You’re not past it. You may even be approaching your peak.

A psychiatrist just told me that women tend to reach their highest sexual satisfaction at 64. I’m 64. And I cannot tell you how many times I’ve heard the opposite message, that desire fades, that this is the time to wind down, that the body just stops cooperating.

Dr. Shila Patel has been listening to patients talk about sex, relationships, and desire for 25 years. She grew up in Kenya, went to medical school in England, and spent the bulk of her career practicing psychiatry in the American South before retiring at 51. When the pandemic hit and the Me Too movement was at its peak, she started writing. Two books later, she’s on a mission to reach people that one-on-one clinical work never could.

She’s also nearly 70, still sexually active, and completely unapologetic about both.

What struck me most in our conversation wasn’t just the 64 statistic - which I found astounding (I hadn’t ever heard before!), it was the context. Because while women are approaching their sexual peak, men are often stepping back. Erectile dysfunction, reduced interest, withdrawal. Dr. Patel saw this pattern constantly in clinical practice, and she sees it in her own life and I’ve certainly seen it in my own. Women in her condominium complex, all roughly her age, laugh and joke about it. It’s a real thing. And most women, she says, just go quiet and accept it.

That acceptance is partly cultural. Dr. Patel grew up in Indian culture, where sex was not discussed. Full stop. Not by parents, not between siblings, not even now. At 70, she and her sister have never once discussed whether either has had an orgasm. She described watching a preview of a Bollywood film where a group of women, talking about an upcoming wedding, couldn’t form the word for orgasm. They landed on “intense pleasure.” She said it with affection and exasperation in equal measure.

But she’s quick to say this isn’t an Indian problem, or an Asian problem. It’s a human problem. Americans of her generation were raised the same way. Her 91-year-old mother still tenses slightly when hugged. The silence around sex, pleasure, and desire crosses every culture she encountered in 25 years of clinical work.

What can be done about it? Quite a lot, actually.

Dr. Patel was frank about her own experience with vaginal atrophy and vaginismus after a hysterectomy and the way the body can, as she put it, just close up. Her gynaecologist prescribed estradiol cream, and it changed everything. Lubrication, libido, comfort. It also dramatically reduces UTIs and vaginal infections, something most women are never told. I have my own version of this story: I found out about vaginal estrogen from a friend, not a single healthcare professional. When I complained about painful sex, she asked if I was on vaginal estrogen. I was angry that no doctor had mentioned it.

If you’re avoiding sex because it hurts, or because desire has gone quiet, it’s worth asking about estradiol cream/pessaries or ring. It has certainly changed my life.

Dr. Patel’s bigger message is about permission. Permission to still want sex at 70. Permission to tell your partner what you need — including that if they’ve stepped back, you might need to look elsewhere for that connection. Permission to adapt: different positions, more patience, a lot of laughter, and no more hanging off the chandeliers.

She said it plainly: we only go through this life once. Are you going to make the most of what you enjoy?

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In this episode, I unpack my long-held scepticism about so‑called “orgasm techniques” and the pressure on women to climax in multiple ways. Then I speak to Steve Bodansky, co‑creator of Extended Massive Orgasm (EMO), a practice focused on clitoral stimulation, deep relaxation, and “peaking” (edging) to prolong pleasure.

We explore how extended orgasm works, why relaxation matters more than effort, and how orgasmic capacity can grow with practice — even into your 70s and 80s. We also talk about aging, self‑pleasure, conditioning the body for pleasure, and what it really means to invest in your sexual wellbeing for the long term.