You're less sent in treated. I'm Nam Kiwanuka.

It's hard to believe that the design of the speculum has largely remained unchanged for around 180 years.

And the medical device has roots that go way back to the Roman Empire.

Until recently, there hasn't been a push to change this medical instrument used for papsmears and surgery, which some women have described as a torture device.

And that's not dramatic because the person who mainstreamed the speculum in gynecology experimented on enslaved black women.

That history motivated two engineers from the Netherlands to create a new tool that was patient friendly for women.

This is FEM. FEM stands for female technology and focuses on innovation in women's health from pregnancy to menopause.

FEM stands for female technology and focuses on innovation in women's health from pregnancy to menopause.

And it's important to note that it's not just limited to women's reproductive health.

The term feech was coined by a tin in 2016.

A is also the founder of Clue, a popular period tracking app.

A lot of tech companies you know like Microsoft, Apple, Meta and Google are held by men.

While these companies have some female employees, women make up only 25% of the tech workforce and even fewer hold leadership positions.

That's why fee is an opportunity to address women's health, which has been historically underfunded and underresarched.

Femch is estimated to be worth anywhere from a hundred billion dollars to a trillion dollars.

Yet, female founders only receive 2% of all the venture capital and often resort to crowdfunding for innovations.

And yes, the Dutch engineers I mentioned earlier had to crowdfund.

And the most popular period app was founded by men.

Our guest today is Marina Gerner.

She's a journalist, an academic, and the author of the vagina business, innovative breakthroughs that could change everything in women's health.

We'll be speaking to her about how fem could address a huge gap in our healthcare system and about the stigma still attached to women's health.

She also tells me that male founders recoil from the word vagina and why she chose to name her book The Vagina Business.

By the way, we're going to be talking about a bunch of products this episode, but we're not endorsing them.

Marina Gerner joins me now.

Marina Gerner, welcome to the podcast.

>> Thank you so much for having me. I really look forward to talking to you.

I was reading your book on transit and with the name like the vagina business and the graphic on the book I was getting like kind of strange looks from people and I'm like no no no this is really for work but in your book you write uh that the title received push back um how come?

but in your book you write uh that the title received push back um how come?

>> Yeah absolutely and it's so funny you say that you reading it on the train because that's one of the questions I keep I kept getting while I was writing the book.

people were saying, but can you imagine with that title, is anyone going to read it on the London Underground? You know, will people be brave enough? Won't they be too embarrassed?

Um, and nowadays I get messages from readers saying exactly what you've said that I read it on my commute and on the train and on the plane.

Um, because they want to see the reaction and because they want to start conversations.

So, that's been something that's really amazed me.

Um, but it definitely hasn't been easy and it was a very conscious decision to have vagina on the cover of the book.

>> How come?

>> So, I have to take a step back and say just a little bit about how I got into this topic.

At the time I was in my early 30s and you know I'm a journalist and I'm also an adjunct professor at a business school and I was looking into conception and uh pregnancy and birth and so on.

And I was looking into conception and uh pregnancy and birth and so on.

And I found out that nine in 10 firsttime mothers experience a birth injury.

And I thought that was just unbelievable for something to be that common.

And there seems to be this attitude of oh you know welcome to being a woman. this is going to hurt.

Um, so I thought that can't be it. There must be people who are part of the solution.

And I found this company in California that's working on a device that is a birth dilator.

So what it does is it pre-stretches the muscles of the vaginal canal in the first stage of labor.

So that by the time the baby comes through, the idea is that the muscles have been pre-stretched just like you would stretch your muscles before you're working out.

And that way hopefully you're less likely to experience tearing and you're less likely to have pelvic organ prolapse or urinary incontinents further down the line.

And I thought this was such a great and kind of intuitive idea and it's not super high-tech.

It's a dilator.

You know, we use them in other areas of health too like vaginismas for example.

And I spoke to other people in the space. I researched the space and I realized that the last big innovation in the standard of care of birth was the epidural which was popularized in the 1950s.

>> Wait a minute. Hold on a second because that's 75 years ago.

>> Yes.

>> And that's the last innovation.

>> Exactly.

The last innovation to focus on the mother.

So we've had other updates that focus on the fetus, you know, things like genetic testing.

But when it comes to the experience of giving birth for the mother, there's not been anything revolutionary since then.

And I always say popularized in the 1950s.

It was actually invented even earlier over many decades and through many iterations.

But I I thought to myself, there's nothing else.

There's no other area of society or technology where we give people something that was popularized in the 1950s and we say, "Hey, look, this is the best we got. Look at this incredible cutting edge floppy disc." Right?

But in birth, that's basically what we do.

Because if you are pregnant, you're about to give birth and you go to the hospital, you know, in most places you will be offered the epidural as the best possible form of pain relief.

And the other thing was I looked into companies with what I call a vaginacentric innovation and I heard again and again from startup founders that they struggle to raise money because most VC funders so most venture capital investors are men something like 90% of them in the US and in the UK.

And they don't want to talk about vaginas in a business setting.

So, I have a quote from an investor who says, "I don't want to talk about vaginas in my Monday morning partner meeting."

And that's the kind of attitude that stands in the way of us, you know, not having birth injuries.

And I was so angry about this.

So, I wrote an article for Wired magazine called We Need to Talk about Investtor's Problem with Vaginus.

And that article went viral. That was a few years back.

And so I realized, you know, I need to focus my energy on this topic.

And so for the book, I've interviewed over 100 people across 15 countries on how to revolutionize women's health because women's health has been underresearched and underfunded for such a long time.

And I think it's time to stop saying, "Welcome to being a woman."

And it's time to come up with better solutions instead.

And so um I'm hoping to show people that a better and healthier more inclusive future is possible. You know if we take women's health seriously and that is why coming back to your original question I wanted to have vagina on the title to destigmatize the conversation to normalize the conversation.

And that is why coming back to your original question I wanted to have vagina on the title to destigmatize the conversation to normalize the conversation.

>> How would you define fem

stands for female technology and that's technology focused on everything from periods to fertility menopause but also going beyond the uterus.

For me, it is a feminist issue because it's tech that moves women's health forward.

It's often times consumer focused and digitally enabled.

It's also quite a broad term in that people include things that are not technically technology like period underwear or contraceptives, which you know are medical.

Um, it's estimated to be a $1 trillion market opportunity.

And I think the term feech has really galvanized and really energized the community.

And so when people say to me, why do we need feech if there's no such thing as men tech? I say, well, most technology has actually been designed for men.

You know, that's just the reality that we live in in where seat belts and phones and voice recognition protective clothing, all of that has been designed around the the male default.

So, a world that was designed around the male body ultimately impacts our health and safety.

So, the fem is a movement that seeks to rebalance that.

And for me, the movement doesn't just focus on innovative startups, but it also includes nonprofits and researchers and investors and other people in the space, other thought leaders because I think it has to be a concerted effort really.

>> You mentioned that the last big thing uh around with innovation around gynecology was the epidural in the 1950s, 75 years ago.

Um I just wanted to take this moment to maybe have you take us through some of the historical innovations around women's health.

>> So we've said the epidurals popularized in the 1950s.

Then the speculum that's used for um papsmears for example is from the 1870s.

The tenaculum which is used for IUD insertion is from the 1840s.

And an early version of that was a tool to extract bullets on the battlefield.

And yeah, that just that's just shows you

>> I mean bullets and your like cervix. It's what?

>> Yeah.

Um it just shows you how gentle, in other words, not gentle these things are.

And nowadays what we're seeing, and this is very recent, you know, in the last few years, what we're seeing are new devices that are made of softer materials and that are warmer as well.

So there are companies that are creating new versions of the speculum that is um smaller and warmer and other versions of the tenaculum.

But I think what's even more revolutionary actually is if we rethink how we test things.

So how we test for HPV for example.

you know, there are less invasive uh other forms.

You don't necessarily always need to have a woman in a medical setting on her back with her legs on a table and with somebody inserting instruments.

Like that's the mental image that we're used to, but that shouldn't be the norm.

And so nowadays, we're seeing several companies that have found ways to use menstrual blood as a diagnostic uh biomarker.

Well, you mentioned the seat belt originally being um designed for a male body, and in your book, you speak on a number of innovations that are coming, including a bra that monitors women's heart health.

We know that when it comes to heart health, there's a lot of attention paid to men.

We know the signs of what a heart attack looks like for men, but women uh exhibit that in different ways.

So, something like a bra that monitors women's heart health for me just sounds like it's like a no-brainer.

Like, I it's like take my money, where do I get one?

Um why are innovations like that happening right now?

I think it all begins with awareness and education

and you know I give a lot of talks and whenever I ask people who do you see when you're imagining a person who's having a heart attack everyone says I see an old white man

and the symptoms that they see are pressure on the chest and then pain radiating down the left hand side and most people don't realize that those are symptoms that are typical for men but not for women

so we're still closing that uh information gap.

Whereas for women, we're more likely to have uh long-term extreme fatigue, jaw pain, and we're also more likely to communicate our pain as discomfort.

So that um pressure on the chest, we're more likely to either feel it or describe it as discomfort.

But I think there's been a lot of advocacy in the heart health community over the last um decade or two and there has been a real concerted effort to increase people's awareness.

And I think as a result of that there's more receptivity and people are more ready to receive something and to think of something and to fund something like the smart bra and it takes a really long time to develop something like that I think it's still in clinical trials right now.

It usually takes about a decade to develop something like that, to test it in a really rigorous way and to then bring it to the market.

It usually takes about a decade to develop something like that, to test it in a really rigorous way and to then bring it to the market.

>> Um, and it's exciting that something like that is in is is on the market, but the fact that it's taking so long, uh, it could be helping women in the interim.

You mentioned that, uh, we live in societies where women's pain has been normalized.

What's been the harm of this kind of innovation taking so long?

One thing that's fascinating is that we live longer on average, right?

But we also spend more years in ill health and there's so much focus and so much hype around longevity right now.

Um, and so you could say, well, we already live longer, but then how do we also live well?

And I think that can only happen if we have a real understanding of the female body and if we design devices and protocols and systems and drugs, you know, focused on the female body.

Stigma seems to be something that comes up throughout the book.

We talk about the innovation with fem, but there's a thread of stigma.

And I just wanted to read something from your book and this was said by Tracy McNeel, the CEO of Materna.

Uh in the book you write, "Becoming CEO of Materna was a breakaway moment for McNeel. I had been worried about what my network would think if I took this job. Would she dare to become the CEO of Vagina? I had spent my entire life pretending I wasn't a woman," she says. And then all of a sudden, there was just no way to keep doing that. On the contrary, I had to embrace being a woman as a strength and bring other women along.

Um, I thought this was such an honest admission by a CEO of a fem company that while she's leading a company that will help women, there was that stigma still around women's health.

And you also write that um 80% of the founders of FEMA innovations are women, but the people with money uh are mostly men.

How does this impact what products are put forward?

>> I love that you picked out that quote because I'm Yeah, I'm also very impressed by how um open and how powerful that quote is and I think it's a sentiment I've encountered again and again and again.

When you look at period apps, the biggest period app is Flow Health in terms of the money it's raised and the number of users it has.

It's a unicorn uh over here in Europe and it was founded by a group of men and so men are more likely to fund other men even in the space of women's health and I think that's that's the mind-blowing thing we're seeing.

Um because obviously if you have more money you can spend more on marketing, you have more reach um and so on.

Um because obviously if you have more money you can spend more on marketing, you have more reach um and so on.

I think men absolutely need to be part of the fech world.

But I think we absolutely have to have women as co-founders and on the most senior levels to have those insights and to to have that skin in the game.

Whenever I read books, I go to the acknowledgements first because you can always find like these little Easter eggs.

And in your acknowledgements, you quote noted journalist and political activist who you actually spoke to, uh, Gloria Steinum, and you wrote, quote, as Gloria Steinum said, the way to overcome stigma is by talking about it.

How did you witness that stigma while you were working on this book?

>> I love that quote and I think it's it's very true and it's exactly what we're doing here right now, right?

We're sitting here, we're talking about it.

I encountered it from the publishing world initially when they wanted me to change the title.

Then when the book launched, I encountered it from venues who didn't want to, you know, host my book launch because of the title.

I um had some other authors say to me they don't want to write a blur because of the title.

the book won an award and the um organizer of the conference couldn't actually announce the name of the book on stage

and then there was a woman who wrote an Amazon review and she messaged me saying that her review was censored because she mentioned the word vagina in the review itself.

So it keeps coming up

>> in 2025.

>> Well, exactly.

Yeah, you'd think it it really wouldn't be an issue and I think things have improved.

Um, but there's still a lot of work to be done.

And you know, at my local drugstore, you have a huge banner saying Viagra, you know, two for one, only $8.99 or whatever.

>> That's a good deal, I guess.

So,

>> I mean, I wouldn't know according to our friend.

>> Yeah, let's just assume. I guess so.

But there's just no equivalent, right?

And we, on the other hand, still recently had an aisle that was called feminine hygiene, a term that I just really don't like.

Um, so there's still a lot of work to be done.

Um, if the word vagina still makes people uncomfortable and we need to actually say the words in order to address the problems, Marina, what's the effect of that discomfort in the innovation space?

Founders in the space, you know, who are starting out, they often say to me, how do I overcome that discomfort when I'm pitching my company to people?

And I've seen two strategies that other people use.

One is to use a lot of data.

So when you're talking about things people might find uncomfortable, you know, you just present them with real world data.

And the other strategy is to just really lean into the word.

So to just say it, you know, several times until people are used to hearing it.

And I think both of those things are really powerful.

And I know that whenever I have a new group of students and my students are business students, um I tell them about my work and about my book of course and there's always somebody who giggles initially.

There's always I I can rely on it and the same goes for conferences and festivals.

I was um I was an MC at South by Southwest in London a few weeks ago and I introduced myself and I mentioned my book and several people giggled and I can just rely on that but then you know that's part of the story and then you say it again and you say it again and then people are on board with it and they they get it.

I can just rely on that but then you know that's part of the story and then you say it again and you say it again and then people are on board with it and they they get it.

I actually think it's um

>> you can win people over quite quickly.

What would you say are some of the criticisms of fem companies?

>> I differentiate between femech and what I call scam techch.

And I think it's really important to look at those two uh different categories because I've seen people use the word fee for everything from lipstick, which you know, I have no problem with lipstick. I like lipstick, but it's just not feech. It's nothing to do with my health. uh or leggings or hair removal or even breast enlargement.

So the term is definitely being abused um by people.

And the way I define scam tech is as technology or products that monetize our insecurities.

And so those can be products that are just completely useless like supplements that don't do anything for um pmenopause or that can be harmful like uh vaginal steaming devices.

The United States and it's a country that's going through their own struggles right now with women's and reproductive health.

Women's health, it seems, has always been political and never more so than right now.

What will be the knock-on effects of that for the rest of us especially in the world of fem

>> I think the slashing of the NIH funding uh the world's largest public funer of medical research is very concerning.

Because their funding supports everything from research on breast cancer to maternal health and companies then use that research to develop new medications or devices.

And companies then use that research to develop new medications or devices.

So if you slash funding for that fundamental research, that's going to have uh repercussions for our health in general and for um the pace of our innovation and women's health, as we've said, has already been underresarched and underfunded historically.

Um but most medical research uh most medical innovation, sorry, overall still happens in the US.

So over 50% of feech innovation happens in the US and so um there continues to be a lot of funding and there is a huge market and there are good conditions for innovation and we've also seen more private money going into the space.

So I think sometimes you see reactions or you know people can be energized by what's happening politically to then get more involved in solving issues they care about.

So I think sometimes you see reactions or you know people can be energized by what's happening politically to then get more involved in solving issues they care about.

Uh and in the book too you write about issues that impact women like endometriosis, fibroids, PCOS, how they're under researched, underfunded.

um as this is happening right now like especially with the NIH uh their funding priorities changing um are you worried about that and how that will impact the innovation that we could have seen moving forward especially in the world of fem

um are you worried about that and how that will impact the innovation that we could have seen moving forward especially in the world of fem

>> it will take longer uh to close those gaps and I've spoken to several researchers who um you know had to change key terms in their papers and who had to very quickly change the way they talk about things to try and and keep their funding and so on.

I've spoken to several researchers who um you know had to change key terms in their papers and who had to very quickly change the way they talk about things to try and and keep their funding and so on.

So there's a lot to be worried about, but there are many solutions in the book and I always try to to look for solutions.

And I think for better or worse, you can't uninvent science.

So you know, we've already created new things like abortion medication.

So that already exists.

And so then we can use technology like drones or like apps to get those pills to people.

Let's talk about solutions and a way forward.

Uh in your research for this book, what did you learn about the state of women's health?

>> I learned that there's so much work to be done and I learned that there are many really inspiring pioneering people who are already doing that work.

I also learned that um you know when I was doing my pregnancy preparation course over here in the UK, the midwife asked everyone if they'd ever heard of the pelvic floor before and nobody had.

And I think it's just mind-blowing to think that something so important like the pelvic floor is not known is not discussed.

Um or something like pelvic organ prolapse which according to some estimates affects 50% of women uh or things like birth injury.

So I think the more you look into this space the more you realize how much work needs to be done.

But I think that can also be very energizing.

>> Um, it's interesting you said that because I think it was only a few years ago when I interviewed Jen Gunter that I learned what the difference between a vulva and a a vagina.

Um, and when you were doing the research in this book, you traveled to many countries.

You spoke to many different people.

In some countries, uh, women don't have access to some of the things that we're talking about.

um in your from your research and all the people that you spoke to, how can fem companies bring more awareness to the issues they're trying to address?

>> I think that's something they're doing by existing in many ways and often times feech companies create communities and there are fem communities for companies.

So, we're seeing lots of people coming together at events and for conferences um when we're looking at this movement and I think that elevates the conversation, you know, just having a movement and having those conferences.

I think that elevates the conversation, you know, just having a movement and having those conferences.

>> What are your big hopes for this sector?

I hope that it's going to revolutionize the way we think about female bodies and the way we create healthcare for women.

>> When you started to write this, it was from the article that you wrote from Wired, I believe.

>> Yes.

>> And having done all the research and traveled and spoken to so many different experts, what have you learned uh through the process of researching and writing this book?

I expected to learn a lot about technology which I have and I was surprised to also learn a lot about my own body and I think that goes back to yeah I think that that goes back to the education gap and I get so many messages from readers who say and this is a very common phrase I hear to say I'm embarrassed by how much I've learned by reading your book and that's so fascinating to me because I've learned learned a huge amount by writing this book.

I think that goes back to yeah I think that that goes back to the education gap and I get so many messages from readers who say and this is a very common phrase I hear to say I'm embarrassed by how much I've learned by reading your book and that's so fascinating to me because I've learned learned a huge amount by writing this book.

But I'm not embarrassed.

I don't think, you know, as women, we're always embarrassed whether we knew something, we didn't know something, we've experienced something, we've not experienced something.

So, I think it's okay.

We can all there's always more to learn and researchers are learning.

We're all catching up.

Um, so I've learned a lot about my own body.

You know, I used to think that the menstrual cycle was 28 days long, but that's a myth.

Only 13% of women have a 28 day cycle.

Uh, and so I think the way we think about what's normal and abnormal, for example, is changing.

>> Well, I love this book.

I learned so much and I feel empowered by what I learned from what you were writing and I've recommended it to so many people and I'm so uh honored that I was able to talk to you about it.

I've recommended it to so many people and I'm so uh honored that I was able to talk to you about it.

Thank you so much for being so generous with our chat and uh for taking time to speak to us.

Thank you so much um for your kind words.

That means a lot to me coming from you and and thank you so much for your wonderful questions.

And thank you so much for your wonderful questions.

>> That was Mistreated.

Thank you for listening.

You can follow our show wherever you get your podcast so you can get notified each time a new episode is available.

Any feedback you have, write me an email at mistreatedodcast@tvo.org or reach out to me on my social channels.

Here's some feedback we received on YouTube from our latest episode on endometriosis.

Thank you.

I've been battling with this for years.

I've had multiple surgeries and I was desperate and I am still battling.

And thank you for listening.

I hope it helps a little bit.

This week's episode was produced by Matthew Amara and me.

Editing by Colin Kish, digital shorts by Ariana Longley, camera work by Max Stussy, teleprompting by Christy Mloud, production support from Jonathan Hallowell, and TVO's digital media services team.

Lorie Fu is the executive producer of digital.

John Ferry is vice president programming and content.

Thanks so much for listening.