The cervical tenaculum is used during millions of gynaecological procedures each year – but its sharp metal hooks were originally designed to extract bullets on the battlefield, not to handle delicate cervical tissue. Consequently, 90% of women report feeling mild to severe pain during procedures which involve the tenaculum. In light of this, Biopôle member Aspivix, founded in 2018, is reimagining gynaecology with ‘gentle’ in mind: the team has developed an innovative suction-based tool called Carevix as a kinder alternative. The CEO and Co-Founder of Aspivix, Mathieu Horras, spoke to us about being a man in the world of women’s healthcare and why he is determined to find solutions to the problem of female pain.

What is Aspivix’s mission? 

We want to revolutionise women’s healthcare! After all, around 110 million women undergo gynaecological procedures involving the antiquated tenaculum every year. We aim to make these procedures much safer and gentler, putting the patient back at the centre of the process.

How and when did you realise that it was important to find a solution to the pain so many women feel during gynaecological procedures?

As a cisgender man, I obviously don’t have any first-hand experience of these procedures – in fact, I had no clue they could be so traumatic, until my Co-Founder, David, who is himself a gynaecologist, mentioned he was concerned by how much pain his patients were experiencing. After that, I spoke to the women in my life and also dove into research literature, and it was a revelation to me that standard, long-established gynaecological procedures could cause women agony. What’s worse, it seemed that medical providers weren’t always aware of this. Indeed, I found a clinical trial that was designed to assess the pain of intrauterine device (IUD) insertion on a scale from zero to ten; on average, patients rated their pain as a six (with some going all the way up to ten), whereas physicians would estimate that their patients were experiencing around a level three.

I found myself questioning why this was. And, having just finished an MBA at INSEAD, and having also previously worked in the medical devices industry, I felt like I was well placed (with my Co-Founders) to turn these nascent conversations into action and bring a solution to market.

Why has it taken so long for a solution like Carevix to be developed? Was there no market demand before?  

There are a number of different factors to consider here.

First of all, the healthcare space has traditionally been dominated by men, who are naturally drawn to issues they can relate to. We first had this idea ten years ago, and when we tried to raise awareness back then, we were primarily talking to male practitioners who had little to no experience with or knowledge of the problem (just like me, before I did the necessary research).

Compounding this, while healthcare is an industry that focuses on providing care, it is also governed by financial concerns, and women’s healthcare was traditionally not a big moneymaker (even though it’s a sector with huge potential). Many male venture capitalists were concerned about investing in a medical device aimed at women, as they couldn’t be sure of a return on investment. I should say that nowadays, however, we see more and more women in these rooms, and they are much more receptive to what we’re saying.

And the last point is that patients didn’t always feel like they could speak out, because there was a taboo around gynaecological appointments and women’s healthcare in general. Thankfully, this is now starting to change.

On this point, as of late, more and more research has been conducted into the gender gap when it comes to pain – The Washington Post recently reported that, in the United States, women experiencing serious medical conditions, from endometriosis to heart attacks, were less likely to receive appropriate pain relief and/or were more likely to wait longer to get a diagnosis. Do you think dismissive attitudes towards women’s pain in general contribute to the taboo around gynaecological procedures?

Yes, there’s something to be said here about women ‘expecting’ (and being expected to endure) more pain – key examples are menstruation and childbirth, where women are told: ‘This is part of the female experience, you’ve just got to deal with it.’

But this actually just creates unnecessary shame, where women think they must suffer in silence. And after all, pain puts a huge strain on the body! Sometimes we butt up against dismissive attitudes when it comes to our company – people say, ‘with your product you’re not dealing with life-or-death situations, this isn’t super serious or important’. But they don’t understand the knock-on effects of pain, especially in a culture of silence. We find, for instance, that people will delay having routine check-ups and/or getting IUDs fitted because they are worried about the pain – and that in turn leads to unwanted pregnancies, and even higher rates of maternal mortality. So, there are huge consequences of dismissing women’s pain.

Are there other innovations in women’s healthcare (which minimise pain and/or simplify procedures) that are being developed? Or any that you look forward to seeing in the future? 

Definitely – there are lots of new start-ups coming up in this space, which is fantastic! R&D has definitely increased.

It’s especially great to see innovation in women’s healthcare happening here in Switzerland. I’m thinking, for example, of Pregnolia, a medtech company based in Schlieren that is developing a diagnostic device to accurately predict the risk of premature birth. This can, in turn, facilitate preventative intervention to prolong gestation and improve neonatal health outcomes.

In general, we’ve seen growing interest in exploring the uterine environment, about which we currently don’t know enough, but which we can examine very easily – after all, millions of women do use IUDs. Various companies are developing sophisticated, sensorised IUDs that can collect data directly from the uterus to better understand what’s happening there.

Another thing I’ve noticed recently is a shift in focus with regard to contraception: previously considered solely a female domain, pills and the like are starting to be developed for men. This is an interesting pivot, as fertility and contraception do affect everyone, but they’ve previously been put in a ‘women’s healthcare’ box. I think we’ll continue to see something of a cultural shift over the next few years.

On this note, how do you envision women’s healthcare evolving over time? Are further efforts needed (beyond companies developing innovative tools) to make progress regarding the gender gap?  

I’ve already mentioned the culture of silence around gynaecological appointments, and I like to think that Aspivix is contributing to the fight against this. But further education is probably needed to make a meaningful change – both on the public and on the medical side of things. After all, an IUD is a very effective form of contraception – and yet, according to industry surveys, up to 30% of women won’t even consider it, because they don’t think it’s appropriate for them and/or they’re scared of the pain. And doctors don’t strongly advocate for IUDs either, nor are they aware that there is an alternative to the ‘grin and bear it’ approach to insertion. As such, we’re supporting a number of physicians (one in Geneva, two in the United States) to educate their teams about our Carevix tool and about pain management during gynaecological procedures in general.

At the same time, we’re also trying to keep an eye on and influence wider industry trends, so as to amplify our overall reach. As things stand, pain or no pain, the tenaculum is cheap and easy to manufacture, and so it is widespread. This is something to consider as we attempt to scale. We are based in Switzerland, a wealthy, developed country, and we want to expand to the US and Europe next. But what will happen when we try to bring Carevix to low- and middle-income countries? Will they be able to afford advanced contraceptive tools? There needs to be a move towards affordable and well-designed gynaecological solutions for all. We see a huge market opening up, and we very much hope to be a part of it. Either way, I think the future is bright!