Is your sex life amazing? Probably not, if you’re like most women. In fact, amazing isn’t even close to how you’ve ever experienced sex, but it isn’t your fault. You can thank Hollywood’s portrayals and society’s silence for your crappy sex life. Rarely do we learn what truly makes sex great for women, why understanding anatomy matters or how our pleasure is not just important, but vital.

In You Are Not Broken, Dr. Kelly Casperson offers a unique perspective as a urologist, coach, and fellow woman wondering, when it comes to sex, is this all there is? Dr. Kelly explores how to adjust your mindset and provides an in-depth look at what makes women physiologically unique. Better sex creates a better relationship between you and your partner. With their life stories, ideas for journaling, and tips to get the conversation going, this book is the sex empowerment secret weapon you really need, to live the life you’ve always wanted.

This is The Author Hour Podcast, and I’m your host, Frank Garza. Today, I’m joined by Dr. Kelly Casperson, author of a brand-new book, You Are Not Broken: Stop Should-ing All Over Your Sex Life.

Dr. Kelly, welcome to the show.

Kelly Casperson: Thanks for having me.

Frank Garza: To start, I’d just love to hear a little bit about your background and how that led to you writing this book.

Kelly Casperson: Yeah, so I’m a Minnesotan by origin and I went to medical school and fell into urology totally by accident. Urology is the surgery of the genital urinary organs. Then I moved to Denver Colorado, spent six years learning how to be a surgeon. Then, I moved to Washington State, was doing urology for about seven years, you know, you get into that seven-year itch everybody talks about, you get pretty good at your job.

I had this lightning bolt in the office. I had a patient that I got pretty close with and I had treated her for cancer, and she was crying in my office about her lack of sex life with her very awesome husband. Great marriage, just had no desire. As I was handing her a box of Kleenex, I saw us, you know? I was like, “Is this all I have?” I just have a freaking box of Kleenex?

It was like the perfect time, you know? You get bored in your career, you’re pretty good at it, and then you realize like, “Oh my god, does nobody know anything about female sexual function?” Because urologists, we’re the bosses of male sexual function, right? We’re the owners of Viagra and all that stuff and so, I just assumed other people were taking care of it, but why didn’t I know anything?

I just took this deep dive into what we know about female sexual health, because of her, and I realized, nobody’s helping the women. I always joke, I’m like, “Who is taking care of the people who are sleeping with the people who we’re giving Viagra to?” I wrongly assumed the gynecologists were, but they’re busy. They’ve got birth control and abnormal periods and taking out uteruses and delivering babies; they’re busy, they’re not really helping women with female sexual health either.

So, I started learning, went to the courses, read all the books and then there was this voice in my head and the voice was like, “You got to talk” and I’m like, I can’t change the world or help that many people just by seeing people in clinic who happened to live in my town, right? It’s not big enough.

So, I started a podcast about two and a half years ago. Fell into menopause then because women kept being like, “What about the hormones, what happened with menopause?” and I’m like, “Oh, my gosh, doctors aren’t helping with that either.” So I got menopause-certified and basically, my friends at that point were like, “Where’s your book?” and I’m like, “I don’t write.”

I’m really good at talking, but I don’t write. I’m like at 120 podcast episodes by that point and I’m like, “Well, you know, people consume content in different forms, right?” There be people that never listen to podcasts who love reading. Personally, I love a good, hardcover book, like, I love hardcover, I love paperback, I’ve never gotten into the ebooks, I don’t do audiobooks and so, since we all consume content in a different way.

So to put on paper, what I had learned was really awesome because, number one, it challenged me to be clean and concise in 200 pages, and then deliver it in a format that I’m not comfortable with. So, it’s totally personal growth and I already know I’ve helped tons of people and I can’t wait to just help all of them more, because now I have a book out.

Frank Garza: Yeah. So it seems like the target audience for your book could be pretty broad but could you tell me about who is the target audience you had in mind as you were writing it?

Kelly Casperson: Yeah, my target audience is middle-aged female, doesn’t have to be post-menopause. I’d say, she’s 35, she’s 40, I’m going to niche down and then I’ll go broad again, but if I niche down, she’s 35 or 40, she’s got a fantastic, high-powered, stressful career, she’s got kids at home, she’s in a long-term marriage with a penis owner and she’s stressed, and the sex life just goes to the wayside. And then she gets blamed for having low desire. That’s her.

Then I niche — I’d go niche back out again and it’s like, this is anybody who has ever socialized in this world around sexuality. Because, when you think about it, we got a sex education, it just wasn’t a sex education that served us. The sex education we get is Hollywood and the top 10 country-rock songs and then disease and pregnancy prevention plan, right?

We never learned that we actually do this because it feels good, and it might actually change as our bodies change, and desire isn’t always spontaneous and that’s totally normal, and desire mismatch is usually what the problem is in a coupled relationship, not that one person has low desire. It’s all these things, that once you just get the education, you feel way less broken.

I mean, going into why the name of the podcast and the book, women just kept saying over and over in my clinic, “I feel broken, I feel broken, I feel broken” and I’m like, “No-no-no, you’re totally normal.” You’re completely stressed out, and when you’re totally stressed out and not sleeping, you have no libido, that’s what bodies do. So little education just normalizes everybody’s lived experience and they feel a lot less shame and broken about it.

What Society Has Gotten Wrong About Sex

Frank Garza: So, part one of the book is called, “It’s Not Your Fault” and chapter one is about how society got it wrong. You touched a little bit on that already but what are some of the other, major ways that society has gotten sex wrong?

Kelly Casperson: First of all, think of who gets sex ed, right? It’s probably middle school and most people aren’t having sex by then. Like, we actually really need a sex education around age 40, when we were like, “Hey, we’re kind of been doing the same thing for a while, it’s not all that fun anymore, there’s probably something wrong with me.”

We actually needed an adult sex education. But, when you think about how women are socialized, what do we call women who like sex? It’s not a nice word. Then we beat women up for not liking sex once they’re married and it’s just this like, you’re totally stuck in this paradox of like, “Don’t like it but you should like it, otherwise there’s something wrong with you” and you’re completely trapped.

So, it’s just the way we are socialized. Especially in the heterosexual — again, going to the niche ‘is this truly is for anybody who wants a better sex life?’ When you’re in a heterosexual relationship, when you look at the data, the men are having way more orgasms than the women are, by a long shot, and you’re like, “Well, if half of the party isn’t having a great time, they don’t really want to go to the party” right? And really looking at, are we making sex equal in enjoyment for both people? And we never get taught that.

We never get taught, “Hey, make sure your partner is having a good time if you want them to have sex with you more or again.” So just like really practical stuff. Everybody always says like, it just makes so much sense, we just don’t get this education.

Frank Garza: Yeah. The next chapter is called, “The Rules Are Ridiculous.” What’s an example of a rule that you find ridiculous or several rules?

Kelly Casperson: Well, I mean, I think the number one again is that women aren’t supposed to desire sex, ever. Then, when they’re 40 and they’re busy and they’ve got kids and they don’t desire sex, well now that’s a problem too. You’re literally always trapped. The other thing about with how women get trapped is, usually, we compare her libido to her partner’s and we standardize the partner’s as the normal.

So, it’s not good for the woman to have a low libido compared to her partner but it’s also not good for the woman to have a high libido compared to her partner. It’s always her being the problem, and that’s not fair, right? And really, kind of branching it out and being like, it’s just a desire mismatch. Just like relationships, I might like sushi more and he might like spaghetti more, I don’t call that like a low sushi problem, you know?

Like, really just normalizing. These are just discussions and things to navigate in your relationship and I see so much, we blame the woman. I see men bring in their partners and being like, “There’s something wrong with her, she doesn’t want to have sex” and I’m like, “You’re just saying that makes me think, you’re not somebody anybody wants to have sex with” right?

The men do care, but it’s more about them fulfilling their needs. I’m definitely not here and definitely not in the book, I’m not blaming the man, because two things, he didn’t get an education either and he doesn’t even have our body parts, right? He doesn’t know anything, he’s just kind of navigating by society’s — again, the heteronormative rules of what sex should be because we only see one thing represented, usually in the movies, and that’s you put something in the woman, he has an orgasm, sex is done. Well, of course, she’s not going to want that long-term, it’s not enjoyable for her.

Frank Garza: Okay, part two of the book is called, “Sex Positive Sex Ed For Adults”, and you go pretty deeply into the female and the male anatomy. What is something about the male or the female anatomy that most people don’t seem to realize or know about or maybe, another way to think about it is, what’s something that really surprises you that people don’t know about male or female anatomy?

Kelly Casperson: I think one super common one, as far as sex goes, is women are like, “I can’t really have an orgasm, you know, with penis in vagina sex” and I’m like, “Well yeah, because the vagina isn’t what gives you an orgasm, right?” Your clitoris is what gives you an orgasm. When we have a lack of sex education, we feel super broken when something goes in our vagina and it doesn’t give us any pleasure.

When you actually look at the data, the majority of women aren’t having orgasms just by putting something in their vagina, it’s clitoral stimulation that’s needed and, the clitoris is completely ignored. We’re hardly allowed to say the word on social media, it’s underrepresented in medical school textbooks. I’d say, the average doctor doesn’t know how to examine the clitoris. They’ve done these things, pricing them on the Internet where you’re supposed to label the female body parts.

People don’t even know what’s going on down there because our society really has, we’ve made it shameful, right? We’ve labeled the body part as shameful and we shouldn’t talk about it, and that only leads to us not knowing if she’s not getting, going back again to the orgasmic inequality, is if she’s not getting as much pleasure — we’ll use orgasm as a marker for pleasure, people will argue like, “We shouldn’t have an end point” but let us use orgasm as a marker for pleasure — if she is not equal in her pleasure, of course she’s not going to want it as much. My analogy is always ice cream. I freaking love mint chocolate chip ice cream but if you give it to me melted and it’s warm and it’s sticky, I don’t want it anymore.

Is the sex you’re having worth desiring in the first place? Because so many people come in with “low libido” and it turns out the sex is crappy and it’s like, of course you don’t want melted ice cream. It’s melted ice cream, you know? Learning what feels good for the woman and what that looks like and how to communicate that, because you are not going to watch that. I haven’t seen the new Top Gun movie, I am going tonight, but it is probably not represented, I’m just guessing. So, we just don’t get the education.

Frank Garza: Okay, another thing you review in this section is the Dr. Kelly Casperson ideal version of sexual etiquette. Tell me about that.

Kelly Casperson: Okay, so I wrote down my ideal version of sexual etiquette, which goes like this. Everybody understands that the female organ of pleasure is the clitoris and that that needs to have as much attention as the penis. Those are basically homologous structures, the clitoris is the penis and vice-versa. That lube is really, really good, so a lot of people are like, a lot of arguments against why people don’t use lube.

I always say that penis and the clitoris aren’t self-lubricating, neither one of them have lube, and lube just helps everything. It decreases friction, it decreases pain. Actually, they have done studies on people who use lube, they have a higher pleasure with sex and higher orgasm. So another thing to switch around, people get into this kind of sexual scripts, right? We have the same kind of sex for years and years and years and then we kind of feel stuck or bored.

Boredom is a huge problem. If you get bored you’re not going to have desire for sex, right? We don’t desire things that are boring, that’s not how our brains evolve, that is not how dopamine works, right? Another option is for the women to have an orgasm first before the penis goes in the vagina, because it takes the pressure off of her needing to orgasm in one certain way. Also, as people age, sometimes penis’s need a little bit more time to have an orgasm.

We can work on different ways that the penis can have an orgasm because we don’t want to put all the pressure on her vulva and her vagina. So, really just talking about what works for us because how our bodies work as we age isn’t how they always worked when we were 18, and it’s such an important conversation to have. The other sexual etiquette is just talking about it. I don’t recommend talking about it naked and vulnerable, especially after if something didn’t go well, but just like the next week.

Be like, “Hey, is sex good for you? Why do you like to have sex?” You are just open, curious. Curiosity is never the wrong answer of learning, “Why does your partner really like having sex with you? What’s their favorite position? What does sex mean?” How often do we even ask our partner, “What does sex mean to you?” Because it means different things to different people like, “Oh, it really helps me relieve stress and I can sleep great after it.”

That’s not everybody’s answer but it would be good to know that if that is your partner’s answer. So, just communicating about sex, people are not good at that. We never get taught.


Frank Garza: Yeah. That is the last chapter in this part of the book, chapter nine, “Communication is Lubrication”, and you list some tips on how to better communicate around sex. One thing that caught my eye was, “Compromise. but be aware of mismatched shoes.” Can you talk about that one a little bit?

Kelly Casperson: Oh yeah, I love that analogy. Yeah, so there is a story of like the woman wanted brown shoes and the guy wanted to wear black shoes, so they compromised. So he left the house with a brown and a black shoe and nobody was happy and it’s like, okay that might not work, right?

But it’s like, be willing to be flexible and go back and forth and be like, “Hey, well, I know this, you really enjoy this but I don’t love it all that much so let us not do it every single time.” So just a way of compromise but not so much where nobody is happy, those are probably mismatched shoes then.

Desire and Low-Desire

Frank Garza: Part three of the book is called, “Is It Actually Low Desire or Something Else Entirely?” and you mentioned how there is so many factors that can contribute to less than desirable desire levels. What are some of the most common ones that you come across?

Kelly Casperson: Stress. Cortisol in our bodies, our bodies do not want to reproduce and have sex when we’re stressed. When we think of fight and flight, right? Go back to the caveman times. If you are being chased by a saber-toothed tiger, you’re not vulnerable and safe and warm and snuggly and wanting to have sex. So many of us are nonstop cortisol at this point, and they’re like, “Oh I have low desire.”

That’s like no, you’re just prioritizing no time in your life to get into the nervous system that’s good for receiving pleasure, so I’d say that’s a big one. Another one is problems with their relationship, right? Is your partner somebody that you’re choosing to desire at this point? I had somebody who came in to see me for low desire and it turns out they were in marriage counseling and probably headed towards a divorce.

I’m like, “Yeah, you don’t have low desire like your brain is actually appropriately responding to the counseling and the stress that your relationship’s in.” Your brain is like, “No, not this guy.” The more I started learning about low desire, the more I realized there’s usually something underneath that, right? There is something else going on. Another big common one is pain with sex. So women will come in and they’ll be like, “I have pain with sex and I have low desire.”

I’m like, “No, you don’t. You have pain with sex” like when you are hitting your thumb with a hammer, you’re not desiring it. Our bodies are developed to avoid pain, so of course you want to avoid sex, why would you ever have a high desire, it would be a very uncomfortable avoidant situation. So I always give them like, you don’t need two problems, you just have one problem, it’s pain with sex. There are many, many different ways to help with pain with sex.

Pain with sex is never normal; I always need to plug that for people. You need to see somebody and then you can get some help with that and then your desire. If you are again enjoying sex, and it is not painful, your desire can naturally usually rise back up. The other thing about desire — real quick because we haven’t mentioned it — is we all think we should just have this spontaneous desire our entire life.

What the data shows is after about 6-12 months, that’s considered a long-term relationship, that once we hit that long-term relationship, our brains adapt to that person. They are not novel and we don’t seek out things that aren’t novel, and it is actually a spontaneous desire that turns into a responsive desire, and responsive desire especially for women. This is Rosemary Basson’s work is, I am not really feeling like having, I am not going to seek out sex.

But like, you start looking good and coming close and touching (nice), and maybe doing some massage or maybe let’s go and see what — “Oh, yep. Yep, I’m into sex now, I totally forgot that I enjoy this” right? So it’s like you’re fine on the couch reading a book and eating ice cream. You are not seeking out sex, but once you go have it, it’s a great time. You love it, yeah, it’s fine, it’s perfect.

That’s normal. But so many people, because we’re fed Hollywood and, again, the top country songs of, “If you’re not spontaneously desiring sex, there’s something wrong with you” and that’s just a huge lack of education of how desire actually works.

Frank Garza: What are some things couples can do to facilitate more of this responsive desire happening?

Kelly Casperson: Prioritize time for intimacy. You know, it’s funny, because you’ll get sex therapists in a room and they’ll debate like, “Should we tell people to schedule sex? Should we not?” pros and cons. It is funny to watch people disagree about this, but I think most people would agree. Prioritizing time for connection and communication, it might lead to penis and vagina intercourse, it might not.

It might just be cuddling, it might be massage, it might just be going on a walk holding hands, because what people are looking for, more than likely, usually, is the connection. We want the connection and the intimacy and the closeness and especially for men, I am gender stereotyping, but especially for men they get that through sex, but a lot of women do not. So, he is feeling very disconnected if she doesn’t just want to have sex all the time.

Again, what does sex mean for different people, and understanding that. When I have sex with you, I feel so, so close and then the woman is like, “Well, I feel close to you when you hold my hand and shoot me text messages in the middle of the day” or blah-blah-blah but it is really that communication of developing the connection, and then prioritizing time, because we are busy. We have kids, we have jobs.

We have everything that wants to pull our attention. You can get social media 24/7 now. You will literally fill your entire day if you don’t prioritize your sexual relationship. This is not just for people in relationships, this is for yourself too. You can prioritize a sexual relationship with yourself or you can choose not to, but it doesn’t just spontaneously — your calendar isn’t just blocked an hour by itself.

The other tip I’d say is, so many couples wait until the end of the day, right before bed, to have sex, and we’re exhausted, right? I always say, if sex is competing with sleep, sleep is going to win. You actually die if you don’t get enough sleep, you won’t die — some people might think they might die — but you won’t actually die if you don’t get sex, but you will die if you don’t sleep. So, if you can, even if the kids are at school or they are taking a nap or you can lock your door, whatever.

If you are more middle of the day, early morning, just to get some more energy in your body, it is just not competing with, you’re physically and mentally drained by the day and now I have to do this chore before bed, of course you might start avoiding your partner or avoiding sex.

Frank Garza: Well, writing a book is such a feat, so congratulations on putting this out there into the world. Before we wrap up, is there anything else about you or the book that you want to make sure our listeners know?

Kelly Casperson: Yeah, I think that — I mean, what most people say is like, “This is pretty approachable. It is not super scary, it’s not super woo-woo.” I read all the books, in going into my education, and so much of it is like woo-woo. There was one book that was like, “breathe into your spleen” and I’m like, “I don’t get it” you know? It’s really an approachable topic if handled with care. 

I just encourage people to be curious, pick up the book, because there will probably be something in there that’s useful. I think working on your sex life is like the last, final chapter in personal development, once you figure that out and you prioritize pleasure in your life and communication, it trickles over into every other aspect of your life. It is a pretty cool superpower.

Frank Garza: Dr. Kelly, this has been such a pleasure. The book is called, You Are Not Broken: Stop Should-ing All Over Your Sex Life. Besides checking out the book, where can people find you?

Kelly Casperson: I’m most active on Instagram, so it’s Kelly Casperson MD on Instagram, and then of course my podcast called You Are Not Broken, wherever you listen to podcasts.

Frank Garza: Thank you, Dr. Kelly.

Kelly Casperson: Thank you.