Stigma is a Business Constraint. Founders Need a Strategy for it

Stigma is not a marketing problem. It is a business constraint — a hidden, systemic barrier that blocks women's health and FemTech companies from raising capital, buying media, opening bank accounts, and reaching the customers who need them most.

Founders in this space face a paradox: they are building solutions to some of the largest unmet needs in health care, yet at every turn they hit barriers that have nothing to do with product quality or market size. These are not isolated frustrations — they are the finding of a four-year research collaboration with Neva Bojovic , Associate Professor at Kedge Business School, and Padmaja Argade , Assistant Professor at the International University of Monaco. Together we studied 26 U.S.-based FemTech companies spanning menopause, pelvic health, and sex tech. The result, published this June in the Academy of Management Perspectives — one of the field's top journals — is a peer-reviewed framework for how founders can actually fight back: the Social Change Framework for Entrepreneurship in Stigmatized Markets .

The framework’s core insight is that stigma is not one problem, but a serious of problems. And there is no single playbook for solving any of them. What follows is how the framework breaks down, and what it demands of the founders who face those stigmas in the marketplace. But first, here is how this research came to exist.

Background: How This Research Started

It feels like another lifetime now — those early days of accepting the realities of COVID’s impact on our lives. Overnight, no part of daily life was business as usual: eating, working, school, caring for our health and our families’ health, even finding toilet paper. It was hard to know where to start, or how to find any sense of normalcy. I remember sitting at my computer, realizing that COVID would mean no business travel and no in-person conversations - at least for a while.

At that point, in 2020 and 2021, women’s health wasn’t part of the mainstream conversation as it is today. Most of the discussion was still happening in small groups, or within the growing women’s health conference community. I started reaching out to people I respected in the ecosystem — founder friends, investors, health care practitioners, academics, and payors. In my experience, the people who had jumped into this space early were among the smartest, most creative, most solution-oriented professionals I had ever met. My hypothesis was that they could offer some much-needed inspiration for surviving — and thriving — through a period of radical uncertainty. What started as a few calls a month became multiple conversations a week, month after month. It eventually turned into more than 100 episodes and a web series called “Quotes from Quarantine.” How This All Started:

Sometime in 2022, I received a call from Neva Bojov ic, an Associate Professor at Kedge Business School , whose research focuses on the intersection of strategy, technology, and social change and Padmaja Argade , Assistant Professor at the International University of Monaco. who were looking for a research collaboration. They believed my conversations could provide a basis for academic study. What began as informal pandemic conversations started to evolve. Ultimately, we focused on a subset of my interviews across 26 U.S.-based FemTech companies spanning menopause, pelvic health, and sex tech, supplemented by follow up interviews conducted between 2020 and 2025, and dozens of additional interviews with industry experts. We also gathered archival data including company websites, press coverage, and policy documents. Both Dr. Bojovic and Dr. Agarde had warned me about the glacial pace of academic research and publications, but even with that warning, I was surprised that it was just this June – 4 years later - when the results of the analytical work finally got published, after many rounds of peer reviews and validation. The result of this collaboration is an analysis, “Diagnosing the Signals in Stigmatized Markets” , published in the Academy of Management Perspectives .

It became abundantly clear how many people working in the space of women’s health (now defined as conditions that affect women only, primarily or differently) faced their “fighting City Hall” moment. This meant that founders had to shift a big part of their energy to just getting their message through social media to educate their audience. I had faced that same barrier when we tried to get the ad for Zestra , a patented blend of oils and extracts clinically proven to improve arousal, desire and satisfaction in women of all ages and life stages, approved on 100 media channels, only to be rejected by 95 of them. Alex Fine, Founder of Dame and women’s health pioneer, experienced her version of the same challenges when she had to sue the MTA to get her ads approved for her women’s sexual health and wellness products. Why the suit? Ads for her for erectile dysfunction were already lining the same walls Dame had been barred from.

We saw from the great work from Jackie Rotman at the Center for Intimacy Justice and the team at CensHERship , that these experiences were not and are not anecdotal, but systemic in nature. It isn’t and wasn’t just happening to one or two companies – it was happening to many companies. As one founder told us, "We cannot fully execute on our mission while being blocked from sharing our story by outdated and inherently sexist advertising regulations.” The barriers extended far beyond advertising. One founder of an adult content platform recounted, "It took me four years to find one bank in America that would allow me to open a business bank account. PayPal won't work with our adult content. Stripe can't.”

How can founders grow businesses when they face a paradox – capitalizing on unmet needs while facing barriers that constrain access to capital, media channels and distribution? How can founders build viable businesses when their products face barriers on advertising on all channels and access to payment platforms? As one entrepreneur put it, "If you can’t advertise on Facebook and Instagram, the VCs say how are you going to scale your business?" It turns out that it is as hard as it looks as entrepreneurs face a dual mandate: they must focus on growth and survival, while simultaneously needing to drive the social change just to get their messages in front of their target customers.

The Social Change Framework

What we found is that stigma is not one problem -- it is actually several problems," said Dr. Bojovic, lead author of the study. "An entrepreneur facing moral stigma in sex tech confronts entirely different barriers than an entrepreneur confronting tribal stigma in menopause. The playbook must match the source.

This insight forms the basis for the Social Change Framework for Entrepreneurship in Stigmatized Markets we created - that matches sources of stigma to social change. It became very clear that four distinct mechanisms were at play, varying across stigma sources: taboo breaking, normalization, reframing and sanitization.”

Taboo breaking means speaking openly about a stigmatized issue to reduce knowledge gaps knowledge. As one founder highlighted, they were designed around one goal: “smashing the menopause taboo.”

Normalization frames the issue as a routine and common aspect of human experience. “We strive to bring awareness about just how common” a certain condition or disease might be," said another founder.

Reframing shifts the conversation toward the broader story — the financial cost to individuals and organizations of continuing “business as usual” — rather than the stigmatized subject itself. Instead of talking about a sex toy, for instance, one company describes “a smart vibrator with a suite of sensors.”

Sanitization responds to stigma that blocks accurate discussion of anatomy, conditions, and body parts with euphemism, deliberate misspelling, or overly medicalized language designed to get past a screen. Instead of “incontinence,” marketers might refer to "pelvic health disorders."

The strongest ventures did more than change words. Their leaders acted across four domains: structures, practices, narratives and emotions. They built credibility through clinical evidence and partnerships. They redesigned products and services to ensure dignity and ease of use. They validated users who had previously been dismissed. And they created communities that replaced isolation with solidarity and information.

The Limits of Entrepreneurial Action

Even the strongest founders acknowledged a hard limit. Entrepreneurs can pressure institutions, build alternative channels and expand public language, but they cannot dismantle stigma alone. Platforms, retailers, investors, payers and policymakers set many of the rules. When those institutions apply standards unevenly, founders spend scarce resources fighting for the right to perform ordinary business functions.

"Entrepreneurs are doing extraordinary work, but they shouldn't have to fight for basic access to banking, advertising, and distribution just because their products serve women's bodies," said Dr. Bojovic. “Entrepreneurial action alone cannot dismantle stigma. The real change comes when policymakers guarantee nondiscriminatory access to the infrastructure every other business takes for granted.”

Stigma thrives on the status quo. Clearly, the status quo does not currently serve the best interests of women’s health. What the companies and founders in this research – and more broadly in this space - have demonstrated is that that they will continue to “fight City Hall” to bring products and services to the market to the people who need them.