Priyanka Jain, CEO and co-founder of vaginal health company Evvy, felt more like an educator rather than an entrepreneur when she first set out to raise funds for her startup. The company, which has raised $19 million since inception in 2021, is direct-to-consumer and sells at-home vaginal microbiome tests. Questions she received from investors — mostly men — included:
- What’s a yeast infection?
- Is it really that frustrating?
- Is this really a problem?
Indeed, up to 75% of women or people assigned female at birth will have at least one vaginal yeast infection in their life. But with the male-dominated venture capital industry (just 8.6% of venture capitalists are women), many investors simply aren’t aware of these facts.
“You have to start with the barrier of what even is this condition, educating them about it, then talking about the prevalence, then talking about the standard of care,” Jain said in an interview. “So it just takes a lot longer for them to jump through the things they have to believe in order to believe in the company.”
Jain’s barriers in raising funds are not unique and are faced by many founders of startups that focus on stigmatized women’s health conditions. Despite women representing half of the population, just 3% of digital health funding focused on women’s health between 2011 and 2020, and a majority goes to startups addressing fertility, pregnancy and motherhood, according to Rock Health.
But do startups that focus on male stigmatized conditions face the same challenges in raising funds? There is no clear answer.
‘I’ll ask my wife about this’
One experience, in particular, is common to the interaction between women entrepreneurs and men investors: being told they’ll ask their assistant or wife about the condition the company treats.
“Obviously, I don’t think anyone wants to talk to their boss about vaginal odor,” Jain remarked with incredulity. “There are plenty of people saying, ‘I’ll ask my wife about this.’ It was kind of frustrating to feel like we were being passed off to people who weren’t investors to evaluate the opportunity, because there were no investors available who had vaginas to help evaluate it.”
Jain added that she often feels bad for these women associates who may have to have these uncomfortable, private conversations with their bosses to bring them up to speed on how big of a problem it is for women — and in order for women’s health startups to get funding.
Stephanie Estey, co-founder of sexual health company TBD Health in New York City, has had similar challenges with a male VC bringing along his female associate or saying he needs to show the startup’s products to his wife. Despite serving all genders, the company often gets put into a “women’s health box.” The direct-to-consumer company’s services include STI testing and contraceptives. It has raised a little under $5 million.
Another women’s health founder, Ellen Rudolph, said she often experienced issues where men investors “wrote me off in the beginning and weren’t paying attention.” Her company, Atherton, California-based WellTheory, serves consumers and employers and offers care for autoimmune conditions, which primarily affect women. The startup has raised $7.2 million.
“I had one male investor who said, ‘I believe that there’s a billion-dollar company to be built in this space, but I don’t know if you or I know what that is.’ And I will never forget that,” Rudolph said. “I think the challenge is a little bit that there’s this dissonance because a lot of the time the person you’re pitching to doesn’t have that lived experience or understanding.”
All of the above is reason enough for VC firms to hire women partners or promote them to those positions.
But it’s not always male investors distancing themselves from women’s health companies. Sometimes it’s women investors who are trying to “diversify away” from the women’s health space, according to Estey.
“I think some of the more surprising things have actually been when female investors — who may naturally have empathy for what we’re doing at TBD — actively don’t want to invest in a category that’s often associated with women’s health,” she said. “So they actively try to not invest in women’s health or try to invest in something that is more like FinTech or crypto or something very different.”
Rachel Blank, CEO and founder of New York City-based Allara Health, agreed that it’s not always men who question women’s health startups when they’re seeking funding. Allara, which has raised about $16.5 million, is a digital health company that treats gynecological conditions like polycystic ovary syndrome (PCOS) and endometriosis. Blank said she received comments from both men and women who thought there wasn’t a big enough market for her company. But once she explained the data that PCOS affects about one in 10 women of reproductive age — as does endometriosis — investors were receptive.
That’s not to say all conversations with investors were met with the kind of passive cluelessness that the women’s health founders shared. Jain said that when talking to women investors, her experience was “split between people who were like ‘Oh my god, this is me’ … and women who were like ‘Huh, I’m now realizing how lucky I’ve been to not be in the cycle of recurrent [vaginal] infections.’”
Evvy has also received funding from Virtue, which is led by male investors Sean Doolan and Emre Karatas, who Jain said were receptive to Evvy’s endeavors.
“From my first conversation with them, they were like, ‘Wow, there’s so much we don’t know here. We’re gonna go get educated,’” Jain said. “And they came back actually with an unbelievable set of information for me of, ‘Here’s how massive this opportunity is. And we did all this research, and here’s what we learned.’ I was just so amazed by their willingness to learn and desire to really be educated on it.”
Do men’s health companies have the same challenges?
When direct-to-consumer telemedicine company Hims & Hers started out around 2017, it primarily focused on conditions like erectile dysfunction and hair loss in men. The San Francisco-based company has since expanded into other men’s health conditions, as well as women’s health, and is now public. Before going public, it had raised about $200 million.
Melissa Baird, COO of Hims & Hers, said that when seeking funding in the early days, there was some investor discomfort. And since erectile dysfunction isn’t a commonly talked about subject, she said that there were often men and women investors who said that they didn’t know anybody who had this condition, even though statistically speaking they probably did and just didn’t know it. About 30 million men in the U.S. are affected by erectile dysfunction.
“I’ve been in meetings where fully grown men would giggle when I mentioned erectile dysfunction, so there definitely was a [taboo] element to it,” Baird said.
But once the company started explaining how big of a market there is for its services, “it stopped the giggling pretty fast,” she added.
Meanwhile, Maple Grove, Minnesota-based Morari, an early-stage startup focused on premature ejaculation, has had its own struggles in raising funds. The medical device company offers a wearable skin patch that helps delay ejaculation during sex. So far, the company has raised about $3 million from friends, family and angel investors. But when it comes to venture capital funding, the company’s challenges often come from the fact that its product doesn’t have FDA approval yet, according to CEO and Founder Jeff Bennett.
He added that there is also an element of discomfort around the topic, “but they don’t come out and say that, they just say it’s not a fit for us.” In this case, he often doesn’t get further information on why the VC chose to pass on the company.
“I think anything about sexual health and wellness, given the taboo nature of it, it’s going to be difficult,” Bennett said.
What the investors say
Several investors agree that women’s health companies focused on stigmatized conditions likely struggle more to get funding than their men’s health counterparts, but said they don’t have the data to prove it. These struggles are most likely due to “who’s in the room,” hinting at the fact that there are more male investors than female, according to Alyssa Jaffee, partner at 7wireVentures.
Jaffee has looked at companies for vaginal dryness, PCOS and postpartum leakage. She said she didn’t make an investment in these companies, but not because there wasn’t an opportunity in the space. Rather, it was that the company wasn’t the right fit, she said.
“This is health, this is healthcare, this shouldn’t be icky,” Jaffee said. “I think that if you had people in a room who didn’t feel as comfortable with the topic, I can imagine that it would feel that way.”
However, 7wireVentures has invested in women’s health companies like Parsley Health, which treats autoimmune conditions, digestive issues, fertility and other areas. It’s also invested in Caraway, which specializes in treating Gen Z women and offers mental, physical and reproductive virtual health.
Sean Doolan, founder and managing partner of Virtue, also noted that some of the struggles women’s health companies face may be because there are fewer women VCs. In addition to investing in Evvy, Doolan also invested in Allara before creating Virtue.
“I don’t think it’s necessarily controversial to say that a majority of investors are still men. And from both personal and professional experience, I think more men than not might be uncomfortable with having certain conversations about women’s health that they can’t directly relate to.” However, despite this, Doolan noted that he sees far fewer pitches for men’s health than he does for women’s health.
Kerry Rupp, general partner of True Wealth Ventures, agreed that women’s health companies face additional challenges, and it partially goes back to the fact that women weren’t included in medical research until relatively recently. In addition, some of these companies struggle with advertising due to the censorship of sexual health information for women. True Wealth Ventures invests in women-led businesses.
“I think investors think, ‘Oh, that’s a mess, we don’t want to get into it.’ So not only do they not necessarily understand or want to talk about the women’s health issue, but then they’re also like, ‘Oh, it’s harder for you to actually execute on your customer acquisition strategy,’” Rupp said.
Despite these challenges, Rupp has invested in a women’s sexual health company called Rosy, which offers wellness plans for issues like body image, sexual pain, sexual trauma and other areas. She chose to invest in Rosy because it was able to show proof of positive outcomes and that its services are evidence-based.
Another investor, while noting that women’s health companies have an uphill battle with the lack of women in the VC world, added that there is another challenge that these startups face that doesn’t have to do with gender. While these types of companies may be successful in a direct-to-consumer business model, it may be harder for them to succeed in a B2B model, according to Ellen Herlacher, partner at LRVHealth.
“When you look at a payer, who is probably unlikely to take their eye off the ball from oncology, cardiology, MSK — the things that are very clear cost drivers — and say there are incremental cost savings that you could provide by covering this pelvic floor offering, it’s just never going to rise to the priority because it doesn’t represent a high enough medical cost,” Herlacher said.
“On the employer side, there’s just a good amount of fatigue,” she continued. “Employers have done a great job of moving the boulder up the hill when it comes to things like fertility, when it comes to things like access to a variety of services that accompany maternity. But I think it’s going to be hard to convince an employer that they’re going to impact culture or medical costs if they cover at-home STI testing.”
Lead with the data
What do investors want from the startups pitching to them? Proof and data that their company can make a difference, several investors said.
For Doolan, this is what Evvy and Allara provided.
“We want to go beyond just the narrative that might catch some emotional strings,” he said. “How does that translate to more of a measurable understanding?”
Rupp echoed Doolan’s comments. Showing information like how many people the company could impact and what the financial opportunity is “could be the thing that excites investors,” she said.
And when it comes to addressing uncomfortable, stigmatized topics, Herlacher said it’s important to not shy away.
“Take it head on,” she said. “Own the fact that it’s uncomfortable. Take on the responsibility of educating the people around the room and then take on the responsibility of explaining why there’s a big business here.”
Photo: asnidamarwani, Getty Images
