The Juicy Cuts: Tania Boler of Elvie on Pelvic Floor Health, Tech, and Education

Picture it: Way back in the halcyon days of 2018. I was researching an article on how the private sector had stepped up to fill in the gaps that education, government, medicine, and research communities have failed us. Specifically the human anatomy and sexual function gap. (Oh, I know, har har har, gaps.) The article was never published, alas, as the editorial direction of the publication changed while I was writing. But I did manage to interview a lot of amazing women who were (and still are) innovating technology that educates. Here’s the chat I had with Tania Boler, founder and CEO of Elvie, where she’s created products that enhance people’s reproductive & sexual lives. Products like the Elvie Trainer, a device that pairs with an app to help folks with vaginas train their pelvic floors. And as a growing line of breast pumps and adjacent products that offer better design and functionality.

Hi, Tania. Thanks so much for talking to me! As research, I started looking into your background and I discovered that you’d already been working in women’s health for a while before you started the company.
tania boler, founder and ceo of elvie

Well, sex education! That’s what I’m excited about! It’s my favorite subject. I mean, when I worked at the UN, I was basically working in HIV prevention and mainly we were talking about sex. I helped build the first-ever UN curriculum about sexuality education. So, yeah, it’s absolutely a topic that I’m very passionate about and definitely is very much linked to our first product. So yeah, I’m very excited to talk to you.

Can you tell me a little bit about the work that you did with the UN and within the context of your larger career, what led you on the path toward developing Elvie technology?

I’ve always been really passionate about sexual reproductive health. And, as I’m afraid I’m a bit of a contrarian, to tackle taboo issues and when it comes to sexuality and our womanhood. There’s so much that we don’t talk about. When I was working in Africa and with HIV, what I realized was the main problem with the HIV crisis was that we were not able to talk openly about sex. So, that’s when I started working on sex education.

I wrote a book about the politics of prevention, all about our inability to talk about sex education. I tried to change the system, I guess, from within. My dream had always been to work in the UN, and I thought I could go and help change policy around this area. But I realized quite quickly that when you’re working in government, they’re inherently so conservative.

And actually, even when I was working mostly with schools…There’s so many barriers to teaching about sex in schools, particularly the formal power dynamics between a teacher and the student. So I started shifting away more from formal education and was working more on women’s health.

And then, going on seven years ago, having thought myself sort of an expert on sexual reproductive health—I had a PhD, I’d written several books—I learned about my pelvic floor. And I literally knew nothing about my pelvic floor, apart from some folks talking about doing your Kegel exercise. You know, people have the idea that it’s just something you do to squeeze your vagina. Is it something weird todo with sex? Is it for men’s pleasure? There’s kind of limited knowledge.

And I think particularly with vaginal health, it’s been one of the most taboo things to talk about, because it’s to do with womanhood. It has to do with motherhood. Pelvic floor health, most women don’t think about it until they have a baby. But it’s also to do with sex and sexuality. And in society, it’s completely impossible to talk about sexuality and motherhood at the same time. And so yes, and to be honest, because my background is in public health and education, I came to this initiated in education. So I thought, “We just need to go out and educate people around vaginal health and pelvic floor health.” I did look into that. But then I realized that there’s no point educating people, if there’s no solution. And really what was missing in this area was technology. And it was clear that there should be a simple solution. There was evidence, clinical trials showing that people had been trying biofeedback, and it worked.

tania boler, ceo and founder of elvie

So if you can just insert something into your vagina and exercise, you can see on the screen how you’re doing, and it helps you really connect with your body, understand how to exercise your pelvic floor muscles.

So, yeah, long story short, it was interesting, from education, where I went from rehashing this as a sex education, health education issue, but landed at the fact that what we really need to do is come up with a technology solution. I don’t know if I was even conscious of this, but what we managed to do by launching the innovation and technology, was start changing the conversation. We’re changing the way women think about their bodies. So you can change perceptions around your health and your body and sexuality through technology rather than through education. Of course, you need both.

I am so interested in the fact that you actually started from a top-down approach and then went in the complete opposite direction. That’s amazing.

I’m so proud of what we’ve done. What we’ve done through creating new technology is, I know I’ve had much bigger impact on behavior change and education and changing norms through launching Elvie than I ever did working with governments on various policies. Because when you use Elvie, I mean, I’m sure you know how it works, but when you insert it in your vagina, it’s a part of your body.

You know, people, women in many societies, they don’t even, they’re not very familiar with their vagina. They didn’t even examine themselves, they don’t know what it looks like. They just sort of ignore it, or if we do think about it, it’s on the increasing-aesthetics side. You know, you wax and all that. And it’s more about making it look good, but not the actual vaginal health.

When you use the Elvie Trainer, suddenly women have a very strong emotional reaction. They might cry, they might laugh. Because you’re suddenly, actually seeing your vagina in action, on a screen, and it’s a very emotive thing.

Do you think that giving the process a visual component is important to the education process?

Yeah. Elvie Trainer is an educational tool. What I realized, was that women showed an education gap. Women have been told to exercise the muscle, but they don’t know where it is, they don’t know how to exercise it, and they never, never see any improvement. Like if you’re training someone for a marathon and you never tell them how fast they’re running, how much they’re improving, they’re going to lose motivation. So this [technology] allows women to be in touch with their bodies and then see for themselves, to educate themselves around that part of the body, and make themselves personal goals.

I love the idea that there’s an external app, an external stimulus that can teach you about the internal parts of your body. It’s sort of a beautiful.

Get to know your body. I mean that’s our motto. If you didn’t know your body, if you’re not attuned to your body, then how can you be aware of health problems there might be, or even live your sexual life to its fullest, as well?

You had said earlier that you were seeing better results of getting people in tune with their bodies this way then then through education. What sort of metrics are you using? I mean, how do you know that?

Well, from a personal point of view, it’s the number of women calling us with this issue every day, who have had health problems for many years and didn’t know that a solution existed. But I think it’s also been in terms of how the technology is changing the conversation. When we started, we were a bit hesitant around mentioning vaginas, but it is such a huge shift with this feminist movement that women are being more open about their bodies. With Elvie, through the technology, we’re able to sort of be part of the whole vagina movement. Let’s be proud that we have vaginas. Let’s embrace them and let’s talk about them. That’s been kind of on a more general level. In terms of the metrics, we have data now. We have the largest global data set on dates on pelvic floor exercises.

Elvie now has more than a million workouts. So we’re constantly tracking the anonymized data to help keep improving the product, but we’re also checking with women to get the results they want. Most women will see a difference within two weeks. And that’s kind of what it’s all about. I mean, women do come to it for different reasons, and you just find out what their objectives are. Women, particularly women in their twenties who didn’t have kids, they just want to have better sex, and that’s was fine with us. But the women who’ve just had a baby, maybe it’s just about wellness, making sure your body gets strong again. And you have older women who maybe have had pelvic floor problems for a while. And then you’d have objective measures, like reduction in stress-induced urinary incontinence or prolapse, which again, is something that nobody talks about in women.

Yeah, that’s a good point. It does seem like issues around maternity tend to be highly medicalized and hush-hush. Like the miracle of childbirth is supposed to be exactly that—a miracle. And if it’s not, don’t tell us about it.

Yeah, nobody talks about it. And it’s one of the only parts of health where we’re not applying science and innovation. Obviously, it’s up to the woman how she wants to give birth. I mean, obviously, we believe women should be given full options and choice and support. [But often], specifically, they focus so much on the baby, not on you as a woman. And then women are so obsessed now with wanting to get a six-pack, and focusing on abdominal re-strengthening muscles, but actually if you didn’t focus on your pelvic floor first, that can cause you long-term damage. Even not just sex problems, but back problems and a whole host of other issues.

Oh. Wow. I had never heard that before. Education!

It’s crazy! Before I had kids, I thought I knew a lot about sexual health, and then suddenly, all these changes are happening to your body, and nobody’s talking to you about it. Like you said, it’s highly medicalized. Even the pelvic floor health has been, like, wait until you have a bladder problem. And in many societies it’s just like, “Oh well it’s just a normal part of having children. As you know, you’re not going to be able to jump on a trampoline without peeing yourself.” And I’m saying, “That’s not acceptable.”

So, the education people have about pelvic floor issues is very low, but do you know where the medical research in that area is? Is there a gap between what our medical research and what people know? Or do we just not know much?

For pelvic floor health, the main industry [is] the adult sanitary pad market, which is more than $10 billion a year. That’s for women who have ended up having bladder problems, having to use sanitary pads. So there’s actually a lot of medical research that tends to be focusing more on the treatment side.

But what shocked me was, when Elvie put out our product, because our product comes in two sizes—because women are all different shapes and sizes and that’s completely normal—we wanted to make sure it was comfortable. So obviously, I went through all academic studies in existence on vaginal anatomy, and there’s only about four studies, which were very out of date. The vagina as a part of the anatomy is incredibly under-researched. And that’s crazy when you know, fifty percent of the population has a vagina.

And much of the other 50 percent of the population wants something to do with the vagina on a regular basis.

Exactly! And so, on the bladder side, bladder problems, yeah. On the medicalized side there’s a lot of research, but when it comes to vaginal or lifestyle issues? When it comes to sexual dysfunction for women, there’s very little research.

Pelvic-floor-related issues are not just that your pelvic floor might be too weak. Often you would have hypertonicity, which means the muscles are too tense, which causes a lot of pain and discomfort during sex. And it’s actually quite easy to treat, through trigger-point therapy. But often, there’s a complete education gap. Women are feeling guilty and unable to talk about the problems they might be having during sex.

Right? The other day, someone told me that her OB-gyn friend had just called her to say, “You’re never going to believe what I just learned! Did you know that the clitoris is actually a large internal structure and not just the small external part?” It makes me wonder how we got this far with so much that we still don’t know.

You’re absolutely right. There’s so much about the vagina which we just don’t know. It needs more research. It needs more attention, but to get that going, you need to have the conversations. And hopefully with Elvie, that’s part of what we’ve been able to help spearhead. And that obviously is happening more widely, on social [media], as women are embracing it more.

I’m an optimist. I think things are changing at a really fast rate. And the same way breasts maybe were very taboo 50 years ago, breast cancer was highly stigmatized. I think that vaginal health is still taboo, but I think that’s changing quickly.

Speaking of breasts, you’ve also developed a breast pump. Did that come from a similar perspective of wanting to fill a gap that you saw in the marketplace?
Tania Boler, CEO and founder of Elvie

Yeah. So that’s less to do with sex, but more to do with the first product. My passion was always helping new moms, especially as that’s kind of where I came from, on my personal journey. As I said, with new moms, there’s so much focus on the baby, and there’s been no attention for the woman. The breast pump is a really important, empowering product for women. That’s kind of why we care about it, because it gives women the freedom to be the woman they want to be and the mother they want to be. You might want to give breast milk to your child, and you might want to get back to work or have some time off. It’s a really important product. And it’s one of those products that’s just been so shockingly badly designed, it’s just horrible technology. It’s painful, it’s noisy, it’s big. You’re tethered to a wall. So it was just sort of crying out for disruption, and again, it’s intimate technology.

I think we’re the experts in intimate technology now. Vaginas and breasts are quite complicated parts of the anatomy to design for.

Is there any way in which you are sharing the knowledge that you’ve gleaned from Elvie about people’s experiences?

Oh yeah. We’re publishing and presenting at academic conferences all the time to help further knowledge in this area. We’re aware we’ve got a global database which has never existed in terms of vaginal health.

I just love the idea that you came from the background that you did. You went into sex tech and now you’re actually feeding information back into the medical establishment through Elvie. It’s a beautiful circular path.

I mean, education is so important. You have to have that piece. You have to change the conversation. Otherwise, you’re not going to get anywhere.

Learn more about Elvie at their website!

Read more of the Juicy Cuts from this article that never happened! I also spoke to Liz Klinger of Lioness, researcher Lynn Comella, and professor Debby Herbenick. There are others waiting in the wings, so check back for more!

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