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Welcome to the 2nd Issue of the Evidence Edit!

This month I’m talking about health benefits of sex and orgasm as well as interesting evidence-based sex technology. I’ll be covering products and the studies I can find related to their efficacy.

At the end of January, the New York Times interviewed Dr. Rebecca Rubin, Urologist and Sexual Health Specialist. She stated:

*Slow clap* I’ve often mentioned to others in the digital health world that in order to make access to FemTech and MedTech more equitable, we need better reimbursement of consumer devices that have proven their clinical value. Then maybe doctors can start prescribing vibrators (which are proven to help with a number of health needs! Read on…)

Let’s start with some statistics on why a healthy sex life is part of being a healthy human.

If you didn't know…there are Surprising Health Benefits of Orgasm. TL:DR: Sex, however you do it, is an important part of human health.

• ​A study of over 700 men and women perceive sex as leading to better sleep quality.​
• While migraine sufferers generally don’t want to have sex during a headache, there is some evidence it might reduce the pain (but it’s not great evidence…yet.)
• ​Orgasms release oxytocin – a feel good hormone which boosts your mood.
• Anxiety and depression scores were significantly lower in subjects sexually active during Covid-19 lockdown.
• According to Penn Medicine, sex is great for cardiac health. ​

Vibrators are normal (And useful!)

A 2009 nationally (US) representative study found that 53% of respondents had used a vibrator and that “Vibrator use among women is common, associated with health-promoting behaviors and positive sexual function, and rarely associated with side effects.” Flash forward to the present and vibrator use is being reported by 69 percent of women ages 18-60 in the US, while 54 percent of men report having used a vibrator. These stats aren’t just for hetero people, almost 50% of gay and bisexual men also report using vibrators.

Vibrator usage is common for both personal satisfaction and partner sex. One study indicated that 21-30% of women climax solely from unassisted vaginal penetration but 51-60% of women orgasm from assisted intercourse, demonstrating that vibrators are a helpful tool in getting to an orgasm in partnered hetero sex. Not in a relationship? Most women report orgasm from self pleasure and benefit from using a vibrator.

A 500 person study of women with chronic anorgasmia (no orgasms for at least 12 years) were treated with group therapy and clitoral vibrators, and the results show that “465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women.” WOW.

​A 2023 systematic review examining the literature around the effect of vibrator use on sexual function, pelvic floor function, and chronic unexplained vulvar pain indicated:

• Vibrators decreased the time to orgasm and facilitated multiple orgasms.
• Intravaginal vibratory stimulation improved pelvic floor muscle strength and reduced incontinence.​
• 83% of women who participated in a study using a vibrator to reduce chronic vulvar pain said they were both satisfied with the treatment and found it acceptable.

I think we can summarize that people across age brackets, sexual preferences, and relationship status benefit from vibrators as means to a happy and productive sex life!

Interesting Sexy FemTech

We’ve established that sex is good for you, but let’s be honest, not everyone is having good sex. Good news! There are some interesting technology tools out there to help.

​THE LIONESS​

Vibrators synced to apps aren’t new – there are many on the market that enable remote control of pleasure devices, but vibrators measuring orgasm are unique. Enter: Lioness.

According to a study by Lioness to confirm that its product could detect orgasm, “Lioness created a “smart vibrator” that detects the force of pelvic floor contractions in two sensors at either side of the instrument that collect continuous pressure (in grams force), temperature, accelerometer, and gyroscope measurements at a sampling rate of 12 Hz. It connects by Bluetooth to a secure internet server from which women can download their pelvic floor output during periods of self-stimulation.” (source)

The Lioness smart vibrator can be helpful from both a personal knowledge standpoint, but what’s even more interesting to me is the Lioness Sexual Research Platform. Women can donate their data or opt in to studies. Being able to contribute data to science from the comfort of a bed versus being in a sterile office with your butt on crunchy paper sounds to me like it *might* lead to better data collecting. Maybe Lioness can run another study comparing orgasms reached in the doctor’s office versus at home to validate my hypothesis.

I found one article giving the side eye to Lioness for being phallocentric and unfeminist…but I have to wonder if the design itself is related to the ability to collect data? I didn’t have time to reach out to Lioness directly asking this question but I plan to in the near future.

You may be thinking…ok this sounds interesting…but does it work? This editorialist seems to think so. She noted that it was, “Just delightful. 11/10 would recommend.”(Full article is NSFW.)
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​Lioness is supposed to have a big reveal on Valentine’s Day, so check out their website! ​

Final thoughts: A peer-reviewed article indicates that as a product, Lioness is effective at measuring female orgasm and differentiating between three types of orgasms. I couldn’t find studies that used Lioness and the platform data to study the intersection of sex and other women’s health issues, nor could I find additional female sexuality studies using Lioness beyond the initial “does it work” study, but I think this is promising technology and I hope to see more articles in the future via the Research Platform. If you are curious about your own orgasms, treat yourself.

​CORAL INTIMACY APP ​

Coral is a mobile app that includes courses, quizzes and guided exercises for individuals and couples to improve their sex life. According to their website, all of the content is contributed by medical experts in the field of OB-GYN, psychology, and sex therapy. Two big names popped out at me. Emily Nagoski is absolutely famous for her book Come As You Are, and I’ve heard her interviewed on numerous podcasts as well as featured on a Netflix show. Dr. Ian Kerner, author of She Comes First, has been called the Sherlock Holmes of the bedroom. Snagging these two researchers definitely adds to the street cred of the app in my opinion. This review by a woman who tried Coral indicated that if you have a working knowledge of sexuality you might not get as much out of the app as a newbie, but that she still found value in the product and it helped her and her husband communicate better about sex after 10 years together.

I couldn’t find any peer reviewed articles on Coral’s efficacy, just one article mentioning it as an example of an app focused on female pleasure as a component of wellness. The Coral website is also pretty slim as far as content goes, and the closest it comes to evidence of efficacy is user testimonials.

Final thoughts: I appreciate the effort to get a star-studded and respected advisory board to develop the app content, but the jury is still out on quantitative data supporting Coral’s use to address female sexual dysfunction or increased desire. If you are interested in learning about sexuality, I think you can trust the content within the app.

​ROSY​

Founded by Dr. Lyndsey Harper, Rosy states on their website right up front that the mobile app was developed by doctors and psychologists. I love to see it. Within the app, you can develop sexual wellness plans based upon a quiz taken upon sign up. There is curated erotica that can be filtered by spiciness level and topic. According to the site, Rosy erotica readers reported improvement in not only sexual desire, but also arousal, lubrication, and orgasm. There’s also a free community to connect with others anonymously, and a subscription gains you access to coaches that can address your own personal questions and needs.

What I appreciate about Rosy is their commitment to evidence-based content (I’ve seen Dr. Lyndsey Harper speak to this on multiple occasions.) Additionally, they are studying how the app improves women’s sex lives, and presented in 2020 that over the course of 30 days, study participants that took the Female Sexual Function Index upon opening the app and 30 days later, reported increased desire, lubrication, and orgasm. I followed up with Dr. Harper and the team at Rosy are continuing to study outcomes from the app and how to make it better for users.

Final thoughts: Rosy has a strong clinical staff and the app was created by Dr. Harper because of the struggles she experienced finding quality resources for patients in her own medical practice. Initial studies show benefits to women and I’d love to see the website bulked up a bit more with the results of their studies over time for both consumers and medical providers.

* The code WELLMADE can be used for a FREE 1-Month Rosy Silver Membership. It can be redeemed at this link: https://meetrosy.com/promo?code=WELLMADE​

​EMJOY​

Emjoy is a mobile app, with three main offerings: audio stories, wellbeing content (related to things like body acceptance), and tracking towards your goals. (In the post-Roe era, the idea of sexual activity tracking makes me a bit nervous for potentially nefarious usage.) The Emjoy app tauts science-backed content on their website, but isn’t very transparent in what they mean. What are the sources of this information? (Honestly I’d like to see more info on this across the board of health apps.) The website lists contributing experts, but with vague titles and no bios. I took a random sample of the listed experts to see what I can find via Google and they seem to be more on the soft side of evidence. Mindfulness experts, self-proclaimed coaches, and relationship counselors.

Final thoughts: Despite being mentioned in a few papers as an example of a sexual wellness app, this seems like the most loosey- goosey of the bunch. If you are interested primarily in audio content, check out Dipsea as an alternative.

In Conclusion:

Like other areas of digital health and FemTech, sexual health technology is still working to establish a strong evidence base. However, there are clearly companies that are making an effort in the space. I can’t wait to see what comes out of the Lioness Sexual Research Platform. I keep considering whether evidence-based content is enough or if we need scientific studies to prove efficacy among women’s health apps. A randomized control trial would move a product into the realm of digital therapeutic – the gold standard all around and the most likely for reimbursement by insurance companies.

In a world where customer acquisition is a top metric by VCs, investors need to accept and encourage spending on research which will open up an entirely new customer segment: healthcare providers recommending products to their patients (a road that Rosy is clearly on.) I’ll beat the drum one more time that evidence-based health technology is a key component to equitable access to digital health and the future holy grail of insurance coverage.

There are other companies in my women’s health technology intelligence database that weren’t covered today. I plan to write a full peer reviewed article this year to add to the cannon on sexual health technology.

Thanks for reading The Evidence Edit! I hope you learned something new. I’d love to hear your feedback! Feel free to reply to this email, forward to your friends, and share on social media. ​
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​Until next month–

Katie D. McMillan, MPH

NB: I started researching FemTech while I was at Duke, then crowdfunded the work the Spring of 2022, and most recently have partnered with MDisrupt to build a searchable digital health intelligence database.

Conversation Starter:

I found this quote from Research from Cedars Sinai Medical Center, published in 2022:

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You are reading The Evidence Edit: A monthly newsletter on science + women’s Health + technology written by Katie D. McMillan, MPH

I spend 10+ hours researching and writing The Evidence Edit. This is a free resource because I believe we need more transparency around women’s health innovation and less junk science. If you’d like to show gratitude for the work, consider leaving a tip. ​

Thanks to UNC for featuring this work: UNC researchers review FemTech offerings: Which ones are backed by science?

Well Made Health works with early to mid-stage digital health companies, providing research, content marketing, and product strategy. Learn more here. ​
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