicity caused by stress, trauma, or pain.
Incorporate vaginal moisturizers (e.g., Reverie, Replens suppositories nightly) into your self-care routine to recruit water molecules, lower pH, and maintain long-term vaginal tissue health.
If systemic hormone therapy does not resolve vaginal pain or dryness within 6-8 weeks, add local intravaginal estrogen as a targeted long-term strategy to improve collagen and overall vaginal tone.
Recognize that oral sex is one of the most effective ways for women to achieve orgasm with a partner, and explore techniques to maximize this pleasure.
During stimulation, when a woman is just prior to orgasm, maintain the exact same pressure, speed, and depth without change, as two-thirds of women report this consistency is key for achieving orgasm.
To achieve a more intense orgasm, use the ’edging’ technique by bringing your partner close to orgasm, stopping, and then repeating the process.
If legal, explore 1-2 milligrams of THC (preferably via standardized edibles) to enhance sexual experience and desire, noting that higher doses may be sedating and counterproductive.
In a healthy pregnancy without contraindications (e.g., low placenta), continue sexual activity as it is completely safe and can be more pleasurable due to increased hormones and blood flow.
Plan to resume sexual activity at six weeks postpartum, regardless of vaginal or C-section birth, after receiving a medical check-up to ensure proper healing.
When educating children, use correct anatomical terms (e.g., penis, vulva) and normalize these as healthy parts of the body to foster accurate understanding and reduce shame.
Teach children that masturbation is a normal, healthy part of exploring their body and sexuality, emphasizing it should be done in a private setting to avoid shame.
Educate young people on consent as specific, enthusiastic, and persistent, emphasizing that it can change as the activity changes and should be continuously affirmed.
Discuss the unrealistic expectations set by pornography with young people, and introduce healthy, accurate resources (e.g., omgyes.com) to provide a more realistic view of sexuality and pleasure.
Educate that penetrative intercourse with a condom is often safer for STI prevention than unprotected oral sex, challenging cultural perceptions and promoting informed choices.
Advocate for and engage in sex education as an evolving, lifelong process, recognizing that bodies, physiology, and sexual needs change throughout different life stages.
Women and their partners can use omgyes.com to learn about female anatomy and various pleasure techniques, such as hard, round, gentle, or internal touches, to enhance sexual satisfaction.