Telehealth Is Now Tackling Sexual and Reproductive Health
In what feels like a natural progression from the primary-care and mental-health telemedicine options that have sprung up in the past few years, new sexual- and reproductive-health platforms are popping up or taking off now, as we’re all becoming more comfortable with virtual care and matters of sexual health simultaneously. “You can address most other elements of your physical and mental health with telehealth, so we thought, why not sexual health, too?” says Leslie Busick, founder and CEO of Pique, an online sexual health-care platform that launched in May and is currently focused on solving the unique sex challenges of menopause. “I think people are starting to recognize the importance of sexual health as part of your overall health and well-being.”
That shift has been a long time coming: If the sex-positive movement of 2019 made it okay to talk about having good sex, and the pandemic led many to further explore their sexuality, then in the current iteration of mainstream society’s sexual awakening, we can anticipate more room for conversations about even stickier sex subjects—namely, sexual dysfunction (think: issues with libido, arousal, or orgasm) and reproductive-health issues. But until recently, there’s been a dearth of accessible venues for getting information and treatment across these areas, in large part due to stigma, confusion, and a lacking health infrastructure.
How traditional health environments have failed to tackle sexual health
Particularly for folks with vulvas, longstanding gender bias in the medical system has de-prioritized sexual wellness to the point of restricting or obscuring treatment—while research dollars have flown steadily to support pleasure for penis-havers (just take the widely available Viagra and Cialis).
“In my experience as a gynecologist, I always wanted to recommend sexual-health resources to my patients, but it was really hard to find and vet them, and it felt like a really fragmented conversation, since there are several factors that can influence sexual health,” says gynecologist Lyndsey Harper, MD, who launched Rosy in 2019 as an online sexual health-care platform in order to bring together resources from different providers who work with sexual dysfunction, including pelvic-floor physical therapists, trauma-informed sex therapists, OB/GYNs, and more.
“In medical school, I don’t think there was a single lecture where we talked about the female orgasm. The result is a lot of health-care deserts in the space of sexual health.” —urologist Ashley Winter, MD
The gap that Dr. Harper was looking to fill is largely a product of our “typical care paradigm,” says urologist Ashley Winter, MD, Chief Medical Officer at Pique. “When you think of an ordinary OB/GYN experience, it really just covers reproductive care and cancer screening…Thinking back to medical school, I don’t think there was a single lecture where we talked about the clitoris or the female orgasm. The result is a lot of health-care deserts in the space of sexual health.”
For evidence, consider the fact that only 40 percent of gynecologists ask patients about sexual concerns, and only 29 percent ask about sexual satisfaction, according to a national survey conducted in 2012. And whether that’s for lack of knowledge, time, or trying is besides the point: Overwhelmingly, there isn’t a typical doctor’s-office visit where these kinds of concerns are regularly addressed by the provider.
Theoretically, that puts the onus of bringing up the topic on the patient, who may not know how to do so in the first place, due to the “abysmal state of sex education in this country,” says Carine Carmy, who co-founded Origin, a virtual and in-person pelvic-floor physical therapy provider, in 2020. “Many folks don’t know the difference between their vulva and vagina, or even that they have a pelvic floor.”
And for the people who do know how to speak about a sexual- or reproductive-health issue and feel confident doing so, the result may be just as bleak. “When I mentioned to my gynecologist that I was suffering with low libido, she brushed it off as no big deal, which was disheartening,” says Busick, “especially because when I started digging into it, I realized that so many people have questions about this stuff or are dealing with the same thing.”
In fact, the often-cited figure from a 2000 study is 43 percent—that is, 43 percent of people with vulvas are purportedly dealing with sexual dysfunction. But a survey from 2013 pins it as high as 63 percent, and that’s assuming that all the respondents who were experiencing sexual-health symptoms felt comfortable enough answering in the affirmative.
For many folks (of any sexual anatomy), the stigma surrounding sex issues can make them feel awkward to address in the cold, clinical, and rushed environment of traditional health care. That extends not only to things like low desire or difficulty achieving orgasm but also sexually transmitted diseases and other sexual-health conditions. “For so long, sexual health and reproductive health, together, have been some of the most taboo areas within health care, which can lead some people to avoid seeking treatment for these conditions altogether,” says Ahmad Bani, CEO of sexual and reproductive telehealth provider Wisp, which launched in 2018 and has seen rapid growth in the past year. “And that only threatens to make matters worse.”
3 ways sexual and reproductive telehealth options expand the landscape of care
1. Providing intel and solutions for all angles of sexual health
Because so much of the barrier to entry for sexual health is tied to a lack of understanding, online platforms are uniquely positioned to educate and inform. After all, it’s tough to know where to even start, or which provider to seek out—urologist, gynecologist, pelvic-floor therapist, sex therapist, the list goes on—if you don’t know the various facets and foundations of sexual health. That’s why both sexual and reproductive telehealth services can serve a major purpose by simply guiding folks in the right direction.
With Pique and Origin, that looks like a virtual intake call with a nurse practitioner or pelvic-floor physical therapist, respectively, who can answer questions, point you toward a diagnosis or better understanding of your sexual situation, and create a plan of care. On Pique, that could mean virtual sessions with an AASECT-certified sex therapist and a prescription for vaginal estrogen (more on that below). And with Origin, that could involve guided pelvic-floor self-assessment and exercise sessions.
On Rosy, you first complete an online quiz about your sexual and health history, after which you’re provided with a package of educational resources tied to your answers, including recorded content from relevant physicians and therapists and a library of arousal-boosting erotica divided into different “hotness” levels. From there, you could also decide whether to pursue group or individual sex coaching on the platform (with a gold or platinum membership, respectively). “I see Rosy as an intervention to help connect the dots for people because many have no idea where to turn in situations of low desire or arousal, or even what a sex therapist or pelvic-floor therapist even is,” says Dr. Harper.
“Fully understanding your own anatomy is the first step on any healing journey.” —Carine Carmy, Origin co-founder and CEO
Easy access to such specialists is also a major perk, as “most Americans, even if they knew they needed or wanted to see a sex therapist, for example, wouldn’t know how to find a credentialed one in their community,” says Dr. Winter. And the benefit of being able to learn from someone like a sex therapist or pelvic-floor physical therapist—either directly via virtual sessions or indirectly through recorded or written content—cannot be understated. “Fully understanding your own anatomy is the first step on any healing journey,” says Carmy. “And I can share from my own experience with sexual dysfunction that it was a game-changer to healing my pain.”
2. Allowing for quick, easy access to testing and prescription treatments
Having to book an in-person appointment to receive a prescription or screening for a sexual-health condition not only reduces access and speed of care, but is mostly an unnecessary hassle. Both at-home testing and online prescriptions have largely proven their viability in other spheres of health, like mental health and dermatology. And platforms like Wisp and TBD Health (a Las Vegas sexual-health clinic which launched with at-home testing for sexually transmitted infections in early 2022) are showing that the same can be true for sexual health. To wit, the convenience of at-home care is of particular benefit in this realm.
“Because of the nature of sexual-health problems, there’s often a real sense of urgency to treat them right when they arise,” says Bani. “But given the shortage of primary-care providers in this country, it can be difficult to get an appointment right away, which pushes some folks to make an uncomfortable trip to the emergency room.” By contrast, after doing a short virtual assessment with a board-certified doctor on Wisp, you can get same-day treatment for all the most common conditions in the areas of sexual and reproductive health, from bacterial vaginosis to herpes to urinary tract infections.
The fact that most treatments for these types of conditions are pretty straightforward is why this approach works so seamlessly. (Though, if symptoms seem to point to a condition not indicated by any of the Wisp prescriptions, the provider can make a referral to a specialist.) The same premise underscores Pique’s online prescriptions for vaginal estrogen—which can help restore vaginal lubrication and prevent UTIs in menopause by rebalancing the vagina’s pH. Because this is generally a safe and effective treatment for vaginal dryness, atrophy, and painful sex in menopause, and at a low dose, comes with minimal side effects (notably, fewer than estrogen patches or pills), it can be similarly prescribed after an online consultation, says Dr. Winter.
The same ease extends to sexual-health testing in the case of TBD Health, which offers at-home screening kits for things like chlamydia and HPV in six states (and they’re currently working to add more). “This enables individuals to access health care on their own schedule, without worrying about things like childcare, taking time off work, or spending a long time trying to get into a doctor, all of which is key especially for folks who need or want to get screened for STIs multiple times a year,” says Stephanie Estey, cofounder and co-CEO of TBD Health. Once you complete the test, you ship it to the TBD lab, where the results are reviewed by a clinician and released in a secure portal. And if you were to test positive? You can get a telemedicine consult and the appropriate prescription through the same platform.
3. Removing the stigma around seeking care and treatment
For many, the benefit of sexual and reproductive telehealth is not just about getting access to sex therapists or coaching or prescription treatments, or even getting it conveniently and quickly. The nature of virtual care also allows you to seek treatment for historically stigmatized conditions without putting yourself in a position where someone else could find out, like at a physical clinic.
“There’s a lot of built-in shame about having problems with sex, and when we access resources related to that, we might not want it to be in public,” says Dr. Harper. “So with having virtual care on your phone, you could be on Rosy or on Instagram, for example, as far as anyone else is concerned.”
In the same vein, being able to test for a condition like herpes in the comfort of home and receive a result in private can, for some, make the whole process less nerve-racking—and, in turn, allow them to more safely and confidently enjoy the sex life that they see fit. “The first time I went to the gynecologist, I was 24 and asked for an IUD. The doctor refused to give me one because she didn’t approve of the fact that I was dating actively and not in a long-term relationship,” says Daphne Chen, cofounder and co-CEO of TBD Health. “Stephanie and I built TBD so that no one would have to have a similar judgmental, dismissive experience.”