Podcast Summary:

My So-Called Midlife with Reshma Saujani
Episode Title: Revisit: You’re Not Broken, Your Sex Education Was Just Bad with Kelly Casperson
Date: November 26, 2025
Host: Reshma Saujani (Lemonada Media)
Guest: Dr. Kelly Casperson (Urologist, Podcast Host, Author of "You Are Not Broken")

Episode Overview

This candid and empowering episode takes on myths and shame around women's sexuality, especially in midlife. Host Reshma Saujani brings on Dr. Kelly Casperson—urologist, author, and sexual wellness advocate—to debunk persistent cultural and medical narratives about libido, sex, hormones, and gender. Together, they explore why so many women feel “broken” about their changing desires and bodies, and what can be done to reclaim sexual satisfaction and self-confidence at any age.

Key Discussion Points and Insights

Challenging Midlife Sex Myths

• Outdated Beliefs: Both host and guest confront common myths: that libido inevitably vanishes with age, that sex is for the young, and that mediocrity is to be endured.
• Dr. Casperson’s Message: “You’re not broken. You can have good sex. In fact, you can have the best sex of your life in midlife.” (Reshma Sajani, 02:15)
• The Real Problem: The roots of dissatisfaction aren’t just biology—they stem from cultural shame, lack of education, and communication failures.

Dr. Kelly Casperson’s Story & Mindset Shift

• Career Pivot: Dr. Casperson shares how career dissatisfaction and witnessing her patients’ sexual struggles led her from standard urology to specializing in women’s sexual wellness.
• “The hospital isn’t going to love me back... The rules are all made up, and you can do whatever you want to do. Once you truly believe that, watch out: your life can change.” (Dr. Casperson, 07:00 & 06:19)

Society’s Role in Shaping Shame & Silence

• Lack of Sex Ed: Most people receive only disease/pregnancy prevention, never pleasure or communication education.
• Myth-Busting:
  • Libido isn’t a simple “drive” like hunger.
  • Many women experience “responsive desire”—not spontaneous, but responsive to the right context or situation. (19:19)
• Shame and Comparison: Not talking about sex with friends or partners perpetuates a sense of isolation and “brokenness.”
• “We just take all these ‘shoulds’—you shouldn’t have fantasies, shouldn’t want to be dominated. Those are all wrong.” (Dr. Casperson, 24:03)

Hormones & Gender—What We Get Wrong

• Oversimplification: The gendering of hormones masks complexity—women have more testosterone than estrogen, men’s libidos are affected by estrogen, etc. (31:16)
• Perimenopause & HRT: The symptoms, management, and lack of mainstream doctor support for hormone therapy, especially for testosterone, are explored.
• Systemic Gaps: Higher safety standards and bureaucratic inertia delay women’s access to hormones; the medical system is built on male-centric studies.
• “The bar for our safety is so much higher that nobody gets anything because it might hurt one person…and we don’t think that way in men.” (Dr. Casperson, 39:26)

Practical Steps for Women in Midlife

• Foundational Advice:
  • 1. “Lube.”
  • 2. “Communicate.”
  • 3. “My book.” (Dr. Casperson, 29:58)
• Quality over Quantity: There's no ideal sexual frequency; ignore comparison and focus on what is satisfying for you.
• “Do you like the sex you’re having?” If not, change the ‘mushy broccoli.’” (Dr. Casperson, 30:34)
• Hormone Therapy: Guidance on how to seek testosterone safely; explanations of why FDA hasn't approved it for women in the US.

Orgasms and Pleasure: The Clitoris is Key

• Orgasmic Equality: Cultural ideas make female orgasm seem difficult, but with proper knowledge and communication, it’s as attainable as for men.
• “Orgasms are easy if you know how to have them.” (Dr. Casperson, 43:14)
• Necessity of Self-Knowledge: Success comes from understanding your body and teaching your partner.

Changing Culture & Advocacy

• Grassroots Change: Movement for better sex education, patient advocacy, normalizing conversations, and demanding change from medical institutions.
• “The ship is turned by the ocean, not the ship.” (Dr. Casperson, 44:44)

Notable Quotes & Memorable Moments

• “You're not broken. You can have good sex. In fact, you can have the best sex of your life in midlife.”
  – Reshma Sajani summarizing Dr. Casperson’s message (02:13)

• “The rules are all made up, and you can do whatever you want to do. Once you truly believe that, watch out: your life can change.”
  – Dr. Kelly Casperson (06:19)

• “We didn’t get any sex education. We got a disease and pregnancy prevention plan, if you were lucky.”
  – Dr. Kelly Casperson (19:48)

• “In perimenopause, if you’re having those high spikes again… your estrogen can go really high sometimes... So you tend not to start with estrogen in perimenopause.”
  – Dr. Kelly Casperson (36:27)

• “We’ve got multiple year safety data in women and testosterone and we still don’t have a product… The bar for safety for women is much higher than for men.”
  – Dr. Kelly Casperson (39:26)

Important Timestamps

• 01:47 – Debunking midlife sex and libido myths
• 04:23–08:21 – Dr. Casperson’s mindset shift, quitting clinical practice
• 09:33–11:10 – Turning point: realizing the gap in women’s sexual care
• 18:29–19:49 – Defining libido and the misconceptions
• 20:04–21:31 – The biopsychosocial model of desire
• 22:35–24:03 – Cultural shame, women’s sexual fantasies, and silence
• 29:58 – Three steps for improving your sex life
• 31:16–33:10 – Hormones, perimenopause, and medical oversight
• 39:05–41:23 – FDA and systemic bias in women’s hormone therapy access
• 43:14 – Clitoral orgasm and sexual success

Final Thoughts

This episode is a lively, irreverent, and truth-telling journey through topics many women (and men) have been taught to avoid. Dr. Kelly Casperson’s expertise and enthusiasm empower women to shed shame, communicate openly, challenge outdated rules, and embrace midlife sexuality as something to be celebrated—not feared or silenced. Reshma Sajani’s honest curiosity and vulnerability make the conversation relatable and actionable.

If you’re grappling with midlife dissatisfaction, taboo feelings about sex, or questions about hormones and health, this is an episode to listen to—and share with the women in your life.