The Orgasm Gap

Johanna is sharing an episode of unPAUSED where Dr. Mary Claire Haver sits down with Dr. Kelly Casperson — urologist, author of You Are Not Broken and The Menopause Moment, and host of a podcast that should frankly be required listening for every woman over 35. In this conversation, they get into everything women were never taught about female sexual health, libido, desire, and dysfunction in midlife — and why the science was always there, it just was never treated as a priority. Spoiler: the orgasm gap between men and women hasn't budged in decades. The silence wasn't because there was nothing to say. It's because nobody thought to ask.

🤩unPAUSED with Dr. Mary Claire Haver — 

https://podcasts.apple.com/us/podcast/unpaused-with-dr-mary-claire-haver/id1846701533?i=1000762539947

Transcript

SPEAKER_01 0:11

Midland's got an honey or nobody's full. Got the side where I'm not the time. Women open midlife. Just away and see.

SPEAKER_00 0:42

Hello, my friends, and welcome back to Not Your Mother's Midlife. I'm your host, Joanna, and today we are talking about something that I think every woman in midlife needs to hear. And every woman's partner, too, for that matter. This may be one of the most eye-opening podcast episodes that I have ever listened to. I mean that. I know we all say that we get excited about something, but this one really blew me away and I had to share it. I immediately shared it with my husband, and he admitted that he didn't know a lot of the things that they discussed either. It's really interesting. So what I am sharing with you is a conversation from the Unpaused podcast, Dr. Mary Claire Haver Show, where she sits down with Dr. Kelly Kasperson. Kelly is a urologist, which means she's trained in the specialty that treats both men and women, their whole below the belt area as far as urinary and the outer genital area, etc. She'll tell you about that when you listen. But having that vantage point gave her a front-row seat to just how different male and female sexual health gets treated. Shock of all shocks, it is not even closely even. Kelly has written two books, You Are Not Broken and The Menopause Moment. She also runs her own clinic, the Kasperson Clinic, and she has a podcast, also called You Are Not Broken. It's great. I've been listening to it. I'll link everything in the show notes. So after the episode, but after I listened to it, I immediately went over and followed her on Instagram. I just I think she's fantastic. She's so interesting and she's got so much information. So let's get into it. They open the episode with the orgasm gap, the gap between how often heterosexual men orgasm during sex versus how often women do. It has not improved in decades. We have better data, better research, and better everything now. And the number, well, basically hasn't moved at all. And I think a lot of us have kind of known this and thought, well, that's just how it is. That women's bodies are complicated, that it takes longer, it doesn't always happen, or whatever. But that framing, that's not science. That's a story that we have all been told, men and women. Kelly talks about the science around female sexual health, the understanding of how women's bodies work, what they need, what gets in the way. That knowledge is out there. The problem isn't a lack of research, it's a lack of priority. Female sexual pleasure and satisfaction were never treated as a medical issue worth solving. Men's sexual health, hmm. Entire pharmaceutical industry is built around it. Women's? That's a whole other story. So what does actually change in midlife? Because I know a lot of us are noticing things shifting, desire feeling different, things that used to work not quite working the same way, maybe some physical changes that nobody warned us about. Well, Kelly goes deep into this and is fascinating. The hormonal shift of perimenopause and menopause don't just affect us with hot flashes and our sleep, they affect the whole sexual response system. Estrogen decline affects tissue, testosterone plays a huge role in desire and arousal. And when those levels drop, it's not in your head, it's physiological. She also talks about something called genitori, I don't know if I'm saying that correctly, syndrome of menopause, GSM, that's easier, which is the whole cluster of changes that happen to the vagina and urinary tissues as estrogen drops. Dryness, discomfort, changes in sensation. There are treatments, local estrogen, DHE, other options, things that actually work, but women often aren't even told about them because, again, this stuff isn't treated as a priority. You might go to your OBGYN and ask about it. They don't learn about it in school, to be honest, and they talk about that in the podcast. You don't spend any time on women's sexual health. It's very sad. The conversation about testosterone is really interesting. Kelly talks about how she prescribes testosterone for her patients and the response she gets. Women saying that they feel like themselves again, that their interest in sex comes back, that they didn't realize how much they'd lost until they had it back. Then they get into the psychological side. And this is where it gets really good. Kelly and Mary Claire talk about how women's desire often works differently to the model that we're being sold. We've been taught by TV or by movies, by basically every piece of culture, that desire is supposed to be spontaneous. You just suddenly want it. And if you don't feel that, well, there must be something wrong with you. But a lot of women's desire is more responsive. It gets activated by the right conditions, the right context, right connection. It's not broken. It's just not the version we were taught to expect. And when women spend years measuring themselves against a model that doesn't fit how they actually work, of course they end up feeling like something's wrong with them. Kelly's whole message, and it's right there in the name of her podcast, is that you are not broken. Your body isn't defective. The information you were given was just incomplete. And I think that message alone is worth sharing. They don't just leave it at the system fails you though. They get practical. Kelly talks about advocating for yourself at your doctor's office because a lot of women go in, mention that they've lost interest in sex or that things are uncomfortable and get told that it's just menopause or just stress or here's a referral to a therapist when actually there's a medical intervention that could help. She also talks about the role of pelvic floor physiotherapy. A lot of the pain and discomfort women experience in midlife during sex is related to the pelvic floor and it's treatable. I'm linking the full episode in the show notes because there is so much more in it that I could never cover here. The thing I keep coming back to is that the silence around female sexual health was never benign. It had consequences. And for our bodies, our relationships, for how we understand ourselves, and the fact that so many of us are in midlife right now, navigating all of this without having ever been given the full picture. That's worth being a little bit annoyed about, I think. But the information is out there now. Doctors like Kelly Kasperson exist. Conversations like this one exist. And you're listening to this, which means that you're already doing the thing. You are not broken. You need to pass that on. So thank you so much for listening. If you enjoyed this episode, please share it with a friend or even your partner, like I did. Drop your thoughts or ideas for future episodes. Um, I'd love to hear from you. Subscribe to the podcast, as usual, and to my YouTube channel, because there's lots of fun videos over there with different information than I share here. Leave me a five-star review. It'll help others find me easier. I'd really appreciate it. And until next week, I am Joanna Hart, and this is Not Your Mother's Made Life. Bye bye.