unPAUSED with Dr. Mary Claire Haver Sexual Health, Libido, and Orgasm: What Medicine Missed with Dr. Kelly Casperson
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Apr 21, 2026 Dr. Kelly Casperson, a urologist and author focused on women’s sexual health, tackles the gender gap in care. She discusses how medicine missed female libido, the persistent orgasm gap, physiology of arousal and orgasm, hormone and medication options, and why social and surgical factors matter. Short, direct conversation about what women were never taught and where solutions are emerging.
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Surgical Repairs Often Overlook Sexual Consequences
- Kelly and Mary Claire recall operating around the clitoris and repairing episiotomy scars without realizing their sexual implications.
- Both highlight episiotomy scarring and thinning tissues as sources of late-onset dyspareunia in perimenopause.
Use External Vibration To Boost Pelvic Blood Flow
- Use external vibration to increase pelvic blood flow as a noninvasive therapy to improve arousal and possibly address atrophy or lichen sclerosus.
- Kelly cites preliminary studies applying vibrators to the external vulva to boost blood flow without internal penetration.
The Brain Is The Biggest Sex Organ
- The brain is the largest sexual organ and dopamine drives pursuit of rewarding experiences, so sex that's not rewarding won't create desire.
- Kelly uses a 'mushy broccoli' metaphor to show why unfulfilling sex suppresses dopamine-driven desire.
