Tackling taboos and silencing stigma. Is FemTech getting the attention it deserves?

These pioneering Femtech - short for “female technology” - startups are normalising everything from reproductive health to menopause, and in the process delivering better, more accessible and personalised care.

And the amount of investment flowing into this space has increased in parallel. Between 2013 and 2019, the amount invested in Femtech companies globally increased from $100m to $1bn. Which initially sounds like we’ve made progress, right? Not exactly. This still only represents 0.4% of venture globally, and given women make up 48% of the population, or 3.7bn people globally, we think the sector is far from getting the attention that it deserves.

Taking a close look at the space we believe that it has evolved in three distinct waves. It began with solutions in the menstrual and reproductive health space, before expanding into pelvic wellness and menopause, and finally into sexual wellness and other urogenital conditions. For investors and innovators who aren’t afraid to tackle previously taboo areas, there are untapped opportunities in all of these sectors, but most notably in the third wave.

Why has FemTech been overlooked? A gap in education and funding.

Historically, female health conditions were regarded negatively (or simply ignored). Aristotle actually viewed menstruation as proof of ‘female inferiority’ - a view that unfortunately persisted into the nineteenth century and beyond. In the 1920s, some believed that menstrual blood contained a poison called ‘menotoxin’ that made plants die amongst other things. And in the USA in the 1960s, it was still suggested that women lacked the ability to hold positions of responsibility and power due to their menstrual cycle.

While we have come a long way from these farcical views, residual stereotyping remains a challenge. Even today, the inclusion of women in health research is far from equitable. Women were essentially banned from participating in clinical trials until 1993 and many medications still aren’t tested on women. This means we have no idea whether they work in women, or even worse than that if they actually cause harm. This leaves a huge gender knowledge gap that is detrimental to women’s health.

In addition, given the natural predisposition for founders to solve problems that they experience themselves, Femtech companies are more often than not started by women. It is sadly still true that female founders receive a minority of funding. Also, when faced with a venture capital industry that is 80% male, a barrier they may face is investors not being able to ‘understand’ or ‘get passionate’ about their business.

Katrina Lake, founder and CEO of Stitch Fix, told Fortune: ‍

“I had an investor say, ‘I think you’re amazing, but I have to pick one or two board seats a year where I feel really passionate about the business, and I don’t think I can be passionate about women’s dresses and retail.’”

Lyndsey Harper, CEO of Rosy and obstetrician and gynaecologist points to the fact that there may be contributing problems in the medical education system too. During her many years of training in women’s health, low libido was never covered in any depth. However, urologists, who deal predominantly with male patients, receive a wealth of training on male sexual dysfunction. When she scanned the market she found that there was nothing available to help the 30m women who suffer from sexual dysfunction however there have been huge investments into erectile dysfunction startups such as Hims and Roman (both at +$150m each).

It is difficult to say whether this is correlation or causation. Either way, it's overwhelmingly apparent that there are systematic problems in the education system, not too dissimilar to those in the investment ecosystem, that are resulting in women's health issues being de-prioritised.

And here lies the beauty of the technology and entrepreneurs that I'll go onto discuss below. They've taken matters into their own hands, and with a mix of passion, skill and buckets of hard work, have managed to transcend structural barriers and build companies that are changing the lives of women across the globe.

The three waves of Femtech

The evolution of the Femtech sector can be categorised into three waves.

Wave One:  It began with a woman named Ida

Menstrual, contraceptive and reproductive health

The spark that ignited the FemTech revolution goes by the name of Ida Tin. Ida, the founder of Clue (a period tracking app), is widely recognised for coining the term “Femtech”, with the goal of taking “female reproductive health out of taboo land” and starting a “reproductive health revolution”.

A trailblazer in the menstrual and reproductive health space, Clue started in 2013 when the ‘quantified self’ trend was still in its early days. Just 14% of people were using apps to track their health and this was before Apple Health was rolled out onto the iPhone. Interestingly, Apple came under a lot of scrutiny after they released the first version without a menstrual tracker.

Glow and Flo followed suit, alongside others (many of which are yet to secure funding) such as Period Diary and Cycles.

Arguably, the success of Clue and co is partly due to a rise of fourth-wave feminism, and women taking control of their health and bodies, many of them publicly sharing their stories via social media. With this autonomy, came increased scrutiny of other products and services in the reproductive health space, most notably, feminine hygiene and sanitary products. Organic tampon companies include Lola, Callaly, Flo and Ohne to name a few.

More recently - fuelled by increasing consumer demand for sustainability and transparency - companies are looking to tackle the 100 billion pieces of sanitary waste generated every year - of which 80 per cent contain synthetic materials. Companies such as Carmesi and Polipop make fully biodegradable period products and Dame has designed the first reusable applicator. (Single-use plastic applicators are a tragic waste!) Others have addressed the problem differently such as menstrual disc startup, Flex, that claims to reduce 60% of the waste generated by tampons, and other alternatives such as reusable period underwear products from Thinx and Flux.

Other innovators in the first wave focused on reproductive health - perhaps in part due to frustrating, lengthy customer experiences with the NHS here in the UK. Pexxi and Natural Cycles are tackling contraception, Hertility and Adia offer at-home fertility tests and access to fertility experts and services, Step One Fertility aims to increase your chances of conceiving naturally and hence bypassing the need to pay for expensive rounds of IVF, and Celmatix is using genetic data to personalise fertility treatments. BabyScript focuses on streamlining prenatal care and BloomLife uses data from wearables to improve maternal outcomes.

Wave Two: 1,2,3….Kegel!

Pelvic wellness and menopause

The first wave was pivotal in starting and encouraging the conversation around women’s health, and normalising the use of digital health tools. Startups in this formative era predominantly targeted a younger, digitally-native customer, and so the next natural progression for the market was to start solving for issues experienced by older women.

We live in a media-driven society that idolises youth, and so stories of pelvic problems and menopause have largely gone unshared. Suffering, up until recently, has remained silent. In addition, the NHS isn’t set up to manage long term conditions such as menopause or pelvic problems and instead are searching for better and more personalised care through a range of products/innovations.

One of the most prominent to start changing the status quo is Elvie, who recently raised a €37.5m series B. Other pelvic wellness providers include Kegel8, Intimina, KGoals and B-Wom.

Over 60 million women in the US alone are menopausal however menopause (an inevitable part of female ageing) is still viewed by some as ‘niche’. There are a number of startups working to change this. Gennev, in the US, offers an online clinic for those with menopause symptoms. General women’s health platforms such as Maven Clinic and Rory also offer menopause care.

In the UK, Live Better With (one of the Forward Partners portfolio) provides people with menopause with content, community and curated products to address side effects and symptoms. We’re also excited for the launch of Alva who are looking to provide products and services aimed at women going through menopause and the same with the new business from the founder of the FemTech fund Sanguine, Andrea Berchowitz.

An overlooked area within menopause is genitourinary syndrome of menopause that affects up to 50% of menopausal women. It will be interesting to see companies researching this space specifically.

Wave Three  —  Sex that is safe (and enjoyable)

Sexual wellness

The most recent evolution is into an area that is age-agnostic: sexual wellness. From STI’s to libido, this is arguably the area of women’s health that is most hush-hush, and thus companies have been slowest to enter this space.

Sexually transmitted infections continue to be seen as shameful yet they are incredibly common and on the increase. Nurx and Rory are two examples of US-based companies that have introduced sexual wellness as an addition to their primary product offering (contraception and general women’s health respectively). Another worth mentioning is Evekit (currently available only in Canada) - which has created an at-home screening kit for sexually transmitted diseases.

In the UK social impact business SH:24 has been operating for a few years. It would be interesting to see companies offering innovation such as point of care testing, rescue packs.

Problems with libido and difficulties having sex also affect over 40% of women. There have been some interesting early movers including Ferly (backed by LocalGlobe in 2019) and Rosy in the US which are modern sexual education startups. Omgyes, an avante-garde educational platform that has ‘touchable videos’ launched last year. BlueHeart founded in 2019 is taking a non-gendered approach to digitising sexual therapy. Ohnut is one company aims to treat deep dyspareunia (pain during deep sex).

Urogenital wellness

Other urogenital conditions such as endometriosis have seen little activity from startups. However, endometriosis affects 176m women globally and the average time to diagnosis is still 7 years. There have been some exciting developments in menstrual blood sample testing that may mean we are closer to a non-invasive diagnostic tool (currently the only way to get a definitive diagnosis is invasive abdominal surgery). Next Gen Jane who are analysing menstrual samples from tampons may look to work on this.

Often related to the above is pelvic pain and dysmenorrhea which is experienced by up to 90% of menstruating women. Daye have created tampons medicated with CBD to ameliorate this problem. We are excited to see the results of the clinical trials Daye have conducted.

Both Daye and Next Gen Jane open up an interesting broader theme of tampons being used as a diagnostic tool or treatment modality. It will be fascinating to see what diseases could be detected through tampons such as infections, cervical or ovarian cancers and whether delivering medications locally can benefit other diseases or symptoms. (However please don’t take anything intravaginally without it being tested!)

Non-sexually transmitted infections such as UTIs and thrush are remarkably common and burdensome to women. In fact, 40% of women will have a UTI and 75% of women will experience thrush, often multiple times a year yet the patient experience is often poor. We are excited to see the evolution of Juno Bio who are researching the vaginal microbiome, the potential use cases of which could be wide-ranging.

We would love to see companies developing novel screening tests for cervical cancer that is relatively common and treatable but burdensome to healthcare systems and ovarian cancer that is less common but more difficult to diagnose. As well as companies with novel uses for menstrual blood samples (a biopsy that 25% of the world’s population give every month) and those looking for new ways to treat dysmenorrhea that affects up to 90% of menstruating women.

What's next for Fem-Tech?

No doubt FemTech founders have had to address and overcome some entrenched thinking and complex historical dynamics however the progress made in the last decade has been tremendous. While we have seen a number of companies addressing menstrual health, reproductive health and pregnancy there is still a noticeable lack of companies in menopause, sexual health and other forms of urogenital health. We hope these sectors will see more companies and funding in the coming years. The benefits of which can and will be felt across all societies and ages.

It remains to be seen how advances in health more broadly will shake up these sectors completely. For instance, how will the advent of CRISPR (gene editing) impact female health? How might personalised medicine and novel therapeutics change the way we treat medical conditions and how might reaching a critical mass of women who have been whole gene sequenced affect medical care?

We feel there is an enormous opportunity for growth in this market and in fact, some reports claim it could reach $50bn by 2025. We’re keen to talk to all founders that aren’t afraid of breaking down taboos and believe you will have a massive impact in this space.

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