Sex on Demand for Women — Saundra Pelletier

There’s this kind of pattern you can see sometimes, when you dig behind very successful projects, a lot of times there is some woman who is dead set on making it happen. And for a lot of them, she’s working behind the scenes and you don’t find out until you get real close, what’s really going on.

But occasionally you meet these women who are badass leaders that are so dogged that they’re going to make something happen by force of will. And I’m always honored to get to meet them. Today we get to spend some time with Saundra Pelletier, the CEO of Evofem Biosciences.

This is a super fascinating company that is dedicated to creating medical and healthcare products for women. You don’t find a lot of companies focused on that, which is sad because women are the ones who drive a lot of the healthcare decisions for their entire families. So I don’t understand why the market hasn’t picked up on that one.

I think you’re going to love Saundra. She’s created a product at her company called Phexxi. It is the first and only FDA approved, non-hormonal contraceptive gel for women. They can use it anytime on demand whenever they want. This is the kind of product that is really important to change the balance of power and determining who ends up procreating and when. We want that control to be in the hands of everyone, but in the past, a lot of the responsibility has landed on women and, they’ve been given, in some sense, relatively crude tools to do it. Most women in America at least are using a hormonal contraceptive, which has a lot of additional health side effects.

As Saundra will tell you, she developed late stage breast cancer. She survived through a double mastectomy but the doctors told her the only real reason that she probably had cancer, in the first this place was being on a hormonal birth control for 20 years. Lots of stories like that, that you probably know and have heard with your own friends and family.

So I think this is a very important project. This type of advancement in a technology that changes what humans can do,  when they can do it, who has the decision-making power is important. We have a lot of options here where I’m at, but when you look globally at what’s happening with contraception in other countries especially in the developing world, there’s a lot of social stigmas that affect what women can get away with when they’re trying to find contraceptive choices.

Giving them some options is paramount, not just because I would like to see population managed in a more thoughtful fashion. And hopefully create a few less humans that we don’t have a plan for, but also to give them the ability to choose when the time is right, who the right partner is, what they want to do,  and not have to subject themselves to the entire weight of society’s idea about what they should do with their lives. That’s important, I believe for humanity as a whole. And so I’m really excited about Phexxi getting some support.  Evofem Biosciences is publicly listed. So I certainly  don’t want to give anybody investment advice, but these are some folks who could really use some help. And if they can get enough support for this company, they’ll be able to take Phexxi around the world and that’s gonna make a big difference for a lot of people.

I hope that you guys love this very soulful conversation I got to have with Saundra, and I’m thrilled to be sharing her with you.

Pablos: What I’m really excited about here is that I think the things that matter in the world for humans to do is how we’re gonna evolve as a species. How we are going to keep going? How are we going to make it possible for more lives to exist? And but also for those lives to thrive in some sense, right? And when you look at what has worked so far in all of human history, it’s humans inventing a new technology, bringing it into the world, solving a problem at a bigger scale, and being able to advance the species. That’s really how we got where we are and we’re not done…we might be done. But we might also be able to effect our fate go forward. And so it is  super exciting to me because, one of the biggest problems in the world in some sense is that we went from millions of people on this planet just a couple hundred years ago to billions of people in the last 200 years. 7 billion in 200 years. And we’re making a lot of extra people. It’s not totally clear that we need them all, but I’m not going to tell you which people are extra. I just think that it might be smart for the species as a whole to figure out if we want to course correct on that a little bit and maybe in the future make a few less. And maybe less but better people would be a goal. But anyway so I know Evofem is…I don’t know if you are fixated on contraception. Is that the only thing guys trying to do or want to do, or is that just the main thing where you started?

Saundra: That’s the main thing where we started. I will say this to your comment. I just want to tell you this, that not only do I find your opening statement provocative but I actually believe that one of the biggest levers to poverty elimination, as we evolve is for women being able to choose when and if, and how often they have children. Access to contraception that they’ll use is a huge poverty eliminator. So yes, contraception is our beginning. But we also are in late stage phase three development for the prevention of chlamydia and the prevention of gonorrhea with the same product. Which by the way, the CDC has said they are on the rise for the sixth year in a row. And gonorrhea, it’s an epidemic because it’s antibiotic resistant. So we’re really leaning into innovation. And that’s why it’s so cool.

We’ll pick this all apart, but just to get the audience up to speed, why don’t you describe the product you have

Okay. So the company Evofem Biosciences, the whole platform is innovation for women. And that might sound like great words, but we are  delivering. So there has not been innovation in the contraceptive category in two decades. So our product is called Phexxi, not just because it rhymes with sexy which is a nice attribute. So here’s it works: it is a gel that comes in a pre-filled applicator. And I know your audience is hearing us, but I’m going to show you. A prescription is a box of 12 pre-filled applicators, and you put it in right before sex or up to an hour before sex. Now women have used tampons.

It’s scary to guys.

It might be scary to guys, although I will tell you…

But the guys will get to use it.

Not only that but guys really love the fact that this is very lubricating. So if any woman has vaginal dryness or pain with intercourse. But here’s how you see. So 5 mLs in each applicator.

Is that the whole dose?

That’s the whole dose.

Okay. So what I’m seeing is like a size of three or four jelly beans worth of gel.

Yep. And you can feel it.

And it just feels like Vaseline or something.

Yeah. And the gel is just so you know, it’s lactic acid, it’s citric acid and potassium bitartrate. And here’s how it works. So a normal vaginal pH is 3.5 to 4.5. When semen enters the pH goes to seven or eight, and a woman gets pregnant. When chlamydia enters and when gonorrhea enters, the pH goes up to seven or eight and a woman gets a sexually transmitted infection.

So what Phexxi does is it is acid buffering. So it helps the vagina just maintain normal vaginal pH inhospitable to semen and inhospitable to STIs.

It keeps it low.

Correct, so there you have Phexxi. So just like men who have had condoms forever. So for example, you could go out with a condom in your pocket and can have safe sex, but women have had to use a hormone every day, every week, every month, year after year. And the side effects…

Doesn’t it seem like a  lottery winner for the few women who take the pill and don’t have a problem?

Yeah. Without question. Want to hear something crazier? I say the worst trick played on women is that most hormones lower your libido. So they’re taking a drug every day that makes them not want to have sex. And they’re having side effects of headache and weight gain  and bleeding. And the one crazy part is that I talked to a lot of young women and they say to me, they were put on an antidepressant or  put on an anti-anxiety product. And then when someone really looked at their levels, they realized it was their hormonal birth control. And once they got off of this hormonal birth control, they felt normal again.

Yeah,  I’ve experienced that multiple times as a close observer.

And by the way, women don’t have sex every day, which you may, or may not have experienced. But like seriously for example, would you take something everyday if you were having side effects that you didn’t even need to save your life.

Well, men don’t have to do that, but I get your point. Okay cool. If I’m using this, can I also use lube?

Yes. You can use lube. You don’t have to use a condom. Like any contraceptive it says it can’t protect you against HIV. But the  wonderful thing about this product, are you ready for this? So in the United States, half of all pregnancies are unplanned. So I want you to imagine that the pill was introduced, even now. There’s 18 categories of contraception. They pill came out in 1960 and still all pregnancies are unplanned because 23 million women identify as saying, we are not going to use a hormone. We’ve tried pills, patches, IUDs . We are beyond hormones and they say stuff like, look, I don’t have hormones in my milk. I don’t have it in my meat. And I joke and say if chickens can be hormone free…come on! Why do women have to put up with hormones? So these women are saying like, I do yoga and Pilates and eat healthy and I care about my longevity. Why am I going to take a synthetic hormone? It doesn’t  make sense. But 23 million women is our target audience and those women are without question very engaged.

They are ready to go.

Yeah.

A of times these technologies, we take them for granted because  it’s what we’re used to now, but that’s just the best technology we had at the time. Fucking with your hormone cycle was the best technology we had at the time. Now we can do better. This is an example of being able to do better. And it seems remarkably straightforward. I’m looking the box it has the ingredients listed.

And by the way, I joke that like I could make this in my garage. I don’t, but it was originally developed by Rush University in Chicago. And when they developed it as a vehicle looking to do HIV prevention studies. So at the time in the early 2000s, there were a whole bunch of academic institutions who said, we need to find something for HIV prevention. But those studies are very challenging, like in South Africa with vulnerable populations. And so the majority of those failed. So what Rush University knew this product is considered to be something called an MPT, multipurpose prevention technology, which means has the capability  to continue to look at areas. So contraception, sexually transmitted infection, bacterial vaginosis. So they knew getting to market as a contraceptive would be the quickest way to get it approved by the FDA.

Okay. So we’re going to play all the legal disclaimers for this, but we’ve got this thing approved already as a contraceptive and it’s on the market. If you want to buy it, you can get it at a pharmacy or where?

Yes, you can go to https://phexxi.com/. We have a concierge, or you can go to your doctor, and they can give you a prescription, but if you go to our website, you can it mailed to you within 24 hours.

Okay, cool. And then the way it works is you install it using a tampon.

Yeah. And throw away the applicator.

Load it up and  throw it away.

Yep.

You’re good to go to have sex and get started within an hour.

Correct. Yes, as long as you put it in right before or within an hour.

What if you’re an all night operational?

Well, you got to use it again. Good for you by the way!

Okay. And then you’re currently working going back and doing trials for some other benefits that it already provides, but aren’t already approved and aren’t already proven and phase three trials, whatever. So that’s the work now?

That’s correct.

And then what hope to show with those is?

The prevention of chlamydia and the prevention of gonorrhea. And just to give you an indicator of how pervasive those are: in the U S there’s 1.8 million cases of chlamydia annually, and 600,000 of gonorrhea. And for the sixth year in a row, the CDC has said both of those are on the rise, is antibiotic resistant and literally there are no products approved for the prevention of either of these.

And look, I want to tell you why some people say to me, why the hell, hasn’t a bigger company with a lot more money done this? And I say, look, number one, it’s easier for them to just come out with a lower dose of hormones. So they’ve got something and they come out with new ways of giving you hormones. And by the way all it is that women aren’t stupid. Come on. They understand that it’s still a hormone. Just because it’s in a patch, doesn’t mean it’s not a hormone. Just because it’s in an IUD, doesn’t mean it’s not a hormone. So they come up with lower doses because it’s cheaper and quicker. But we have really taken the heart painful work of developing this new innovation. But the good thing is that the year, the FDA has given us a fast track review for chlamydia and gonorrhea. So we’ll have a six month review instead of a month review. So we’re excited about that. I have to be honest right now we are getting so much positive response from women on this product and that is phenomenal.

So let me ask a couple questions. If you get through all those trials, then the same product will be approved and could even be prescribed in some sense.

Yes.

If maybe if you don’t care about like I got fixed, but I am excited because I still get to use this product

Yes. And women who cannot get pregnant, they can still use it to prevent chlamydia gonorrhea.

Yeah. Or will be able to. And I think one of the things you mentioned that I think is important to point out is a barometer for whether something is worth developing, whether it’s a good idea or whether it’s gonna work or whether it’s any of those things is not whether or not existing medical technology companies who got around to working on it. That is not a good metric because, I think one of the things you alluded to earlier is the market, that they go after 23 million women in their minds probably isn’t enough. And maybe partly because it’s only 23 million and partly because it’s women. And so we’ve got to find a way to change those dynamics and show that this is a viable market. We’ve gotta be able to show that we can make products that are profitable in that market. And that seems like the more pioneering thing that you’re doing as a company.

I have to tell you, I love you for saying that. Because you gotta think about it this way, right? When you really evaluate, women are really the healthcare consumers for themselves, or their husbands, for their children, for their parents. When they get older. If you can get the right positive lever in a woman’s mind as a company, right? A woman trusts you and thinks you really care about innovation: 1) They are the consumers and 2) to your point, they’re half of the population, but 3) so little innovation is introduced to women. I have gotten a lot of investors will say to me, if it’s not immuno-oncology, diabetes is man and women, heart disease is man and women. This is just and women and we don’t know if we’re interested. And I say, listen, I want to remind you’re here because of a woman. And at the end of the day, when a woman’s quality of life is better because she feels better. She doesn’t feel a little crazy because she has a synthetic hormone in her body and when she doesn’t feel that she’s suffering every day. You know that whole adage, when mama’s happy, everybody’s happy? This product is so important because women now are more empowered than ever. And they’re saying to themselves: I need to care about my longevity. This isn’t just about having sex with my partner. I need to be around for my kids. Women really getting savvy on what are the silence sins that happen when I take something that I don’t even need everyday. Some girls start the pill when they’re 17 and they stop taking it when they’re 35.

Oh yeah. It’s it seems insane to me. So we haven’t really done better than—we’ve done slightly better than the pill—but basically haven’t done better than hormones. If you took hormone based contraceptives for women out of it, what’s the second most popular contraception like in America?

After hormones, I would say that condoms. Withdrawal is actually considered a method. I think it really is considered a method

Don’t try that at home, kids!

Yeah. But I would tell you this, there is one other non-hormonal product, but it’s a copper IUD. It has to be put in by a provider and taken out by provider. And it has pretty intense side effects of abdominal pain and bleeding.

I’m always shocked by that one too, because basically the idea with the copper IUD is that you’re living with a wire inside of you that’s supposed to scrape the wall of the uterine lining. And it’s just seems so primitive.

And you have to think about that, right? You know what I said the other day, I was talking to a friend of mine and she is into yoga, into meditation, and  she rides her Peloton every day. And then I said to her, and then you go and you pop your synthetic hormone. I said why don’t you swig whiskey and and smoke a pack of cigarettes tonight?  I’m like what the hell are you doing? You need to look at your total healthcare!

Whiskey and cigarettes!

You want to know what else is awesome? This doesn’t have systemic side effects. It doesn’t matter what your weight is. It doesn’t matter what are concomitant medications you are on. So I talked to ER doctors and they said when somebody comes in and something happens, if there’s an event they have to give a woman contraception, they know if they give her this they don’t have to worry because there’s no hormone.

Okay. This seems like dream product to sell. How hard could it be to talk people into buying and using this product? I feel like I could have girl scouts sell them in front of Safeway.

I’ll tell you this. You know wha? It’s a double-edged sword. So when we did our direct to consumer campaign called Get Phexxi on Valentine’s day when we launched the commercial, everything changed. Our units doubled. So the FDA requires to educate doctors first, before you can go out and talk to women. So women get this so intuitively, it’s amazing. I obviously love women, but I love women everything from the brain, backbone, and soul. It has been a challenge in two ways. When talking to some male doctors, some of them will say things like, these women don’t want to have something on demand or something they control, rather they should have an IUD.

And I say, look half of all women won’t use something that they can’t control. And if you take a moment to think about and counsel your patients and let them know that this is available you would be surprised. For example, even the simplest thing like  breastfeeding women, they don’t want hormones in their breast milk. And women are spacing their pregnancies. They don’t want to put up a hormone in their body, that they then have to  cleanse out of their body before they can get pregnant again. And I said there’s, by the way, there’s lots of young women between the ages of 18 to 25 that say, are you kidding? I don’t want my mother’s contraception. I don’t want something draconian. Why wouldn’t we just put this in our pocket and put this in our purse? But so the challenge has been to convince some providers who have old mindsets

Because they have to prescribe it?

Correct.

How much of the market do you expect to be provider’s suggesting it versus women going and asking for it?

I think it’s going to be 75% women asking for it and 25% of people prescribing it. No question. So women are driving the demand.

But even considering these old fogy doctors, it seems like you’ve got a compelling enough product and story should be able them in the dust and say okay thanks, anyway and move on to the next one. How hard could it be to find gynecologists or doctors who want to get behind it?

And now we just started to expand to say how about all the women? There’s 23 million women that won’t use hormones, but there’s also a lot of women that can’t cause they’re contra-indicated. So there’s a huge amount of women that they’ve had a cancer, many of them can never use a hormone again. So we’re starting to now talk to oncologists. I just did a keynote oncology conference for a group called Ncoda. And was remarkable to see that one of the really cool oncologist said to me, I got to tell you something. When I see male patients who have prostate cancer privately, the first thing they say to me is can I get an erection again? She said, I want you to imagine that if a woman came in and said can I have an orgasm again. So do you know what we would think? We’d say, what is wrong with her? You just saved her life. Why is she worried about it? But women are so worried about the disruption of their partnership. They want to go back to the life they had before. They want their intimacy. They don’t want to be left because they’re a cancer patient. They don’t want to deal with that stigma forever. You want to get better and beyond, move on, and have your life again. And so that’s what I found fascinating is that because this is lubricating, that after you have cancer often times you are on anti-estrogen products, which produced vaginal dryness pain with intercourse. And this lubricating product with no hormones, it’s perfection for these women.

Yeah. Okay. Good. All right, so can we go talk about where this can go? How long you’ve been on the market?

Just since May of last year.

Less than a year in and the job is to go sign up doctors. So do I need to tell my doctor about it or how does that work?

Yes. So a few things. We are educating doctors and we’re educating women. So we’re doing direct to consumer advertising with social media influencers. We have an incredible 20 social media influencers that cover all demographics. So they’re influencing—incredible and extraordinary. So social media influencers. We have ads on Hulu and Bravo and all the channels of our target audiences. We’re also doing the same journals and CME programs and sending it out to doctors. Women are either going on phexxi.com. We have a concierge program, which means that you click in and a provider interacts with you. They ask you all the right clinical questions and as long as you answer all the right questions, boom, you get it sent to your house.

They can can do a prescription.

Or they go into the doctor’s office and say that I want this non-hormonal option backseat and boom. And by  the way, they can go in and say you know what  I’m having sex more than 12 times a month. So their monthly prescription could be 24. It could be two bucks, depending.

Yeah. Oh, okay. Otherwise get on a drip and it comes in the mail every month.

Exactly.

Is there a shelf life to this stuff?

Three years.

Okay. Can I use it with toys?

Yes, definitely. Definitely. Definitely. And I would you our chief commercial officer—once we have world domination—he has big plans. He’s like we should do flavor.

Is there anything sitting between you and world domination, other than time? It sounds like this is a slam dunk, but what’s the hard part now?

Money.

You need more money to do more advertising? You can’t grow fast?

Yes, because what happens is direct to consumer advertising is super expensive. Oh my goodness. It’s super expensive. And so here’s our issue: I am convinced we have the right product. I am convinced that we have the right team and I’m convinced we have the right strategy. However—not that I’m on an island—but when you have an innovation that has no benchmark that has never been done before. When you’re doing uncharted territory. Sometimes people are like I’ll wait and see and once you’re successful, I’ll give you the money you need. Then how are we going to get successful f you don’t give us any money we need? The classic chicken and egg. Now we have had some amazing investors who know the category very well. They not only are believers, but they recognize that there’s a huge need for innovation within women’s health. It is almost like it’s like a joke. It is like me telling you I’m going to grow a third eye right now in the next five minutes. People don’t innovate in women’s health because to your point, it doesn’t impact both the male and the female population. So we have some great investors, but raising money is hard. It’s very hard. Admittedly, I don’t want to be a cry baby because I signed up for this and look, I was raised raised in the northernmost city in the US, in a place called Caribou, Maine. It is the Northern most city you can fly to from here.

I grew up in Anchorage, Alaska. So I don’t think you quite convinced me of that, but I’ll take the word for it.

There were probably should have been a military general. She was like, you can be sad for one day. You got 24 hours to feel sorry for yourself and that’s it. You know what I mean? Yeah. So she would be like suck it up buttercup, you know what I mean? Like she’s hardcore women, but my point in telling you that is that what has been a little bit hard is that there is a group of not long-term healthcare who understand pharmaceutical launches in the category and how it’s done. And look, it takes time to build demand. You gotta educate doctors. Then you gotta educate women. Then you’ve got to drive them in. Then they’ve got to get prescriptions. Then they got to get refills. And it’s not like we’re not going to get there. We’re already on our way, but it just takes a little bit of time. And there’s some impatience that exists with some of the retail investors.

Who invested in iPhone apps.

Yes!

That were dreamt up last week and were supposed to be worth a billion dollars this week.

When they get angry, they go on social media and the stuff that they say, it’s staggering to me. A t first, I was reprimanded by our counsel and our advisors said I should not engage. Because I said, who raised you? Like  why would you say this to another human being, for God’s sake? Like these things are violent and vile. And that, I will admit and it might make me sound naive but that that gobsmacked me and shocked me. And then I had to grow a pair. And I have strong backbone, but I needed to strengthen it a little more to just be like, you know what? I just gotta my head down because you know what the best revenge is? Results and success. So I’ve had to really shake that off. But it’s not always easy for me to shake it off.

Look I get it. It’s hard. This is a world where there’s just an epidemic of bad behavior on the internet and there’s no way to hide from it. And I think if you look, there are very few successful examples of engaging.

I couldn’t agree more.

You got to take the high road. It’s really sad that you have to have that experience and that you have to even have the same problem. I have the same problem if I read the comments, I’m like oh my God. But I think the right answer is you gotta stay focused on what you’re doing and what you’re good at and just ignore them. They’re not your audience. Ans hopefully your audiences and listening to them, anyway,

A great person from our audience and one of our biggest investors sent me this quote that said: don’t let success go to your head, but don’t let criticism go to your heart. Don’t let it go to your heart. Just shake it off. You’re doing the right thing. Keep your head down and keep showing progress.

Especially with investors, you have a real problem where because of the way that access to the public, because you have as a publicly traded company access to public markets. And we saw this with RobinHood and GameStop and all these kinds of things. You have a lot people in the market now who are trading. A lot of them are doing derivatives trading options. They don’t any comprehension whatsoever of you, your company, your product, anything at all. They’re just looking at technical data on the stock performance and trading on that. There’s a kind of abstract argument to be made that this is valuable for making sure that market stays efficient. But it’s not really something that is going to help your  company at all. And the flack from those people, it needs to be ignored and not just by you, but by everyone.

And I agree, and I think your point is right. It’s so important because when you look at the long-term opportunity to really deliver  shareholder return. I’ll  give you one example that, when you talked about being able to build a market, the interesting thing about this category is that if we were to just get two and a half percent, two and a half percent, that’s a billion dollar market opportunity. So for shareholders, it’s extraordinary, but they have to be patient. If you’re patient and wait. Like right now, we’re so undervalued that it’s a joke. But the point is that if you look at what our growth is now, and you look at that being compounded month after month, quarter after quarter, it’s amazing the impact that we can make for shareholders. But the tough thing is that you want people to listen to all that negative rhetoric because they get nervous.

I don’t know if this’ll help, but there’s no exceptions, right? It’s not just you. It’s everybody.

Yeah.

Every single company gets flack. Tesla gets more flack than  positive support from the same people. And there’s a noise there. It’s not signal. You gotta learn to ignore that.

I like that. I appreciate that sentiment.

If customers are saying this sucks for some reason or you heard investors were saying this sucks some for reason, that is signal, but it’s not signal, it is noise. And especially that those particular type of investors—they’re not really investors—they’re opportunistic folks who are trying to milk the market.

Yes. You’re right. It’s like a pump and dump kind of strategy. Women, I will tell you and our long-term health care investors know, not only do they know and recognize the opportunity for non-hormonal contraception, they also recognize the forthcoming to your point. We’re in this phase three study, we have top line data readout in the second quarter of next year. And we’re very excited about that. You know what I loved and I want to go back to is your comment that sometimes people make an investment. I’ve found that sometimes I meet , incredibly smart people, scientifically minded people, who have this great idea, but what they haven’t done is the market research.

Just because it’s a good idea doesn’t mean payers are going to cover it. It doesn’t mean you’re going to get investment for it. I meet some people and they have a great concept and they’ve gotten through phase one but they have no money. They don’t have way to differentiate themselves in the market. They don’t have any marketing opportunity to show investors. And here they are having spent all their money they had to get to this one point and they can’t get any further. And it’s heartbreaking. And one of the things we say is look just because there’s an unmet need, it doesn’t mean that the market’s going to bear it. It doesn’t mean that payers are going to cover it. And unfortunately, if you’re bringing a pharmaceutical product to market, you have to make sure that the insurers and payers are going cover it. Because if they’re not, you can’t get access.

And healthcare is so complex. 

So complex. Yes.

In my mind, any entrepreneur willing to work in healthcare or medical technology or about tech is a Saint just because you’re willing to try and innovate in a heavily regulated, very complex, big, old institutional environment. I couldn’t do it. I cheat and I go where there’s no regulation make a big mess and then set it on fire and bail out.

You are smart. Smarter than I. I have to tell you the truth, it is sometimes like a torture chamber. I’ll give you an example. And this isn’t Don’t Cry for Me Argentina.

There’s a reason to do it, which is that we’re trying to take your scar tissue and help the next generation of entrepreneurs and people who are trying to make a difference. Look, there’s very few people who can learn from their own mistakes. And then it’s like a subset of them who can learn from other people’s mistakes, but they’re the ones who are going get furthest and that’s who we’re trying to help out here. So, let’s get to the story. It’s not to cry for you. 

No. But what I meant was is when sometimes when I talk about our story, sometimes depending on the audience and in the right moment, one the reasons I’m so passionate is I spent my whole career on women’s health, literally. And my whole career when I say that, looking at the mindset, doing quantitative and qualitative market research, puberty through menopause. So when women do want to get pregnant, when they don’t want to get pregnant, when they want to space their pregnancies. And so really what are the levers? What do women really care about? But then a few years ago, I shockingly was diagnosed with late stage cancer. And when I was diagnosed, I had no family history. I had no genetic predisposition and I had a clean mammogram the year before. So for me, what was so shocking was that howI have all those positive factors and end up having aggressive late stage breast cancer and have to have a double mastectomy three weeks after my diagnosis start chemo. I had to my uterus removed and my ovaries removed.

Wait, they’re not in your breasts. How does that work?

Because they wanted me to get rid of everything that was going to increase estrogen. Everything because my cancer was estrogen positive breast cancer. So they said we need to kill a fly with a sledgehammer because your form of cancer is so aggressive. And then they said the only thing that we can really point to frankly, is that you have used hormonal birth control for 20 years.

Wow.

But here is where we talk about the regulation of this, right? I was on a podcast months and months ago. It was a very provocative broadcast. and they were talking about sexuality and intimacy and couples and it was a man and wife and I joked that chose to not have reconstruction so I look like Edward Scissorhands. So then I talked my own journey, just mine, but one of our competitors turned in the interview and said that I was suggesting that any woman who took any hormone was going to get cancer. And I was trying to scare women, it was outside of regulations, and I was doing off-label promotion and we got in trouble. And all I said was, this is my reality. This is my truth. It happened. It’s real. I didn’t have any of those factors and I ended up with cancer. Okay, that scares the hell out of you. And I said, look, if I had a daughter, which I don’t I have a son, but if I did, I would never let her use her mobile contraception. Not because we have a long family history because we didn’t, and I still ended up with cancer. That’s no joke. And so why this regulation is that any little thing you say in any little nuance and why they make us of those little disclaimers at the beginning is because the FDA wants to just make sure that it’s regulated but the one thing that I think is a bit of a bummer is my story.

Yeah, of course.

Right? It is.

That’s not FDA jurisdiction.

Right. Exactly.

I get it. You’re not the one who said that it was possibly hormonal birth control it caused the cancer.

Correct.

You had a medical professional who’s suggesting that possibility or at least the highest probability thing they know of. And yeah we don’t know for sure or when you were going to know for sure, but regardless it can’t be hard for any woman come up with a reason to not want to externally modify their hormonal balance all the time. There might be times you want to do it on purpose for a reason. But anyway, so look, you’re on the right track with the product. That’s awesome. How did you end up at Evofem? What were you doing?

Oh, wow. I be too verbose. At least I say sometimes what you choose chooses you. So I honestly mean this. I don’t know what Anchorage what was like, but where I grew up women really didn’t think they had a lot of choices and they really thought their choices was who they married or how many kids they had. My mother and all her friends, all felt like they were martyrs, that they have an opportunity to really be empowered. It wasn’t a thing yet. So I had all this in my subconscious. So when I left, my mother said to me, when you leave here you should not come back. And if you want me to visit you, you should send me a plane ticket. And we’d never been on a plane. We didn’t have enough money to go on a plane. I’m sitting at her like what? Honestly when I was growing up, she taught me no domestic skills. She said, you don’t need that. Cooking and cleaning is never going to get you out of here. Who cares about that? And I left and I thought wow. So my point is that my job out of college was in pharmaceuticals for a women’s healthcare company. And I started out as rep calling on  doctors. So the one great thing about being the CEO is not only do I know the drill. The reps that for us are pretty extraordinary humans. And they like me and I like them.

And one of the reasons they like me is that I know what the hell I’m talking about. I’m not somebody who is just a scientist who’s never been in the field. I lived and died by going out and talking about a product and how it worked. And I sold a variety of different products. Anyway, I did every job. I was a rep. I was a manager. I took over a region that was last in the country and turned it around. I was in marketing in the US and marketing internationally.

And so long story short, I spent most of my time running a global franchise. And that’s when I got my bug for what are we going to do for this vulnerable? Women that are outside of the United States. It forever changes you. So, I ran this franchise where we launched brands outside of the US where we went in to say what are the right products to launch in these markets because of socioeconomics and religious belief systems. And what changed me when I went, there was my ignorance. I had all of crazy ideas about what people wanted and thought there. And it was so insane. I literally was so foolish. I thought like they had pharmacies they could go to to get pads and tampons.

I’m only smart and Silicon valley everywhere else in the world. I’m completely idiotic. That’s what’s amazing about traveling and learning.

So I was so humbled and ashamed. I was humbled and ashamed and I thought, God I’m like silver spoon fed. I was still like oh my God I’m just so privileged. And it was extraordinary.

What part of the world had you gone to?

So most these experiences were in Kenya.

And South Africa, okay.

And I went to urban rural villages. I talked to the