Here’s the line about Hillary Clinton I’ve heard umpteen times from Democratic women: “I really want a woman president. But …” The Iowa caucuses on Monday night dramatically turned up the volume on those quavering doubts as Bernie Sanders – a grumpy old white guy with gout whose call for a political revolution was dismissed by many Democrats as a throwback to a more radical era – overcame a 40-point deficit to claim a virtual tie with Clinton.

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In some places the contest was so close it had to be settled with a coin-toss. Afterwards Clinton said she was “breathing a big sigh of relief”. Her campaign claimed it was all over for Sanders.

Not so fast. Clinton made political history, becoming the first woman to win an Iowa caucus – the first votes in the election calendar. And she is still the broad favourite to win the nomination, with the Sanders surge expected to sputter out once the campaign moves on to bigger, more diverse states – Sanders has struggled to expand his support among African-American and Latino voters. But the results suggest that Clinton has failed to overcome reservations about what she really stands for. She has a lot of work to do between now and the nomination.

Is she the kindly Grandma-knows-best who made a brief appearance at the start of her campaign? The self-professed workers’ champion who raked in millions of dollars delivering high-priced speeches to banks and corporations? The born-again climate change advocate who, as secretary of state, was ready to sign off on the controversial Keystone XL pipeline? The self-proclaimed defender of women’s rights who waited until it was almost too late to declare her support for marriage equality?

Facebook Twitter Pinterest ‘Sanders has remained focused on his message of income inequality, railing against the influence of billionaires on public life – and attacking Clinton for not doing enough to rein in Wall Street and corporate lobbyists.’ Photograph: Joshua Lott/Getty Images

For younger and more liberal voters especially, it is difficult to muster enthusiasm for the prospect of voting for the first woman president when it’s unclear what she stands for.

Sanders, meanwhile, has remained focused on his message of income inequality, railing against the influence of billionaires on public life – and attacking Clinton for taking speaking fees from business, and not doing enough to rein in Wall Street and corporate lobbyists.

As in 2008, when Clinton came in a humiliating third place in Iowa behind Barack Obama and John Edwards, the first round of voting has exposed the flaws of the Democrats’ establishment candidate, and the establishment itself, for thinking that the party would simply acquiesce to their judgment that Clinton was the most viable presidential contender. Instead, the results have reaffirmed Clinton’s failure to connect with the powerful longing for change among a significant share of Democratic voters. Even more damning, she has failed to convince those voters that she can be trusted.

After 2008, when Clinton started the campaign at a huge advantage only to see victory slip away to Obama, it is striking to see the first viable woman presidential candidate struggle against a long-shot rival. Sanders did even better than Obama among young voters, women as well as men – beating Clinton by 70%. He did better among voters earning under $50,000 a year, among single women as well as single men, among those who identified as liberals and independents, and those who care about income inequality. He was considered more trustworthy than Clinton by 73% of voters, according to caucus night polling.

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Clinton, for her part, trounced Sanders on such issues as experience, electability, continuing Obama’s legacy, and her ability to deal with terrorism and healthcare. This time around it seems the weaknesses in Clinton’s candidacy are unlikely to disqualify her from the nomination.

Sanders, who is from Vermont, is expected to take New Hampshire next week, where there is a deep well of affection for the New Englander. The campaign then moves on to Nevada and South Carolina, where there are large constituencies of unionised labour, Latinos and African-American voters. The Clinton camp remains confident that she has the name recognition and the grassroots organisation to turn out those votes.

But the flaws in her candidacy could hurt Clinton when it comes time to seek votes from Republicans and Democrats down the line. After discouraging other candidates from entering the race – including progressive champions such as Elizabeth Warren who were deemed, like Sanders, to be too leftwing – the Democratic party would do well to consider how to gin up enthusiasm for Clinton among voters next November.

Or better still, listen to what voters are saying about what kind of candidate they want.