Journalist Marina Gerner is out with a book today on a topic near and dear to our hearts: the women trying to change lives through innovation in women’s health. Her title pulls no punches–The Vagina Business–and accordingly, neither does she. We sat down with Marina to talk about how she got started on the book in the first place, how we’ve been stuck with the technological equivalent of the floppy disc when it comes to labor and delivery, and what she hopes a male investor would take away from reading her book.

This interview has been edited for length and clarity.

Meghan: So, how did you get into the business of writing The Vagina Business?

Marina: It began with bra, which was about five years ago. When most of us imagine a person having a heart attack, most people picture a man. And it’s usually an old man, and he’s clutching his chest, and he feels a lot of pressure on his chest and pain radiating down the left side. But at the time, I learned those symptoms are typical for men and not for women.

And so, as a result, women are 50% more likely than men to be given the wrong diagnosis after a heart attack. And that’s because we have this legacy of most medical research being focused on the male body.

So, I was really excited to come across a company called Bloomer Tech. It’s a startup out of MIT, and they’ve created the coolest thing–a smart bra that uses ECG technology that can help women who are at risk monitor their heart health, and it could also be used remotely in clinical trials. I was super amazed to learn about this, because there’s not just a problem, there’s also a solution. And I wanted to write the story of the smart bra.

Marina had to push to get that piece published, but once it was finally out there, it went viral. She was then invited to speak at a conference on femtech, and things took off from there.

Marina: I spoke in the morning, but then I stayed on and I listened to all the other panels because I was so fascinated. I was drawn into this world of health tech focused on female bodies, and I expected to learn more about technology, but I realized I was learning a lot more about my own body too.

Because you think you know about your own body, but in reality, there’s just so much more that we can learn about the menstrual cycle, about hormones, about all of these things. I was in my early 30s at the time. I knew I wanted to have children soon, and I also knew that nine in 10 first time mothers end up with a birth injury. So that was something else that was kind of on my mind.

And I came across another innovative startup in California, called MaternaMedical, and they are working on a dilator that could potentially help us prevent vaginal tearing and prolapse. I started researching the space, and I learned that the biggest innovation in the standard of care in the birth space was the epidural, which was popularized many decades ago. And that was just mind blowing to me–to realize that we’re dealing with an invention here that is very old.

You know, there’s no other area of technology where you would say, ‘Oh, we popularized this in the 1950s and look, this is the most cutting-edge thing we have. Here you go. You know, here’s a floppy disk for you.’ Isn’t that incredible?

Meghan: Indeed! I know it might be hard to pick, but what is one of the most interesting things you learned in the process of writing this book?

Marina: I think cervical mucus is a really interesting one, because most people don’t know–and I didn’t know–how it changes throughout your menstrual cycle. It becomes more or less sticky at times, so that sperm can or can’t swim through. In the book I’ve written about a non-hormonal contraceptive that is not on the market yet, but that could potentially help the cervical mucus stay sticky so that spell can’t swim through.

There’s also the myth of the 28-day menstrual cycle. Less than 20% of women have a 28-day cycle, whereas everybody else doesn’t. And how ovulation is not statistically in the middle, it’s actually a bit further into the cycle. So when your healthcare provider, for example, predicts your due date, they base it on a 28-day menstrual cycle, which just doesn’t apply to most women.

Meghan: Why do you think it’s taken so long for some of this work to happen, especially in the business of women’s health?

Marina: A lot of founders have told me that they felt that they were ignored or neglected by the healthcare system, and so that’s why they’ve created products specifically for consumers, right? There have also been various companies that were selling to consumers initially, and now they’re finally selling to businesses, because they realize it makes more sense to work with insurance companies, or employers, or healthcare providers.

Meghan: One product you profiled is a dilator that health care providers would use to prevent tearing during birth. I was looking at the diagram of that one, and I was like, I don’t know if I’ve ever seen a diagram of what a baby’s head looks like at the angle. And thought, ‘why hadn’t I seen that?’

Marina: Yeah! I’m so glad you’re saying that, because I put up a fight to have illustrations in my book. I was like, ‘No, we must have these illustrations, because people can’t even visualize what these things look like. No, not just the products, but the body parts. And because it’s all invisible, it’s all internal.’

Meghan: It’s crazy that I’ve given birth but had no idea what this looked like! Beyond the basics of female anatomy that many of us are missing, what is a takeaway you’d like a potential male investor to get from this book?

I’d want them to not say to founders, ‘Let me go home and ask my wife.’ Because that’s something founders tell me all the time– they pitch their product to investors, and investors will reply by saying, ‘Oh, you know, let me go home and ask my wife.’

You just wouldn’t do that with any other product. You wouldn’t base a decision on the experiences of one person. You would look at the market, you would look at the statistics.

But there just seems to be this hurdle that femtech entrepreneurs face, which is that the issue has to be relatable to investors on a personal level. Even though, when they invest in crypto for example, it’s not like they necessarily know the ins and outs of that. So I think often times it’s an excuse. In other areas, it’s very normal to have advisors as an investor. It would be easy to get a gynecologist to give you advice, and try to get over that personal relatability hurdle.

Meghan: What changes have you over the past five years when you first started on this journey?

If you look at the amount of VC funding that goes to female founders, it’s it doesn’t change much. It’s always around the same. [Ed: Under 3% of VC funding goes to all-female founder teams.] I think people often hope that these things are changing rapidly, but they’re not changing rapidly. It’s all incremental changes. Things are changing very slowly.

But I do think the conversation has changed a lot. When I started working on the book, you know, it’s very rare for somebody to know what endometriosis is, whereas nowadays it’s everywhere, and there’s just so much more awareness around perimenopause as well.

You can buy The Vagina Business here. Marina also has a biweekly newsletter you can subscribe to here.