Nurse Maureen‘s Health Show

You're Not Broken: eSense and the Science of Wanting Sex Again with Dr. Lori Brotto and CEO Elayne Wandler

• Maureen McGrath

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Maureen McGrath :

Sexual concerns, such as low desire, arousal issues, lubrication, sexual pain, difficulty experiencing orgasm, are valid and common concerns, yet too often dismissed or may go untreated. My guests on tonight's episode are committed to changing that by working on a platform called eSense that aims to offer accessible, evidence-based support for women's sexual health and well-being. Good evening. I am Maureen McGrath, registered nurse, nurse continence advisor, sexual health educator. Thank you so much for tuning in this evening. It's my pleasure to have you and it's also my pleasure to talk about this extraordinarily important subject for women and men, and they and the world. Basically, eSense is a digital health tool developed by leading experts in sexual health, delivering clinically proven therapies, cognitive behavioral therapy and mindfulness-based therapy through an interactive, self-guided online program. It's designed to help women address sexual concerns privately, at their own pace and without the barriers of traditional therapy.

Maureen McGrath :

Elaine Wandler is the CEO of eSense Health, a digital health company focused on delivering accessible, evidence-based care for women's sexual health. She has 25 years of leadership experience in the biotech industry, medtech, pharma, digital health. She's held senior roles at organizations including QLT, abbvie and AccelRx, to name a few. Her career has centered on commercialization strategy, advancing innovative health solutions. She's a passionate advocate for impact-driven innovation, which this certainly is, and she also mentors health startups and brings entrepreneurial insight from her time as the founder of a successful multi-location retail business.

Maureen McGrath :

I also wanted to invite somebody who could speak to the science the science that powers this platform and how user feedback is helping to shape its future. To that end, I invited my colleague and friend, dr Lori Brotto. Dr Lori Brotto is a registered psychologist professor in the Department of Obstetrics and Gynecology at the University of British Columbia. She's the executive director of the Women's Health Research Institute as well, and she's internationally recognized for her groundbreaking research on women's sexual health and well-being, and I, for one, have learned so much from her. She's pioneered the use of mindfulness-based therapies to address sexual concerns. Her work bridges clinical science and compassionate care, aiming to empower women through evidence-based approaches, and she's also the author of one of my favorite books Better Sex Through Mindfulness and is a passionate advocate for closing the gender gap in sexual health research and treatment. Good evening ladies. How are you both?

Elayne Wandler:

So great, Maureen Thanks for having us.

Maureen McGrath :

Well, thank you so much for coming on the podcast. I really appreciate it.

Dr. Lori Brotto:

Yeah, it's a pleasure to be here.

Maureen McGrath :

It's so great, and you know, two brilliant minds coming together collaborating with eSense, I want to talk about the technology and also about the science as well. Elayne eSense is on a mission to deliver accessible, evidence-based care for women's sexual health. Can you share the origin behind the story, behind the company, and what gap in care it aims to fill?

Elayne Wandler:

Absolutely so our founders, and we'll mention too we have another co-founder, dr Kyle Stevenson from Xavier University in Cincinnati. So, as you said in the introduction, Lori and Kyle they're both clinical psychologists and, frankly, world experts in sexual health. And Lori has been pioneering, you know, developing mindfulness-based therapy for female sexual dysfunction for many years. Kyle has been developing mindfulness-based therapy for female sexual dysfunction for many years. Kyle has been very focused on cognitive behavioral therapy and trauma. So both saw how effective these approaches were in clinical practice, but then also saw how few women were getting access. And, of course, we know there's a shortage of sex therapists, which means long, long wait lists, and you know that's only one of the barriers to women getting treatment. You know there's also the stigma, financial resources, geography, et cetera. So they decided to take this very effective therapy and approach and package into a digital online tool with the specific intention of bridging that access gap, so providing effective, evidence-based tools that are truly grounded in science.

Maureen McGrath :

Which is amazing, and digital health has exploded in recent years, but women's sexual health has often been left behind. I don't know if it's just still such a taboo subject, but how does eSense harness that technology to overcome the stigma and silence around these very important issues?

Dr. Lori Brotto:

Yeah, sexual health is still one of the most stigmatized areas in medicine, and it's even more invisible for women. So, if you think about it, male sexual dysfunction affects approximately 20% of men, and it's a multi-billion dollar industry and you'll see ads everywhere, right? Female sexual dysfunction affects approximately 40% of women, which is twice as many, and it's rarely talked about. So when you think about that, it's not really surprising. Only 20% of women grappling with sexual concerns ever received treatment. So eSense really leverages the strengths of what a digital platform can offer, which is to provide evidence-based care that's available on demand and entirely self-guided. So women don't have to worry about awkward conversations or waiting for referrals or traveling to clinics at set times. They don't even need to bring it up with their doctor if that's uncomfortable for them or go somewhere to get a referral. They can just sign up directly. So I think, by allowing women to engage privately and at their own pace, you know, I think that's going to help reduce the shame and discomfort that often stops people from seeking help in the first place.

Maureen McGrath :

And it's not available yet, but it's, shall I say, or dare I say it's, on the plateau of availability Very close. Yes, yes, so that's great, and so women can go to the website and sign up now in preparation for it.

Elayne Wandler:

They can. We'll be starting a commercial pilot within the next couple of months. So yeah, if they want to go ahead and sign up on the website, we'll inform them when it's closer to commercialization.

Maureen McGrath :

And what is the website actually where they should go if somebody should be tuning in right now and is extremely keen to deal with their sexual health concerns?

Elayne Wandler:

So it's a HTTP colon slash, slash, and then eSensehealth.

Maureen McGrath :

Excellent, thank you so much. Now, dr Brotto, as a clinical psychologist and researcher in sexual health, what drew you to collaborate with eSense, and how does it align with your academic and clinical work?

Dr. Lori Brotto:

Yeah, thanks so much, Maureen. I mean you know well, so well also as a sexual health expert yourself, that you know a lot of women are suffering. They're suffering in silence or suffering for many years, and for a lot of those women they simply never access evidence-based care at all. And because I had been doing research on mindfulness based interventions really for the last 22 years and showing, demonstrating in the science, that actually this skill is very, very effective, that the outcomes are retained In fact, women continue to improve, even up to a year after they stop practicing. But there was still a gap in implementation of taking these evidence-based strategies that we know work well when we test them in a research setting and actually exporting them into real life. And the same would apply for cognitive behavioral therapy. And that's why my partnership with Kyle Stevenson has been so wonderful with this, he, of course, being an expert in CBT for sexual dysfunction.

Dr. Lori Brotto:

And so in the early days we had the idea you know, if we put the information on a website, will they come, will they engage, will this be usable, will they find it satisfying? And then, slowly, with some research funding, we showed feasibility, usability. Then we got funding from the Canadian Institutes of Health Research to do a randomized clinical trial with a control group and indeed found that all of the effects were replicated when we tested it in a much larger sample of women with low desire. And then eSense was born. We gave it a name. We worked hand in hand with patient partners to do the illustrations that are embedded within eSense, to craft the stories, to talk about the interactivity and ensure that it was all designed in a way, with the user at the center. So I feel really proud of this work because it was constructed alongside, hand-in-hand with patients, and I think it really reflects what matters most when it comes to women's sexual health.

Maureen McGrath :

It's amazing and I love the puns. I have to say will they come and you've demonstrated that they will?

Maureen McGrath :

know many women struggle to talk about sexual concerns with their partners, with their doctors. Why is that, and how does eSense help create a safe, science-informed space where women feel heard and supported?

Dr. Lori Brotto:

Yeah, I mean this is the legacy of, shall we say, Freud, although I think it predated Freud. For so long women's health in general has been sort of shrouded in secrecy and mystery. And you know, for the longest time we used to think that all of women's ailments were due to hysteria or the wandering uterus that floated around the body and gave symptoms of chronic pain and anxiety and distress, etc. And then, alongside that, there's been a tremendous lag in research, in science actually studying women's health conditions.

Dr. Lori Brotto:

So this isn't specific to sexual health. We see it across all domains of women's health in general where, you know, really it's only been in the last 20 years that women have routinely been included in clinical trials. Even so, we've got a ways to go. But certainly sexual health has that sort of double, double whammy of taboo being a women's health topic. But also, you know, historically women's sexual concerns were dichotomized into either nymphomania, which is a terrible term that unfortunately still lingers today, which reflects women with too high desire, or again, thank you Freud they were labeled as frigid and there was absolutely no nuance in between to capture all of the kind of various ways that women might express and feel their sexual health. So we're changing that and I think again in the last 20 years certainly since Viagra was approved for men, we've seen a real interest in research in female sexual health and, alongside that, developing evidence-based treatment. So I think the tide's slowly turning and we're excited about that.

Maureen McGrath :

Which is great, and you know those two words that you use frigid and nymphomania. They denote such shame and you know, so many women have such shame around sexual health or their sexuality or their desires, and it's very difficult for them to talk about it. And I think, like menopause, perhaps a lot of physicians have not received sexual health education in medical school, and so I think we do need to, you know, provide the education so that they could speak to the female sexual response cycle with their patients and that patients won't think that they're talking about a sex toy, which is what one of my patients thought. So, you know, we really need to get the information out there and clarify it, and I think eSense is, you know, doing that with aplomb.

Dr. Lori Brotto:

, even beyond improving how they feel and their relationships and sex life, the program has the potential to provide skills that they can take and apply to other parts of their life. You know, and there's such a need among so many populations. And, lori, I don't know if you want to, if you can mention the comment from a cancer patient that you told me about earlier this week.

Dr. Lori Brotto:

Yeah, one of the adaptations we're doing, maureen, is for cancer survivors, and so we worked with a patient advisory group of gynecologic cancer survivors and they said that eSense and addressing their sexual health is a way for them to continue to feel alive, even in the midst of cancer treatment and even among those who maybe are at a very advanced stage of their cancer treatment. So recognizing and validating their sexual health and giving them tools to improve their sexual health really is a statement that this part of your life is such an important aspect of who you are, even in the face of a concurrent chronic health condition.

Maureen McGrath :

Wow, that gives me chills as well, because so often a woman that has a cancer diagnosis, you can see where she might be shamed if she's saying well, what about my sex life? Well, you have cancer, we're going to cure that. What are you thinking about sex for? But, as you say, it's very important and it is what keeps women alive.

Maureen McGrath :

The other thing I wanted to mention, Elaine, is that you mentioned about women don't have the language. That speaks to the lack of education, sex education, for so many women and you know barriers to this type of education. I find women in my clinical practice of all ages don't have the language and I, you know, I sort of in a not really in a joking way, but it just seems so, you know, unusual that I am finishing their sentences for them. You know you hear that about couples, you know we're so connected. We finish each other's sentences. Well, I'm finishing sentences for women in my clinical practice because they don't know how to describe what's going on. They don't know how to say this is the first time that they've ever had sex. They might be 45 years of age and so they're so uncomfortable talking about it. And I do think that eSense has the capacity to address that as well. I want to get to the current science about the most common sexual health issues that women face, Dr Brotto.

Maureen McGrath :

And how can digital tools like eSense help address them effectively?

Dr. Lori Brotto:

Yeah, so there have been quite a number of large population-based studies in thousands of women, across ages, across demographics, across ethnicities and across the studies. Again and again, low sexual desire continues to rise to the top. And now, of course, we're having a conversation about menopause finally and we were just talking about that when we were off air, about how great it is that, you know, there's an increase in kind of public discourse about menopause and we're also talking about low desire in the context of menopause, and so it does still continue to be the most prevalent of the sexual concerns. But not far behind, you know. Pain with sexual activity, pain with vaginal insertion, loss of pleasure, low desire, lack of satisfaction, difficulty getting aroused, those are all still pretty common.

Maureen McGrath :

And how about orgasms? A lot of women don't know if they've ever experienced an orgasm, and I mean, why is that?

Dr. Lori Brotto:

Yeah, yeah, great and really important that we differentiate orgasms from vaginal stimulation, from orgasms from clitoral stimulation. What we know is is that 80% of women in the large surveys do not reach orgasm or experience orgasm through purely vaginal insertion, that the vast majority who do experience orgasm is through clitoral stimulation. So this suggests that there's a real need for us around education. And so the woman who says, oh, I've never been able to reach orgasm, really important that we explore with her. Are you stimulating the clitoris? Are you using a vibrator? Are you using different tools? Are you focusing your mind on the pleasure? Are you staying in the present moment?

Dr. Lori Brotto:

And so we call that the person who's maybe never been able to reach orgasm because maybe they haven't familiarized themselves with what feels good in their body. We call that lifelong anorgasmia, and it's very treatable, and it's largely treatable through a combination of psychoeducation how the body works, how to ask for pleasure, combined with mindfulness skills teaching them to really stay focused on the body. And then, of course, there's the women who develop difficulties with orgasm, what we call secondary anorgasmia. That might be after a surgery, maybe after use of an antidepressant or another medication, maybe after some other significant life event or stressor, and in that situation it's a bit more challenging, because sometimes the factor that caused the onset of the anorgasmia has ended, but the person is still having difficulties there, and so we have slightly different approaches that we use, depending on our understanding of what the underlying causes are.

Maureen McGrath :

And I want to mention menopause. A lot of women have no difficulty experiencing orgasm until they reach perimenopause or menopause, or the time after menopause as well. Yeah, so this is why this education is just so critically important. You know, many women have experienced sexual abuse, rape, unwanted sexual advances. It impacts their sexual health, their sex lives, their desire. Is eSense an option for those women?

Dr. Lori Brotto:

Yeah, great question. Great question there, maureen.

Dr. Lori Brotto:

So in our randomized clinical trial we found that half of our participants, in addition to the low desire they endorsed a history of sexual assault.

Dr. Lori Brotto:

And so one of the things we were interested in looking at, of course, was did those women who had a history of sexual assault, did they not improve to the same degree as those without a sexual assault history in terms of improvements in desire and distress, and actually found no differences between those groups?

Dr. Lori Brotto:

So really reassuring that eSense and I think it's because you know, built within all of the modules we talk about the multitude of contributors to low desire, including history of sexual assault or PTSD or depression or anxiety, and so those women who have that history themselves they feel heard, they feel validated as they're working through eSense. It's not kind of a boutique program only for a tiny niche group of women. And then the second thing I wanted to point out that we found was actually, in addition to improvements in desire and stress and other facets of sexual health, we also found improvements in post-traumatic stress disorder symptoms after doing eSense, and so we've got a paper in the works right now on that. But again, really reassuring that for those women who have kind of that history of both the history of trauma and PTSD as well as low desire, that eSense is probably a really good fit for them.

Maureen McGrath :

Yeah, that is absolutely amazing. That's incredible. And again, the clinical trials are still ongoing. Is that correct?

Elayne Wandler:

Yeah, so the main clinical trial where we looked at in a well-powered large study against a control group, that's been done and it's published in Behavior Research and Therapy. And then the additional papers that we're working on right now are some of the papers looking at how does eSense work, so the underlying mechanisms, are there particular subgroups of women that do better in eSense compared to other women? So looking at predictors of improvement. And then, as I mentioned briefly, we have adaptations of eSense to cancer survivors, to trans-identified women, to neurodiverse women and to other subpopulations that we're continuing to do research with in the years ahead.

Maureen McGrath :

And are you still recruiting participants?

Dr. Lori Brotto:

We sure are, yep. So probably the best way to find us is through the website that Elaine mentioned, which is eSensehealth, and there's a single email at the bottom there and that can take you to some of the current studies we're recruiting for. So the large trial we're recruiting for right now is for gynecologic cancer survivors, so any type of gynecologic cancer endometrial, vaginal, cervical, etc. And that person has concurrent sexual health concerns. So that's the large trial we're recruiting for right now. But we're also recruiting for women with low desire who want to. There's an arm of eSense where we're testing whether augmenting it with an AI chatbot, so an opportunity to kind of get some validation and kind of ongoing check-ins with a chatbot. We're trying to see how well that works. So we've got another study that's evaluating that too.

Maureen McGrath :

Amazing, Dr. Brotto. You've come such a long way. I think my first education from you was on the mindfulness around a blueberry.

Dr. Lori Brotto:

Yes, it was.

Maureen McGrath :

Wow, you've come a long way. Yeah, by the way, by the way, maureen, that exercise is in eSense. That's awesome. Because that was so good, I'm using it 20 years later. You know, something we hear a lot about is women are complicated. Women's sexual health is complex. It's multifactorial. What are some of the biggest myths or misconceptions you wish more people understood about female sexuality?

Dr. Lori Brotto:

Yeah, I mean, I think that's one of them. Because women's sexuality is so complex, there's absolutely nothing that we can do to help women feel pleasure again, and it's a complete myth. I mean, we now have quite a number of studies proving that low sexual desire, or desire, is like any emotion it's something that emerges in response to a trigger. So if a person has low desire, we want to pay attention to well what are the facets that are happening, external to them, internal to them, that are not pulling out their sexual desire. So I think it's a really reassuring message that women's sexual desire is very flexible, that absolutely women can experience a rebound or a whole new experience of desire at any point in their life. That's a really big one.

Dr. Lori Brotto:

And then maybe another myth I'll tuck in, because it's really relevant to eSense, is that psychological methods don't work as well as medications do. And although we haven't directly compared eSense to a medication, we've compared the effect sizes. So in our study we can actually get a magnitude of just how powerful the improvements are compared to some of the published pharmaceutical trials of drug treatments for low desire, compared to some of the published pharmaceutical trials of drug treatments for low desire, and both the CBT arm and the mindfulness arm within eSense show effect sizes or a magnitude of effect that is much higher and quite impressive actually.

Maureen McGrath :

Oh, absolutely. There's very little effect with some of the medications, unfortunately for women, but hopefully that with eSense we're going to be able to change the outcomes for many women who present with sexual health concerns. Affordability and access, elaine, are major barriers for many women, and how does eSense ensure that its services will be both inclusive and equitable and affordable, especially for the underserved or rural populations? Affordable, especially for the?

Dr. Lori Brotto:

underserved or rural populations? Yeah, great question, because eSense was built really with accessibility in mind from day one, so that was really the intention. So the entire program is available online, which removes the geographic and other logistical barriers. In terms of price, we're not fully commercial yet, so I can't give you an exact price, but our goal is to make it accessible as broadly as we can, so it's definitely going to be priced significantly lower than traditional therapy. We're exploring future models like employee coverage or partnerships with public clinics to expand with, you know, diverse users in mind. There are fictional case studies throughout the program that represent women with different issues and cultural backgrounds and life experiences. And then, as Laurie mentioned earlier, we're developing adaptations for transgender women, cancer survivors, postpartum women, so really trying to not leave anybody out.

Maureen McGrath :

I am so excited for this platform to be launched. You have no idea, I think it's going to benefit so many of in their own time and have evidence-based solutions, provide them with information. I think it's fantastic. You know there is this cultural narrative around women's sexual health. Dr Brotto, how do you see eSense transforming not just access to care but the cultural narrative around women's sexual health, particularly in how we approach pleasure, which we never talk about, pain and also emotional connection? And I just want to add in there that I hear so many women will say I shut that door a long time ago. I, you know it's over for me. Sex is done, that's it, you know, and you explore the reasons and you know they're not necessarily reasons that don't have treatments, and so it's so sad because, as you say, it's what keeps us alive. But how can we alter that cultural narrative?

Dr. Lori Brotto:

Yeah, I mean ideally, in the long term, we would love to see, you know, a group of women together and one says to the other hey, have you heard of eSense?

Dr. Lori Brotto:

I tried it and it's great. And I mean that's kind of a long-term ideal. But I think, because it was delivered lockstep with patients and we heard their experiences and their voice and, as Elaine pointed out earlier, one of the things that many of them told us was, yes, it improved my desire and distress, which was the main issue, but it really improved so many other facets of my life and quality of life and how I see myself and my confidence, which then has a ripple effect on so many other domains of life. And and so that's what I'm also really excited about is that, yes, of course we, if we can address the very high rates of sexual dysfunction and low desire in women. But you know, women represent the largest increasing group in the workforce. Women are living longer. We spend 30 years in our postmenopausal state. We contribute so much to GDP and society, and so anything that we can do to help women live better, happier lives makes me really, really happy, and I think eSense has the opportunity to do that.

Maureen McGrath :

That is awesome, you know, yes, we, we're bigger and we're living longer, and damn it, we deserve a great sex life and a great life in terms of mood, self esteem, body image. You know all of relationships, connection, intimacy all of it can benefit from. You know, understanding women's sexual health and women understanding what may or may not be happening with them. Elaine, looking ahead, what's your vision for the future of digital sexual health care for women and how does eSense plan to lead in that space?

Elayne Wandler:

Yeah, I mean our vision is really to normalize sexual health as part of whole person care right and to provide these high quality tools that are universally available, so no matter where a woman lives or what her background is, and just there's that whole stigma piece. I'll just give you an example. I was speaking with them a company that offers sort of virtual assistance for various aspects and just trying to get information on it and when I mentioned what eSense Health the company does and said that you know we're addressing female sexual dysfunction, she stopped and she said oh, we can't help you, like you can't be a client of ours because we don't want our employees to feel uncomfortable, so took me off guard. But perfect example of the stigma and sort of what we're up against.

Maureen McGrath :

Right.

Elayne Wandler:

Yeah. So to me, ultimately, eSense isn't just a product, it's part of a movement to sort of shift the conversation around women's sexual health from silence to support right and and, as you said, menopause is going in that direction. It's finally in the spotlight, but we don't want sexual health to be left in the shadows, so Absolutely, and it's tremendous work.

Maureen McGrath :

I cannot thank both of you enough. I want to mention the website again. It's esensehealth. com that will get you to this bastion of knowledge and understanding as to whether eSense is for you. It talks about low sexual desire and arousal, their outcomes from their clinical trials, and you know if you'd like to learn more, there's so much information there and you know, thanks to all of the creators and collaborators of eSense, I mean it's extraordinarily forward thinking and I really appreciate that, and I appreciate both of you coming on the podcast to talk about it.

Elayne Wandler:

Thank, you so much, Maureen.

Dr. Lori Brotto:

Yes, thank you. It was fantastic for doing this.

Maureen McGrath :

You're both so welcome, and if you know somebody who might benefit from this episode, somebody who has secretly shared with you their sexual health concerns, or even a patient or a friend or a daughter or a mother, feel free to share this podcast with them and tell them about eSense. We need to share this information with our friends, our mothers, our daughters, our sisters, our cousins, everybody, and I want to thank once again Elaine Wandler, the CEO of eSense Health, and also Dr Lori Brotto, registered psychologist and professor in the Department of Obstetrics and Gynecology at the University of British Columbia, and also the executive director of the Women's Health Research Institute and a collaborator on eSense, and I want to thank you for tuning in. Thank you so much. As you know, it's always my pleasure to talk to you and to have you perhaps listen, so thanks so much. I'm Maureen McGrath, registered nurse, nurse contents advisor, sexual health educator and host of this podcast. Nurse Maureen's Health Show Podcast. Gentlemen, let's talk.