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The Promise of Hormone-Free Tech: Can it Bring Better Sex?

Having your period can be rough, but not having it is no fun either: Whether caused by hormonal changes associated with giving birth, breastfeeding, perimenopause and menopause, reproductive cancers, taking the pill, or even just garden-variety stress, many women find themselves with (incredibly common) problems that no one ever told them about. “Dryness, painful or not-as-good sex, and low libido are all side effects of normal hormonal fluctuations, and as many as ¼ of women who give birth vaginally get stress incontinence at some point in their lives—but women generally suffer those conditions in silence,” says Dr. Elizabeth Eden, president-elect of the New York Gynecological Society, an OB-GYN in private practice in New York, and gynecologist and consultant for VSPOT Medi-Spa.

“People don’t talk about it,” agrees Rebecca Nelken, a uro-gynecologist in private practice in Beverly Hills and a leading expert in female pelvic medicine and reconstructive surgery, as well as assistant clinical professor of OB-GYN at USC. Part of the reason for the silence may reflect the lack of effective treatments: Kegels make a difference in many symptoms, but need to be done consistently—and forever. “Patient compliance with kegels is difficult,” says Eden. (See our story on the app/device Elvie, which makes them a bit more fun.) And Kegels alone are often no match for stress incontinence or serious dryness. Addyi, a drug for low desire, came out last year, helps some women, but does come with side effects.

“Dryness, painful or not-as-good sex, and low libido are all side effects of normal hormonal fluctuations.”

Supplementary hormones—in creams, gels, pills, patches, etc.—help with dryness and painful sex, but systemic versions don’t always treat vaginal atrophy, the thinning of the vaginal tissues caused by hormonal shifts and aging, and topical creams can be messy. All come with some uncertainty about health risks, and are not an option for women who’ve had reproductive cancers. In fact, Tamoxifin, which many breast cancer survivors take long-term, can actually cause dryness and painful sex—which survivors cannot use hormones to treat. “These women effectively have their sex lives taken away,” says Eden.

And surgery—for stress incontinence, it’s the gold standard in treatment—is surgery, with risks. “It’s a 30-minute outpatient procedure, but it’s 6 weeks of no heavy lifting, no intercourse, and anesthesia,” says Nelken.

But new technologies—some of them borrowed from dermatologist treatments originally developed for the face—now offer drug- and surgery-free solutions. Besides the fact that they don’t hurt; involve no hormones, drugs, or surgery; and make sex possible for many people for whom it’s become too painful, and better for those who don’t enjoy it as much as they could, the very existence of these new devices is throwing light onto common yet unspoken problems experienced by women all over the world.

“The very existence of these new devices is throwing light onto common yet unspoken problems experienced by women all over the world.”

Much of the tech is so new that there are fewer scientific studies completed than most gynecologists would like—but the anecdotal evidence is so strong and the risks are so few that many are already using it with their day-to-day patients. “The studies out of other countries are impressive, though we need more validation—over time there’ll be more data. But my patients are doing great,” says Eden, who performs the FemiLift CO2 fractional laser treatment, a technology originally used in dermatology to rejuvenate skin. “The potential uses are huge.”

“This technology represents an amazing non-surgical option for pelvic-floor dysfunction of many sorts,” says Nelken, about the ThermiVa radiofrequency treatments—also rooted in dermatologic therapies—she’s been using in her practice. “There’s not a lot of published hard scientific evidence yet, but the conditions they treat are so prevalent, the anecdotal evidence is strong—100% of my patients with vaginal atrophy have seen results, it’s been life-changing for them—and the beauty of radiofrequency is it’s so safe that there’s little risk. These are common problems with limited treatment options. It’s kind of amazing to see how excited women are when they hear about it.”

“After my girls were born I was shocked,” says Cindy Barshop, the founder of VSPOT, which partners with gynecologists to treat patients with the FemiLift CO2 fractional laser. “I couldn’t laugh or even sneeze without worry because of urinary leakage. Sex wasn’t as satisfying—in fact, sometimes it flat-out hurt.” Barshop drove several hours to try the Femilift treatment when she heard of its potential to treat her stress incontinence: “It was painless, and it was so simple—to be honest, I felt like there was no way it could actually work.”

“Libido is the target of a new wearable out of Silicon Valley: Fiera by Nuelle, something of a drug-free answer to Viagra, for women.”

Both fractional CO2 lasers (roughly similar to Fraxel treatments for the face) and radiofrequency (akin to Thermage treatments for the face) use heat to promote the growth of collagen and increase blood flow in the tissues of the vagina (which has no heat receptors and few pain receptors, hence the no-pain aspect). Downtime involves refraining from sex for three to four days—and little else. Researchers are still debating the relative effectiveness of each method, but most women report results after even the first treatment. “If you can make the vaginal tissue thicker, healthier, and more supple, you treat the incontinence, painful sex, and dryness,” says Eden. “Increased blood flow increases lubrication, which helps with everything, even libido and intensity of orgasm.”

Libido is the target of a new wearable out of Silicon Valley: Fiera by Nuelle, something of a drug-free answer to Viagra, for women. “Forty-three percent of women in the United States report having sexual problems,” says Dr. Leah Millheiser, chief scientific officer at Nuelle, a fellow in the American College of Obstetricians and Gynecologists and the International Society for the Study of Women’s Sexual Health. Just as with men, low libido can be caused by all manner of physical issues, but can also be the result of plain old boredom. “Novelty—just like it does for men—goes away,” says Milheiser. “My patients come in and they always say the same thing, almost like a disclaimer: ‘…But I love my partner…’ This is a drug-free solution.” The hands-free device, which is worn for 5 or 10 minutes to increase desire for up to several hours before sex (the number of hours it works for people varies) is not a vibrator and generally doesn’t result in orgasm; it enhances blood flow, which increases lubrication, and triggers arousal through neural pathways. Clinical trials back it up; more studies are underway.

“For so many years, there were all these white-haired men in VC meetings, listening to pitches about women’s health—and that’s begun to change, and the result is this explosion in tech and women’s health.”

“We see ourselves as supporting healthy relationships,” continues Milheiser, who, like Eden, sees some of this technological boom as a direct result of more women in tech. “For so many years, there were all these white-haired men in VC meetings, listening to pitches about women’s health—and that’s begun to change, and the result is this explosion in tech and women’s health.”

“It’s a feminist issue,” says Eden. “And there are finally more options for people.”

Like so many other aspects of women’s health, insurance doesn’t yet cover any of it: Fiera costs $250, a series of three FemiLift treatments approaches $3,000, ThermiVa treatments go for similar amounts. The laser and radiofrequency treatments need to be repeated every year or two (studies are still determining ideal timing, which differs from individual to individual); Fiera requires inexpensive refills every so often. The expense, for many, is worth it. “Intimacy seriously affects your sense of well-being,” points out Milheiser. For Barshop, having her own life transformed was one thing, but talking to happy patients represents another level: “When someone tells you how this technology has changed her everyday life, her relationships, her body image,” she says, “There’s nothing like it.”

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