Portrait by Devyn Glista
Improving women’s lives has always been Patty Brisben’s main goal. Sure, she was focused on their sex lives while building Pure Romance into one of the largest direct sales companies for relationship-enhancement and intimacy products. But as business grew, Brisben began to see that her ultimate vision stretched well beyond the bedroom.
She started Pure Romance in her Milford basement in 1993, launching with 55 consultants. By the early 2000s, approximately 10,000 consultants were selling her products at house parties across the country.
“Every night, they were hearing women’s deepest secrets,” says Brisben. Those conversations became a constant stream of e-mails and calls from her consultants relaying women’s questions and concerns. Sometimes, they were worried about pain during intercourse or bothered by unwanted dryness. Maybe mystified at a sudden drop in libido. The queries kept coming.
Brisben, always quick to remind her consultants that they aren’t doctors and should never give medical advice, began to think about all the medical researchers and professionals Pure Romance had worked with to create its lines of vibrators, sex toys, skin care, lingerie, and lubricants. Might she be able to connect women to the information they were seeking?
Upon closer look, Brisben learned that nearly half of all women experience sexual difficulties at some point in their lives. While the World Health Organization says sexual health “is fundamental to the overall health and well-being of individuals, couples and families, and to the social and economic development of communities and countries,” information related to sexual health concerns and conditions is hard to find or simply nonexistent. The research necessary to find the answers? Lacking.
“We needed more research to be able to really treat women,” Brisben says over brunch at The Cincinnati Club. “That’s when I went, You know, I’ve got an army of women. I want women to know that they’re not crazy. This is really happening to you.”
So she created the Patty Brisben Foundation for Women’s Sexual Health in 2005. This year the organization opens a new chapter by rebranding and revamping as the SHE+ Foundation.
Brisben has hired a full-time development director and is doubling down on the nonprofit’s efforts to advance science-based education, advocacy, research, and innovation related to women’s sexual health while creating safe spaces for women and their supporters to learn about women’s sexual health and well-being and build solidarity and community. “It’s so important to have healthy women in every household, in every workplace,” she says. “But let’s face it, when you’re talking about intimacy and sex, any of that, it’s an uncomfortable topic.”
Photographs courtesy SHE+ Foundation
On a warm summer evening at the Junior League of Cincinnati, a young woman holds a microphone in one hand and a question from the audience in another. “Is there any truth to the saying, If you don’t use it, you can lose it?” she asks a panel of sexual health experts at the BrowseHer event organized by the SHE+ Foundation.
Several of the experts are members of the foundation’s medical advisory board, including Karen Connor, a pelvic health physical therapist at University Hospitals in northeast Ohio and owner of the Cleveland Pelvic Wellness Center, who takes the question. According to Connor, keeping the pelvic floor mobile is important to help maintain countenance and a healthy sexual life.
A group of women, all ages and races, has assembled at the free event, invited to bring their questions to the experts as opposed to browsing their way down a rabbit hole on the internet. “From a psychological perspective, it’s also true,” adds Sheryl Kingsberg, a clinical psychologist and chief of the behavior medicine division in OB-GYN at University Hospitals Cleveland Medical Center. “Because if you don’t use it, then you tend to get anxious about when you do want to use it.”
Let’s take a step back. What is sexual health? For any given person, it’s a complex and very individual combination of biological, psychological, and sociocultural aspects, says Kingsberg.
Biological components can include hormones, brain chemistry, and overall physical health conditions that might impair sexual function. Psychological aspects can include depression, general anxiety, or performance anxiety. Sociocultural values also come into play. “The idea that sex is not for women and women are supposed to be shameful can certainly impact sexual health,” says Kingsberg, who is also a professor in reproductive biology and psychiatry at Case Western Reserve University.
Then there are factors related to interpersonal relationships with past and/ or current partners, which can range from healthy to abusive, she says. When we talk about sexual dysfunction, it’s tied to the body’s sexual responses, meaning problems with loss of sexual interest or desire, decreased ability to become aroused, difficulty reaching orgasm, and experience of genital pain during sexual activity. Study after study has shown that regular sex, either with a partner or with oneself, has health benefits that can include lower blood pressure, an improved immune system, decreased depression and anxiety, and better sleep.
Why then, asks Brisben, acting as moderator at the event, don’t doctors talk to women about this stuff? Why are many gynecological exams so quick, in and out?
Anita Mikkilineni, M.D., chimes in. She’s an OB-GYN at George Washington University in Washington, D.C., and a faculty member at the Sexual Health and Gender Affirmation Center. Like Kingsberg and Connor, she’s a member of the foundation’s medical advisory board.
Women’s sexual health is not standard in medical professionals’ curricula, Mikkilineni says, so doctors like her must seek further training on their own after they finish their residency. “We do that in our first few years as an attending doctor in a new position,” she says, “while possibly trying to start our own families.”
Women’s sexual health is playing catch-up for a lot of reasons, says Mikkilineni. “Historically, science has considered a male body the default and a woman’s body too complicated,” she says. “Gender roles have minimized women’s health issues of sexuality, reproductive health, and menopause because of stigmas and taboos against talking about it.”
Also, funding priorities have tipped toward issues more critical to men, she says, because decision-making bodies—including medicine, government, and medical institutions—have historically been led by men. In addition, commercial interests prioritize research perceived as having a larger consumer market and promises of high profitability, like erectile dysfunction medications for men.
“But I’m hopeful that women are having their moment now, as we’re taking more leadership positions and fighting back more for better funding at the highest levels of the government,” Mikkilineni says.
Over the course of the roughly two-hour BrowseHer event, the panelists answer questions on topics ranging from perimenopause and menopause to pelvic pain during intercourse (experienced by one in seven women in their lifetime), hormone therapy, birth control, and so much more. “I want to start bringing more and more women together so we feel confident when we go to our doctors,” Brisben tells the crowd. “We can speak out. We can understand our bodies better.”
Photographs courtesy SHE+ Foundation
The education piece is a huge part of the SHE+ Foundation, says Bri Ledsome, its new development director. That’s why the BrowseHer event is available to watch on YouTube and why it’s included in the foundation’s Research Hub website.
The Resource Hub has a plethora of materials, from links and online resources to books to read and videos to watch on all sorts of women’s sexual health topics. The hub also has pocket guides on how to start a conversation with a healthcare provider about a range of sexual health concerns, including perimenopause, menopause, desire and libido, and physical and sexual abuse.
Prior to joining SHE+, Ledsome was a social justice advocate on many fronts, including working with survivors of sexual assault. “We want to break down barriers and give access to information you might not have otherwise,” she says. “And we want to have these conversations in public all together, but also in smaller, more anonymous settings.”
SHE+ is spreading its message of advocacy, solidarity, and respect on social media as well, with accounts on Facebook, Instagram, and TikTok. Doing this work means confronting stigma and shame surrounding women’s health, Brisben says. “I want everybody to get comfortable with their body,” she says. “I want both mothers and fathers to teach their children about their bodies, which helps take the shame out of it, because that’s where shame begins and that’s why people stay quiet.”
Quiet about sexual abuse. Quiet about a sexual dysfunction. “It’s not just that the foundation is giving money for better research and information,” she says. “I really feel we’re going back to ground zero and starting all over to help people understand why this is so important.”
Brisben is proud of the foundation’s research component. It’s given out nearly $1 million in grants over the past five years, with an average grant amount of $48,000. The foundation has awarded almost $200,000 so far in 2024.
The projects fall into one or more of the foundation’s eight focus areas: endometriosis, female genital mutilation, the impact of perimenopause and menopause on sexual health, intimacy-related sexual dysfunction after cancer treatments, libido and desire, LGBTQIA+ health, pelvic pain, and vulvovaginal pain.
Endometriosis is a condition in which tissue that’s similar to the inner lining of the uterus grows outside of the uterus, causing pain, infertility, and other health issues. Cases range in severity, but endometriosis is often painful, with some women reporting pelvic pain during sex.
Roughly 10 percent of women of reproductive age suffer from endometriosis, yet a diagnosis on average takes more than seven years. The SHE+ Foundation is committed to advancing research, raising awareness, and providing support for women with endometriosis to improve their lives and well-being, Brisben says. A grant of $66,836 was awarded to Medstar Health Washington Hospital Center in 2022 to study the use of platelet-rich plasma injections to improve sexual function and decrease pelvic pain.
Over the years, SHE+ has given money to 61 research projects across the U.S., including the Boston-based International Association for Premenstrual Disorders, which launched a program designed to help women facing the impact and abruptness of surgical menopause. The program has provided approximately 90,000 women with support and resources as well as continuing education and training via a smartphone app.
SHE+ also gave money to the Society of Gynecologic Surgeons in 2021 to develop a standardized counseling tool for patients after pelvic reconstructive surgery. The foundation has worked with and supported the UC Health Women’s Center with funds to develop a strategy to educate women about sexual health in the doctor’s office, producing three videos on sexual health: one for younger premenopausal women, one for midlife and older women, and one for women with a history of cancer.
“Sexual health was not cured with Viagra,” says Michael Thomas, M.D., chair of the department of obstetrics and gynecology at UC’s College of Medicine. “Having one partner who is sexually receptive or functional does not equate to a healthy sexual relationship. The SHE+ Foundation is one of the few foundations funding innovative research in sexual health, and without these monies, female sexual health would be on the back burner.”
Photographs courtesy SHE+ Foundation
Brisben wants women to take control of their own sexual health first by understanding their bodies, second by better understanding female sexual function and dysfunction, and third by demanding what they need. There are ways to preserve sexual function, avoid pain, and protect your health, the panel at BrowseHer explains.
As mentioned before with the “use it or lose it” question, pelvic floor health is important and is part of a broader muscle system of strong hips, strong glutes, and strong abdominals, says Connor. Sex is one way, but certainly not the only way, to keep this area of the body strong. Pelvic floor exercises can ward off pelvic pain and help with incontinence, which one in three women experience in their lifetime.
Kingsberg suggests that we not think of vibrators as sexual toys but as sexual tools that can be helpful to bring into the bedroom if you have a partner or if you don’t.
When it comes to drop in libido, dryness, and other sexual health problems, hormone therapy is available. Thomas says it’s important, when considering hormone therapy, to find a doctor who spends at least 30–45 minutes going through medical history and considering what medications a woman is already taking.
Related to menopause, everyone knows about hot flashes and brain fog, but they may have also heard that menopause is a leading cause of osteoporosis, a progressive condition in which bones become structurally weak and are more likely to fracture or break. Yet studies have shown that women can suffer the most bone loss in the years prior to menopause, Mikkilineni says. “That completely ignores the up to 10 years prior, with the average year of menopause being 51, of hormonal fluctuations and changes that can have some serious long-term effects,” she says.
On the other end of the life cycle, reproductive and social trends are also changing for women. “Millennials don’t want to get pregnant anymore,” says Thomas. “They want to see me to freeze their eggs. The population of women wanting to get pregnant over the age of 40 is increasing, and that’s a large segment of where healthcare is going.”
Conversations about all of these topics should be had with your doctor, panel members say, and if they can’t answer the questions, ask who can. “You need to start demanding this both in your doctor’s office and in your local governmental agency,” says Mikkilineni. “Reach out to your congressman. Get loud on social media. Start demanding the things we need. This doesn’t fall just on women. It’s on everybody.”
Ledsome says the SHE+ Foundation will step up support for all women as they demand better medical information and treatment. By the end of spring, its Medical Advisory Board will have reviewed and chosen the recipients of the next round of grant funding.
There is still so much research to be done, and so much to be learned, says Christine Vaccaro, D.O., a urogynecologist and sexual medicine specialist who is also a member of the foundation’s medical advisory board. “I wish everyone knew that women’s sexual health was just as important as men’s sexual health,” she says. “The human clitoris has 10,000 nerve endings, which was only discovered last year. The clitoral anatomy was first described correctly in 2005 and wasn’t included in medical textbooks prior to that.”
Fund-raising is imperative to create lasting change in women’s sexual health, says Ledsome, including the foundation’s annual gala in October and a greater focus on individual donations. “That’s my personal bread and butter,” she says, mentioning her seven years working in campaign politics. “Cincinnati has a very robust young professional community of people who have disposable income, and a lot of them already dedicate part of their budget to philanthropy.”
SHE+ will maintain its advocacy efforts, setting up booths at community events like the Flying Pig Marathon, medical conferences, and annual meetings like the International Society for the Study of Women’s Sexual Health in February in Long Beach, California. “At University Hospitals in Cleveland, we train our doctors to talk to their patients and say, Most of my patients have sexual concerns after a baby or at menopause or with Type 2 diabetes, what are your concerns? How hard is that?” says Kingsberg.
Brisben launched Pure Romance so women could make their own decisions about what happens in their bedrooms. The SHE+ Foundation will continue to bring that empowerment out from behind closed doors.
“Sexual health is general health,” says Brisben. “It does not discriminate. It’s universal. But right now we have to be our own advocates.”
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