[music] I'm Alexander Heffner, your host on The Open Mind.

I'm delighted to welcome our guest today, author of the book, The Vagina Business The Innovative Breakthroughs that Could Change Everything in Women's Health, Marina Gerner, thank you so much for joining me today.

Thank you so much for having me.

And thank you for the invitation.

Marina, what motivated you to write on this subject from the outset?

Was there something in particular that sparked this for you?

Yes.

There was.

So it all began with a bra.

A few years ago, I had a new insight, which is if we ask most people to imagine a person who's having a heart attack, most of us tend to picture the same kind of person.

Who do you picture?

Huh.

Who do you see?

Yeah, I think so.

I picture a morbidly obese person, you know, having a heart attack.

And usually it's a guy.

Usually it's an old man.

And so the symptoms we typically think of, are pressure on the chest and then pain radiating down the left hand side.

And I found out that those symptoms are typical for men, but they're not typical for women.

Which I thought was really surprising, because that is what we typically see in movies and so on.

And we know a lot less about how to spot heart health issues in women.

And as a result, women are 50% more likely to be misdiagnosed after having a heart attack.

And that's because most of our medical research has focused on the male body.

And so as a journalist, I was really excited to come across this company called Bloomer Tech that has created the coolest thing.

They've created a smart bra that can help women who are at risk monitor their heart health.

And I was amazed because not only did I learn about a problem, but I also thought, okay, this could be part of the solution.

And I met the founder, Alicia Chong Rodriguez, at a conference.

I was sitting in a balcony seat, and in the lunch break, I ran downstairs to ask for her business card because I wanted to write about her, I wanted to write about this bra.

And then I messaged all of my editors, and there was this perception that the topic was a bit niche.

Nobody was really interested.

And I thought that was nuts because, you know, we're over 50% of the global population.

How can this topic be niche?

The topic of technology that's made for female bodies.

And you know, the topic of heart health in women.

And then Covid happened.

And I think a few things shifted during the pandemic.

And I think we started to pay more attention to sex differences in health because men were initially more affected by Covid.

I don't know if you remember this, -but men initially had -Yeah.

worse symptoms.

Nowadays, we know that women are more likely to have long term Covid.

Especially perimenopausal women seem to have, long term Covid.

But at the time, men were more affected.

So if you wanted to be cynical, you could say, suddenly we started to pay more attention to sex differences in health.

And at that time, a book, called Invisible Women was also doing really well.

And I managed to publish the story about the smart bra in The Guardian.

And that story did really well.

And it got me further into the world of women's health innovation.

I was invited to chair a panel on one of the first FemTech conferences, and I was expecting to learn more about technology at this conference.

But I was drawn into this space because I was learning more about my own body.

And that was amazing to me because you kind of think you know about your body.

But in women's health, there's so much more to learn.

And I knew that I wanted to have children soon.

Which leads me to my second origin story.

I also knew that 9 in 10 first time mothers experienced a birth injury, which is just unbelievable to think nine and ten first time mothers experience that.

And it's not something we often talk about.

It's the kind of thing where sometimes women who have already given birth will say, oh, you know, don't tell her about it.

You don't want to put her off.

You don't want to scare her off.

But I think it's something we need to talk about because I think knowledge is power, and we need to be able to look into our options, and so on.

So I found a company in California called Materna Medical, who's created a preventative device.

It's a dilator that helps us pre-stretch the muscles of the vaginal canal in the first stage of labor.

So that by the time the baby comes through, those muscles have been pre stretched and you are less likely to experience a birth injury.

So that's the hope.

If the device makes it to the market.

It's currently in clinical trials.

And I spoke to the CEO, she's called Tracy McNeal, and I learned two things from her.

I learned that the last big innovation in the standard of care of birth was the epidural, which was popularized in the 1950s.

And that's mind blowing to think that if you go to a hospital right now to give birth, you'll be offered the epidural, as you know, the best possible option for pain relief.

But it's many decades old, and I thought there's no other area in society or technology where we wheel something out from the 1950s and we say, hey, look, look at this cutting edge floppy disk.

You know, this is the best we got.

There's another device called the forceps, which we use in delivery.

And that was invented in the 17th century.

And it's basically a set of salad forks.

So I was amazed to see that that's the state of innovation in birth.

And as I spoke to more founders that focus on vagina centric innovation, I learned that they really struggled to raise money because investors who are predominantly male are embarrassed to talk about the topic.

So they don't want to invest in companies that are vagina centric.

And I have this quote from one investor who says, I don't want to talk about vaginas, in my Monday morning partner meeting.

So that tells you that the kind of attitude and that made me really angry.

So I wrote an article called We Need to Talk About Investors Problem with Vaginas for Wired magazine.

And the article went viral and it really hit a nerve.

And then I took it from there.

So, has your reporting inspired any investigation into what should succeed the epidural?

It's seaming, sounds like it's pretty antiquated and maybe not as effective as the pain relief should be for women experiencing childbirth.

So.

-No, I think it is.

-what's the next?

It is pretty effective in terms of pain relief.

But I think we need more things that are, preventative.

Mm hmm.

You know, this device, that dilator is a preventative device, and it's actually a very simple device.

Not everybody wants to have an epidural.

Not everybody likes the idea of, you know, not being able to move and so on.

So I just think we need to have a much, much bigger range of innovation in that space so that women have more choices.

Got it.

Let me ask you about the smart bra.

When you say it can predict heart attacks early.

How early are you talking in that example of innovation, is it weeks out or days or hours?

That's something you'd have to ask the company.

So they're still working on this.

And I know that they're tracking various different, inputs, and it's, you know, to monitor those various inputs.

But the hope, because you've reported on the company, their aspiration would be to give people some warning.

So it's not like, you know, they give you two minutes, you know, you get maybe two days or something.

-And how does, I know that -Yeah.

there's a lot of, innovation going on with the Oura Ring now too, to be able to track some of that same data.

Yeah, exactly.

And to track your, menstrual cycle, there are lots of, new companies that focus on that in particular.

And you can track your menstrual cycle in lots of different ways, you know, whether that's the date of your menstruation together with your, body temperature in the morning or whether that's through your breath or through your saliva.

There's also a new company called Level Zero Health that's developing something like a continuous glucose monitor.

So you can continuously track your hormone levels and that can be very helpful for, symptoms in menopause or IVF treatments as well.

So you talked about the stigmatization of the subject, and the failure of people to act on, opportunities for innovation because of this sense of embarrassment.

It sounds rather childish, but I I know what you're talking about.

I mean it's, harder for some people to get over that hump.

Especially people who take themselves too seriously in some ways.

But what about the privacy considerations and concerns?

Because I think that's also been a reason that this has been such a long time coming that people have not wanted digital records of the various things that we're talking about here.

You know, there has been internationally more movement towards reproductive care and autonomy for women.

But here, as we record this in the United States of America, there is a political party in control that has for many decades wanted to have government control over what women can or cannot do with their bodies.

Yeah.

That's a really, really important, concern.

And if we look at period apps, for example, and the data they collect, there are real differences between them.

So there are over 300 period apps on the market, and some of them are run by companies that, you know, put a lot of thought into your data privacy and security, whereas others are just gaming companies that create loads of different apps.

And among them, they've created a period app because they realize there's demand for that or utility companies.

So I think when you're choosing a period app, you know, I have a whole chapter on this.

It's really important to look into the company that's behind the app.

And one company that does really well in academic research is called Clue.

They are based in Berlin, so they're regulated by GDPR, which is, a very strict privacy policy.

So I would always recommend Googling whatever it is that you're downloading together with the word scandal or court case or data privacy and see what comes up, because these things keep changing as well.

You're saying that Europe's data regulations, prevent them from doing what?

That those companies could do right now in the United States.

From handing over any data that they have on their users, you know, from being subpoenaed, from handing that over to anyone, they told me they've never actually been asked to do that.

So it's in some ways a theoretical fear.

The other thing, to remember is that period apps or menstrual data is not the most revealing kind of data.

Messages that you've sent to somebody or your geolocation can be much more revealing than that.

Whereas in an app, it's easy to just input false information.

Right, right.

Well, sometimes just merely by having a certain app on your phone.

Even if it is not an app that wants your location or ostensibly, uses it, it can still collect it.

Are there more damning or, potentially perilous pieces of data than, related to ones, you know, cycle, a woman's cycle, that have come up in the discussions about innovation around, you know, vaginal health and what you write about in your book.

I mean, there's period tracking, but there's probably other things too.

Yeah.

So nowadays, some sex toys are smart as well, and, you know, Bluetooth connected and so on.

So I've interviewed a couple, they're a married couple in Canada, and they call themselves the Internet of Dongs.

And what they do is, in their spare time, they hack into sex toys to test their security, and then they write reports about them.

So that's something most people you know wouldn't even think of.

But that's another concern.

And what about the broader, health considerations that you mentioned?

Kind of that the pandemic, prompted us to reevaluate, whether we were giving preferential treatment in the study of disease to men over women.

Evaluating that now in 2025 and whether there's more of an equilibrium in research and, ensuring that, you know, there is as much, study of men or masculine health as there is women or, feminine health.

-Do you feel like, -Mm hmm.

some of that imbalance has been rectified now?

So the incredible thing is that women and people of color were only officially included in clinical trials in 1993.

And since then, we have definitely increased the proportion of women in clinical trials.

But we still haven't reached parity.

So it has been, an upward trend, but we're not at parity yet.

And the other issue is that, in earlier studies, female mice still tend to get excluded.

And researchers use all kinds of excuses for that.

I have one quote in the book where researchers say we excluded female mice because their cages were harder to clean.

And you just wonder, you know, how can that be a reasonable explanation?

The other issue is that studies that have included women oftentimes still don't analyze their data by sex.

So they're able to say, yes, we've included women, but then they don't actually look into what that means.

And there have been some guidelines at publications like Nature that have tried to rectify that.

But from what I'm told by people in this space, is that there are no consequences.

So if you're not analyzing your data by sex, you know, nothing, actually happens.

And now, unfortunately, in the US, we've seen that, you know, NIH funding has been slashed and that's going to have a huge impact on the world of medical research in general and on women's health in particular, because that has been historically both under-researched and underfunded.

And NIH funded studies are used by companies as well, so that will impact innovation too.

There will be many, many consequences of this.

How do you look at the issues you grapple with in the book?

I mean, egg freezing is something also that you tackle in the book.

Recognizing the the plummeting population in a lot of places, and the lack of social support and safety nets for people to embark on parenthood or families.

It gives the impression that we're living in this age where, the health considerations you're discussing are, a woman and, her sex life as opposed to a woman and her hope to be able to, have a family.

But, in other words, these technologies are forming at a time when, it seems like people are going to be at a socially disadvantageous place when it comes to child-rearing or, building up their family.

And it seems kind of like the ideal would be we're embarking on this innovation and have the policies to support people making their journey into parenthood.

Exactly.

I think those are, not mutually exclusive, right?

They're both sides of the same coin.

Whether you're talking about sexual wellness or having a family, I think that is, in reality, those are like, you know, very connected things, right?

And I do think it's a matter of policy to both have the research to look into maternal health or increasing C-section rates.

And it's also a matter of creating more transparency in places like the egg freezing industry, because what I have found is that there's a huge lack of transparency in terms of both the, likelihood of it working and how many eggs you actually need to freeze and how much it's going to cost you.

So I've included a whole infographic on, you know, how many eggs you need to freeze, depending on your age and how much it's going to cost you, and all the different parts of the cost that are revealed in egg freezing.

So I think for those who want to freeze their eggs there needs to be more transparency.

And in general, we need much more family friendly policies, right?

So paid parental leave, flexible hours, affordable childcare, those policies will make it easier for people to have families.

What did you find in your research, just about, you mentioned childcare.

But what about the, just the cost of giving birth in the first place?

In America or around the country?

Is that also inhibiting people's path to, you know, health, their vaginal health or their children's health?

It seems as though in this country, the procedure is kind of like a get rich quick scheme for hospitals to charge you, a ton of money just simply to give birth in the first place.

Yeah, absolutely.

And I mean, the cost of health care is prohibitive in the US, compared to European countries.

And I think we need to look at both policy and innovation in this space.

And innovation can sometimes provide access, right?

If you are in a remote area, in a rural area, it can bridge that gap.

But it really is a matter of policy and a matter of ensuring that, you know, women who don't need C-sections.

Women who don't need episiotomies.

Do not end up getting those interventions that are, you know, more expensive than if you had, a different kind of birth.

What did you find in the difference, if you will, looking at this from the British perspective, I think you spend a lot of time in the UK, you live in the UK, you spent some time in America for your research and, how would you describe any differences in, approaching women's health, in the health care system that you find in the UK versus the US?

I think, actually, France and Germany are really good examples for good, postpartum care.

Because they are well resourced and universal healthcare systems where, mothers, new mothers are taking care of, you have a midwife that's there to advise you.

You also get, physiotherapy to, you know, make sure that your pelvic floor is fine, because pelvic organ prolapse is really, really common further down the line, urinary incontinence is very common.

So there are things we can do earlier on after giving birth to prevent those.

And they do that really well in France and in Germany, less so in the UK, even though it is slowly changing.

And the US by comparison, where did you see, kind of the state of maternal health in the US as you navigated the opportunities for innovations and then kind of the realities on the ground here?

Well, the statistics in the US look, you know, really bad in terms of maternal health mortality, morbidity, compared to all other high income countries.

So.

And did you find that any of these innovators, want their approach, if not their devices, to change that?

Absolutely.

So FemTech, is not just focused on devices, but, it can also include, you know, telehealth and, research projects and so on.

So I think that movement of women's health innovation brings together all sorts of people, entrepreneurs, researchers and investors.

And one example of a really big, unicorn FemTech company is Maven.

And they are a telehealth provider, and they're looking into maternal health in the US a lot.

What kinds of exchanges have you had with American women about the book?

I'm sure you've gotten some insight into, their reactions where they think, kind of the innovations are most helpful, where you think they may be kind of more a distraction than actually dealing with the problems that we have.

Yeah.

I think it's never either or, right?

I think of it as, you know, just because I've written a book about innovation and technology, that doesn't mean I think the human element isn't just as important or even more important.

I think it's like saying I want airplanes to be really safe.

But I also love walking.

Right?

So they're, two different things.

And the feedback I'm getting from American readers is really incredible.

It really resonates with people.

I think some of the most powerful messages I got is when women say, you know, I finally had a conversation with my mother without using euphemisms or you've changed the way I talk to my daughter.

Or, you know, I've heard from several universities who've put the book on their reading list for medical students, which is incredible.

-And I get lots of messages -Yeah.

from physiotherapists, from gynecologists, but also from business students who want to go into the space.

Yeah.

You know, you allude to early in our conversation, a businessman's uncomfortableness with the subject matter, but, I think some of it also stems from illiteracy.

How much of that did you trace back, the average American businessman does not know anything about the vagina?

Maybe the average man, American male, also, knows nothing.

So, in the few minutes we have left, [laughs] what are the highlights that the average man, who may be borderline illiterate to semi informed about the vagina, ought to know?

[laughs] I think it's actually not just about men, but it's about everybody.

You know, we all need to learn more about the female anatomy.

And I have lots of visualizations in the book, that people can look at.

And I want everybody to be able to to draw a clitoris, for example.

I think that would be, life changing because we see so many penis doodles, you know, in public bathrooms and so on, but nobody can draw a clitoris.

And I think, that's a very simple intervention, that I suggest.

But it's not a simple topography.

I mean, relative to the male genitalia, right?

I mean, I think that that's why one, you know, a third grader or fifth grader or whatever, six, I guess, say, you know, high school sex ed class.

Would be asked to do that, and it would be much harder to achieve the drawing for the woman than the man.

I mean, the sexual organ.

There's a lot more mystery around, the sexual organ of a woman, but also it's more complicated.

Is it not?

Than the the male sexual organ?

Oh, yeah.

But I have a drawing in the book, there's definitely something you can draw.

It's just that people are not use to visualizing it.

We don't have the language.

Even if you ask women, for example, you know, how big do you think your uterus is?

Most women go like this, but in reality it's more like this size.

-So, you know, we -Right.

simply need to talk and think more about the female anatomy and start there.

And I think it has to start with education, because otherwise you don't even know what you don't know.

We still have the myth of the 28 day menstrual cycle, for example.

You know, in reality, only 13% of women have a 28 day cycle.

And research has shown on average, it tends to be longer.

There's also a lot of individual variation.

And so that's something else to be aware of because that influences how people plan to conceive and it influences due dates and so on.

Yeah.

Well, I thought your first comment about heart health, was important.

Just in the minute we have left.

Is there anything similar to that?

It was kind of like, that would confound people.

That would illuminate something about a woman's health that we don't know, because that was pretty, jarring to hear.

You know, the disproportionate outcomes not being driven by the obvious factors, you would think, when it comes to women's health and even, vaginal or not.

Is there anything kind of like that, that you came across in the book?

Yes.

So, we have five times more studies into ED, erectile dysfunctions, than into PMS, even though only 19% of men have ED, and close to 90% of women report symptoms of PMS, and across 770 types of diseases, women are diagnosed an average of four years later.

We're also twice as likely to experience severe side effects from medication.

So I think sometimes it's worth showing people these statistics as a starting point.

Got it.

Marina Gerner, author of The Vagina Business The Innovative Breakthroughs that Could Change Everything in Women's Health.

Thank you so much for your insight today.

Thank you so much for the conversation.

And congratulations on the book.

Thank you.

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