By Bertrand Beauté

Men have an entire arsenal of pharmaceutical drugs at their disposal to treat sexual dysfunction. But women have practically nothing. "It’s as if there’s a double standard," said professor Carole Clair, co-head of the Medicine and Gender department at Unisanté in Lausanne. "Erectile dysfunction due to age is considered a pathology for men, whereas for women, the drop in libido after menopause is seen as normal." For women, it’s not seen as an illness but just a part of ageing. Why is there such a difference? "Medicine was invented by men, for men," said professor Carole Clair. "There is a lot less interest in female pathologies, such as endometriosis, menopause issues and some chronic conditions, than there is for male pathologies."

One symbol of this disinterest in female medicine is Pozzi forceps, often nicknamed the "butcher’s hook". Invented in the 19^th century, this instrument is used to seize the cervix during gynaecological procedures such as an IUD insertion. It has not evolved at all since it was invented, despite the pain it causes. This is not surprising, given that only 4% of funds dedicated to R&D in the healthcare sector specifically target women’s health, a ccording to UK big data platform FemTech Analytics.

Indeed, for years, women have been systematically excluded from medical research: researchers believed that hormonal fluctuations in women could distort the results and it wasn’t ethical to include women in studies due to risk of pregnancy. "Young white men were considered the norm, and medical knowledge based on that population was then extrapolated to women," said Clair. But this methodological bias led to a problem: "Medicines and treatments are overall safer and more effective for men than for women," said the specialist. A study published in 2018 in the journal JAMA Oncology demonstrated that chemotherapies had more side effects for women than for men. This phenomenon has been seen in many other treatments. To change the status quo: "Including women in all phases of research is therefore necessary to increase the safety of treatments," said Clair.

"Medicines and treatments are overall more effective for men than for women"

Carole Clair, co-head of the Medicine and Gender department at Unisanté

To this point, things are starting to change. Shaking up the masculine focus, startups are currently making waves in the healthcare industry with one goal: a focus exclusively on women’s health. Among them, Vaud-based startup Aspivix is developing a painless ventouse to replace Pozzi forceps, Zurich startup Ava created a smart fertility bracelet and Muvon Therapeutics, a spin-off from the University of Zurich, is developing a treatment for urinary incontinence. These are just a few examples. According to FemTech Analytics, more than 1,300 companies around the world are now focused on women’s health. This new industry is called femtech, short for ‘female technology’.

First appearing in 2016, this neologism includes all solutions that meet women’s health needs, including pharmaceutical companies, medtech and technology companies.

"The Food and Drug Administration (FDA) did not lift its recommendation to exclude women in clinical trials until 1993," said Maria Velissaris, founder and director of SteelSky Ventures, a New York investment fund specialising in women’s health. "This several-decades’ delay compared to research on men has made women’s health a new industry that is just beginning, with significant unexploited potential."

And it’s not just in terms of gynaecology or fertility problems. Zurich startup CorDiFio, for example, uses artificial intelligence to better diagnose heart conditions in women. This is very important: "When a woman has a cardiac emergency, she is much more likely to be in a life-threatening condition than a man would be," said Carole Clair. of Unisanté "Improving treatment for women is therefore a vital public health concern, including for pathologies that affect both sexes."

"Femtech is a very large and diversified market," said Marwan ­Elfitesse, head of startup programmes at Station F, a Parisian startup incubator by Xavier Niel. "It includes solutions having to do with periods, fertility, pregnancy, maternity, sexual health, menopause, and also women’s health in general."

Partly thanks to support from global stars such as actress Gwyneth Paltrow, this growing industry has become more visible in recent years. "Even just three years ago, no one was talking about femtech," said Maria Velissaris. "Now, the New York Times and the Wall Street Journal cover this industry."

As proof of this increasing attention, several femtechs have gone public with wild success in recent years. Swiss biotech Obseva, which develops a treatment for endometriosis, joined the Nasdaq in 2017, and US-based Sera Prognostics, which sells a test for predispositions for premature birth, has been listed since July 2021. Other startups have been acquired by pharma giants. In August 2020, for example, Bayer paid $425 million to acquire UK company Kandy Therapeutics, which specialises in treating menopause symptoms.

The industry can also boast significant expected growth: according to the latest report from FemTech Analytics published in December 2021, the global femtech market is expected to be worth $75.1 billion in 2025 compared to $45.5 billion in 2021, which is an average annual increase of 13.3% over the period.

But these excellent outlooks miss the bigger picture. "Despite the explosive growth, the sector and its entrepreneurs remain underfinanced and neglected." said Maria Velissaris of SteelSky Ventures. Indeed, while femtechs focus on women’s health in all capacities, subjects such as contraception, fertility, pregnancy and maternity take up most of the capital, to the detriment of other sectors such as menopause, mental health and sexual well-being.

"It’s not every day where a niche market affects half of all people on the planet!"

Marwan Elfitesse, head of startup programmes at Station F

Among the publicly listed companies, those active in contraception, fertility, pregnancy and maternity make up 77% of the total capitalisation of femtechs, according to FemTech Analytics. "The other femtech segments do not have the same visibility at all and are not recognised in the same way by investors," said Elfitesse. Why not? Since most investors are men, they struggle to see the business opportunity of femtechs that are active in sectors other than fertility (as this also concerns men), and even more so because mental biases push them to provide more support to male entrepreneurs than to female entrepreneurs. "The majority of femtech founders are women and we know that female founders historically struggle to access institutional capital," said Velissaris. In 2020, in all industries combined, companies created by female founders only received 2% of capital invested in startups financed by venture capital in the United States. And there are only 12% of women leaders in US venture capital funds."

As a result, many investors believe that femtechs are a niche market. "But it’s not every day where a niche market affects half of all people on the planet!" said Elfitesse. In order to encourage contact between investors and companies, several startup incubators dedicated to femtechs were created in recent years, such as FemTechLab in London, Station F in Paris and Tech4Eva at the École polytechnique Fédérale de Lausanne.

"The creation of accelerators, and the success of venture capitalists in recent months, show that the industry is promising. It creates a virtuous circle and grows interest from investors," said Velissaris. "2021 was the first year where investments in femtech surpassed $1 billion and we predict that the industry will exceed this number in 2022 as institutional investors take more of an interest. They are starting to understand that investing in femtechs results in better health for women, but also positive returns for investors." Marwan Elfitesse shares this optimism, saying "Femtechs are a very good investment, because they address an enormous market and remain – for the time being – very under-market."

Covid: women more affected by vaccination

Between January and December 2021, nearly 11,000 instances of undesirable side effects linked to the coronavirus vaccine were reported to Swissmedic. In 64% of cases, these instances were from women. "Women have more side effects after the Covid‑19 vaccine than men. This trend was also observed in Canada, the United Kingdom and the United States, for example," said Swissmedic. One of the reasons could be that women’s immune systems seem to be stronger. Women have a tendency to produce more antibodies but also develop allergic reactions after a vaccination.

Since women’s metabolism and physiology are different from men’s, the side effects are also different. Side effects were reported regarding the menstrual cycle. Some patients observed a shorter cycle after the vaccine, whereas others had heavier and more painful periods. "The vaccine doses are unique, regardless of our sex, biology, or size," said Carole Clair, co-head of the Medicine and Gender department at Unisanté. We have cause to conduct research to see if women could be equally as protected with a smaller dose of the vaccine."