50: How Underfunded Is Women’s Health? The Numbers Surprised Me
The World's Tightest Community - A Podcast About Vulvodynia, Vaginismus & Women's Pelvic PainShow Notes
Is women's health actually underfunded - and compared with what? For episode 50, I'm going solo to dig into women's health research and funding. Drawing on my background in finance, I separate two questions that usually get blended together: are the conditions affecting women getting enough research attention, and when research does happen, does it give women the answers they need? We look at what the McKinsey 5% figure really measures, NIH funding for women's vs men's health, male-biased animal and cell research, sex as a biological variable, women in clinical trials, disease burden, private investment, and what I'd like to see change. If you've heard the statistics a hundred times and want to get more precise about where the gaps really are, this one is for you. :) Sponsors: The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support the podcast: https://tinyurl.com/mtxnzhsd Chapters: 00:00:00 Episode 50 Solo, Research and Funding 00:01:22 PubMed, Erectile Dysfunction, Vulvodynia 00:02:25 If Men Had Periods, Reductionism 00:03:41 Getting Precise, Finance Background 00:04:56 Quantifying Underfunding, Data Limits 00:05:29 Two Questions: Attention, Useful Answers 00:07:21 McKinsey 5% Figure, Pipeline vs Funding 00:08:21 Defining Women's Health, Three Groups 00:09:52 Cardiovascular Disease, Sex Differences 00:10:45 Heart Attack Symptoms, Risk Calculators 00:13:16 What Counts as Women's Health Research 00:14:24 McKinsey Revisited, Oncology, 1% 00:15:05 Drug Pipeline vs Total Research Funding 00:16:49 NIH Funding, Women's vs Men's Health 00:17:56 NIH Classification, What It Means 00:19:27 Three Questions on Underfunding 00:21:11 Whose Biology, Male Animals and Cells 00:22:17 2014 Study, 80% Male Animals 00:23:59 Invisible Women, Male as Default 00:24:46 1993 Inclusion Legislation, NIH 00:25:54 Sex as a Biological Variable, 2016 00:26:59 2026 Study: 61% Both Sexes, 44% Analyzed 00:28:11 Averages Hiding Sex Differences 00:29:19 Trial Representation, Cardio, Psychiatry 00:30:45 Representation vs Meaningful Analysis 00:31:51 Zolpidem, Ambien, 2013 FDA Dose Change 00:33:51 Missed Benefits, Male-Only Research 00:34:51 Maternal Health Gaps, Intersectionality 00:36:45 Disease Burden, DALYs, Vulvodynia 00:38:35 NIH Funding vs Disease Burden, 2021 00:40:11 Breast Cancer, Funding Outlier 00:41:32 Private Investment, WEF, BCG Report 00:43:27 Commercial Opportunity, Investor Logic 00:45:01 Pelvic Pain, Underdiagnosis, Investment 00:46:16 What Needs to Change, Long-Term Research 00:47:13 Analyzing Sex Differences 00:47:57 Women in Research Leadership, Authorship 00:49:33 Tool: Questions for Funding News 00:50:05 Takeaways, Nuance in Women's Health 00:51:41 Call for Researchers, Thank You
More from The World's Tightest Community - A Podcast About Vulvodynia, Vaginismus & Women's Pelvic Pain
Why do the tissue changes we link to menopause also show up in women on the pill, breastfeeding, or in their twenties? I'm joined by Dr. Sameena Rahman, OB-GYN and sexual medicine specialist, founder of the GSM Collective in Chicago and ISSWSH scientific committee chair. We unpack genitourinary syndrome of menopause (GSM), why the same hormonal mechanism drives vestibulodynia in younger women on birth control or spironolactone, and how vaginal estrogen, vaginal DHEA and estradiol-testosterone cream are used. We also cover the removed boxed warning on estrogen, why under 5% of women are offered a treatment linked to fewer UTIs and deaths, blood work, mast cells, and medical gaslighting. For anyone told their hormones are "normal" when something clearly isn't - and the clinicians who treat them. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Dr. Sameena Rahman: Instagram: @gynogirl Website: thegsmcollective.com Book: "Brown Girls' Disease”? coming out October 6 Resources: isswsh.org, prosayla.com Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support the podcast: https://tinyurl.com/mtxnzhsd Timestamps 00:00:00 Introduction, Dr. Sameena Rahman 00:01:28 GSM, Terminology 00:03:12 Vaginal pH, Thinning Tissue 00:04:37 Recurrent UTIs, Sepsis 00:05:12 Vestibule, Pain with Sex 00:05:52 Lactation, Cancer, Fertility 00:06:36 Birth Control, Androgens 00:07:24 GSM in Younger Women 00:08:37 Dryness Misread, Q-Tip Test 00:09:40 GSM Prevalence, Prevention 00:11:15 Chronic Progressive Condition 00:11:48 Nerve Proliferation, Mast Cells 00:14:31 Birth Control and Vestibular Pain 00:15:43 Anti-Androgen Pills, Spironolactone 00:17:13 Drospirenone, Yaz, Yasmin 00:18:13 Tool: Flagging Side Effects 00:18:50 Genetic Testing, Pelvic Floor PT 00:20:09 Weighing the Pill 00:20:54 Local Hormone Therapy 00:22:22 Vaginal DHEA, Formulations 00:23:01 UTI Risk Reduction 00:23:47 Tool: Coming Off the Pill, IUD 00:24:22 Estradiol-Testosterone Cream 00:25:36 Choosing Treatment, DHEA vs Estrogen 00:27:26 Breast Cancer Fears, WHI 00:28:10 Boxed Warning Removed 00:29:16 No Systemic Increase 00:30:01 Undertreatment, UTI and Sepsis Data 00:32:11 Tool: Treating After a First UTI 00:32:48 AUA Guidelines, Premenopausal Gap 00:33:42 ISSWSH Vestibulodynia Algorithm 00:35:04 Tool: Reactions, Switching Products 00:37:26 Blood Work, SHBG, Testosterone 00:40:26 Mast Cell Staining, Pain as Trauma 00:41:26 Pelvic Floor Botox 00:42:19 Medical Gaslighting, Team Care 00:43:55 Reasons for Hope, New Treatments 00:45:46 Hypermobility, Connected Conditions 00:46:43 Book: Brown Girls' Disease? 00:49:42 Where to Find Dr. Rahman
In this episode, I sit down with Dr. Christina Enzmann, a board-certified OB-GYN and functional medicine practitioner specializing in vulvovaginal disorders, to explore how gut health and the vaginal microbiome connect to persistent vulvar and pelvic pain. We cover the everyday products that disrupt the vaginal barrier, why pain can persist after repeated yeast and BV treatments, how endometriosis and gut inflammation may be linked, which tests are worth doing, and when probiotics can backfire. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Connect with Dr. Christina Enzmann: drchristinaenzmann.com Connect with Mathilde: IG: @theworldstightestcommunity theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support: https://tinyurl.com/mtxnzhsd Chapters: 00:00:00 Introduction 00:02:19 Functional Medicine 00:04:12 "Test Don't Guess" 00:05:10 Gut Health, Vaginal Barrier 00:07:22 Endometriosis, IBS, Bladder Pain 00:08:07 Pelvic Organ Connection 00:08:51 Siloed Care 00:10:10 Gut vs Vaginal Microbiome 00:11:06 Lactobacilli, Acidity 00:12:41 Estrogen, Glycogen 00:13:13 Postmenopausal Microbiome 00:14:06 BV Misdiagnosis 00:14:51 Change Without Symptoms 00:16:40 Tool: Vaginal Estrogen 00:19:23 Microbiome Disruptors 00:20:37 Antibiotics, Yeast Overgrowth 00:21:32 Gut-Vagina Axis, Inflammation 00:22:22 Blood Sugar, Immunity 00:23:09 Insulin Resistance 00:24:29 Panty Liners, Hygiene Products 00:25:52 Soap, Scrubbing 00:27:43 Tool: Quitting Soap for BV 00:28:37 Monistat, Hypersensitivity 00:29:55 Product Marketing 00:30:49 Lube Osmolality, WHO Report 00:32:09 Tool: Silicone vs Water-Based 00:33:09 Bacterial Vaginosis 00:34:47 Yeast Infections 00:35:43 BV Risks: STIs, Preterm Labor 00:36:27 Endometriosis Microbiome 00:37:11 Sponsor: Origin 00:39:26 Sponsor: The Pelvic People 00:42:15 Persistent Pain After Infection 00:43:02 Barrier Breakdown 00:44:21 Repeated Treatments 00:45:48 Formulations, Aloe Vera 00:47:08 Tool: Gabapentin, Fewer Topicals 00:48:09 Vestibulodynia, Q-Tip Test 00:49:14 Central vs Peripheral 00:49:54 Chemical Sensitization 00:50:53 Endometriosis, PCOS Overlap 00:52:40 Endometriosis Pain vs Lesions 00:53:37 Estrogen, Beta-Glucuronidase 00:55:30 Histamine, Trigger Foods 00:56:27 Tool: Whole-Body Workup 00:57:13 NAATs, Vaginal Cultures 00:59:24 Antifungal Resistance 01:00:47 Vaginal, Gut Testing 01:02:22 Food Sensitivities, Flaxseed 01:04:09 Immune Complexes 01:04:55 At-Home Microbiome Tests 01:06:40 Snapshot Results 01:08:30 Tool: Actionable Tests Only 01:10:41 "Shotgun" Vaginal Tests 01:11:30 Probiotic Downsides 01:12:42 Oral Probiotics 01:13:55 Vaginal Probiotics, Topicals 01:15:23 Cost, Access, Online Care 01:18:08 Tool: Ditching Products 01:18:39 Vulvar Wipes, Barrier Creams 01:19:46 Where to Find Dr. Enzmann 01:20:35 Wrap-Up, Key Takeaways
In this solo episode I catch you up on my own treatment. I talk you through what pelvic floor Botox was actually like at a specialist vulvar clinic in Oslo, why my new physio's homework for the whole summer was to lovingly touch my thighs, and what that taught me about anticipating pain and turning even rest into something to achieve. I also explain the TTNS machine I'm using, which puts electrodes on my ankle to target pelvic pain. We've now passed 10,000 listeners a month, so I share what I'd love to build next for this community, and how I got past the embarrassment of talking about vulvar pain in public :) JOIN US THIS WEDNESDAY Body, Desire and Pleasure: an online writing evening with Sara Sturek of Writing Shamelessly. Wednesday 23 September, 7-8:30pm US Central. No writing experience needed. Sign up: https://docs.google.com/forms/d/1r3R0TnRjuc9NbUPTjrsCCW1DI2B2nL0Q7EjdPD1W7gk/edit?ts=6aa2ab9f
You had a baby, and months later something still hurts. Sex, sitting, the scar. And you've been told this is just what happens now.
Stephanie Berman has lived with vulvar pain since 2011. She spent eleven years being dismissed, misdiagnosed and told to be patient, and the referral that finally moved her forward came from an Instagram DM she sent to Dr. Corey Babb. She is also the founder of the Aziza Project, a nonprofit that pays for women in pelvic pain to physically get to the care they need.