Vaginal prolapse: The term itself can be unsettling, hinting at a condition that could affect anyone with a vagina. So why have we never heard of it? Like so many aspects of women's health, vaginal prolapse is an often-overlooked, rarely discussed topic in mainstream conversations, despite staggering statistics: an estimated 50% of women over 50 will experience it.
This is where Reia stepped in. This women-founded and women-led startup is revolutionizing the pessary, a device used by those experiencing prolapse. We spoke to the founders of Reia about why they designed a new pessary device and what the realities are for people experiencing pelvic prolapse. The founders also share about their innovative work in shedding light on a long-neglected issue and providing much-needed relief for women who, until now, have relied on a device largely unchanged for nearly 100 years.
“50% of women over 50 experience prolapse to some degree.”
Let’s start at the beginning. What is vaginal prolapse, and why do so few people talk about it?
Photograph by Lauren Lear
The pelvic floor muscles are a muscle group that span the bottom of the pelvis from the tailbone to the pubic bone. When healthy, they act like a hammock to hold up the pelvic organs – the bladder, rectum, and uterus. Prolapse occurs when the pelvic floor muscles are weakened or damaged, allowing the pelvic organs to descend, or “prolapse.” This can cause an uncomfortable feeling of pressure, aching, bulging, or heaviness in the abdomen or vagina.
Prolapse is incredibly common! It’s estimated that 50% of women over 50 experience prolapse to some degree. Not all are symptomatic, but still, 1 in 8 women in the US have surgery for prolapse in their lifetimes. When we first encountered these stats, we couldn’t believe it. How had we never heard of something this common, that would probably happen to us?
After many years of working in the space, we noticed a lot of factors contributing to the silence around prolapse. Societally, there’s a long history of a lack of education in women’s health and reproductive health, in particular, [the issue] has been treated as taboo. This silence breeds shame and isolation. When people think they’re the only one experiencing prolapse, they’re often embarrassed, so they don’t talk about it. On top of that, from a young age, women’s pain is frequently underestimated and dismissed. Beginning with period cramps, women are told their pain is normal, to be expected. After giving birth and experiencing big changes to their body, the message is the same. Then again, during perimenopause and menopause: You’re fine, this is just how it goes. So, it’s no wonder that many people experience prolapse symptoms for years before getting diagnosed.
We think the tides are turning though. We’ve seen that once someone realizes how common prolapse is, they’re often (justifiably) angry. Angry that no one told them about it and that they didn’t get treatment sooner. We hope that just as topics like menstruation and fertility have become less taboo, menopause and pelvic floor conditions like prolapse will be more readily talked about too.
What is a pessary, and how can it support people experiencing prolapse?
A pessary is like a little shelf, inserted into the vagina to support the descending organs. While a pessary does not cure prolapse, it provides relief from the symptoms.
Animation by Michelle Mildenberg
Pessaries have actually existed for thousands of years. In the time of Hippocrates, they wrote about using pomegranates as pessaries. Cut in half and soaked in wine, they were inserted into the vagina for support. In the 1800s pessaries were made of glass, brass, cork and finally in the 1930s we got the silicone pessary most people use today.
While they provide support and symptom relief when they are in place, traditional pessaries are difficult and painful for people to insert and remove. As a result, users often go to their doctor quarterly to have the pessary removed, cleaned, and reinserted. In addition to being a logistical nuisance, constant wear can cause damage to the vaginal tissue and prevent people from having penetrative sex.
Since women routinely insert and remove tampons, menstrual cups, and the ring – it seemed crazy to us that there wasn’t a pessary that people could insert and remove (comfortably!) on their own. That goal is what inspired Reia.
Can you tell us more about that inspiration?
Ari, Kaitlin, and Meegan studied engineering together at the Thayer School of Engineering at Dartmouth. In our final year of school, we did an independent study on engineering and gynecology instruments. At the onset, we assumed that we would redesign the speculum, since it was the tool we were most familiar with, but we looked at many instruments, including the single-toothed tenaculum (which thankfully also is currently being updated), the birthing table, IUDs, and more. During our exploration, we were connected with our 4th co-founder, Dr. Paul Hanissian, a urogynecologist at Dartmouth Hitchcock, who introduced us to pessaries and prolapse, neither of which we had heard of. Paul expressed his frustrations using pessaries and it was obvious to us that there was a lot of room for improvement.
After graduation, Meegan, Kaitlin, and Ari all got other jobs, but the whole team couldn’t stop thinking of the pessary. The 4 co-founders kept in touch and 4 years later started redesigning the pessary in earnest after being awarded our first NIH SBIR grant in 2019.
We’re curious about the personal, professional, or systemic forces that made this feel urgent. What makes your approach to pessary care different from what’s been available until now?
The Reia pessary and applicator system enables, for the first time, self-management for all stages of prolapse. From the pessary and applicator to the packaging and instructions, we want people with prolapse to feel confident managing their pessary on their own.
The Reia pessary collapses for easy insertion and removal. To insert it, a user simply pinches the pessary to elongate it. To remove it, they pull on the removal loop, and it collapses on its own. The Reia pessary was evaluated in a clinical trial where pessary users wore it for 3 months and compared the experience to their old pessary. The Reia pessary enhanced quality of life, reduced pain during insertion & removal, increased self-management, and provided equally effective prolapse support.
Our companion applicator is a first of its kind. The applicator holds the pessary collapsed during insertion and has large, easy-to-grip features. The applicator’s length helps reach the right place in the vagina, which can be difficult for people with mobility limitations. While we initially designed the applicator for people with dexterity challenges, we’ve found it improves comfort for all users.
Photograph by Lauren Lear
The packaging and instructions are designed to empower users. Many women feel overwhelmed at the doctor’s office. Reia instructions are clearly written, illustrated, and in large font – a resource people can confidently use at home.
What has surprised you most, either from patients or the pelvic health system, since launching?
We have been awed by the scrappiness, tenacity, and pure ingenuity of people who want to try Reia. Since we are new, most practices do not have Reia in stock – often they haven’t even heard of Reia. Rather than be dissuaded, patients return to their practitioner armed with our product information and clinical data. Sometimes, they even email us asking how their practitioner can order, then pass the information on to their practitioner. Once the practices try Reia, they often continue to offer it to their future patients.
Just last month we received this email from a practitioner:
“I had the pleasure of fitting a patient with Reia for the first time last week (she had done all the leg work, ordering and teaching us how to fill out reimbursement form). We both were floored (pun intended) by how easy and comfortable this product is. We've been waiting for a woman-designed product like this forever.”
We hope to get to a point where Reia is more widely known amongst practitioners and patients do not have to go through Herculean efforts to get the treatment option they prefer. But, for now, we are so appreciative of the work they do for themselves and for other women to be able to access Reia.
If Reia were a friend, how would you describe their personality?
Reia is really a mix of the 4 cofounders. Reia is warm and approachable like Ari, witty and organized like Kaitlin, honest and credible like Paul, open and lively like Meegan.
Reia is the no-nonsense friend/sidekick that the sequel is about.
Reia is confident, but on the quieter side – they’re definitely not the loudest person in the room. They are hardworking and set high standards for themselves, but they leave space for a bit of fun. While they are usually friendly and relaxed, they know their rights and will stand up for what they believe in.
Reia values honesty and clarity – they think trust is earned not only by experience and expertise, but also by readily admitting what you don’t know. They are also playful, they like to sneak in a 90s movie reference. They don’t necessarily need everyone to understand their jokes, that they make themselves laugh is enough.
If Reia did the Myers Briggs test, they would get an ISTP. (Or perhaps our collective approach to Reia is ISTP! Who’s to say!)
