Under the Microscope: Axena Health

Why Avestria Ventures Invested in This Pelvic Health-Focused Startup

Avestria Ventures
5 min readSep 7, 2023

In this series, we explain why we invested in our current portfolio companies. In the process, we hope to highlight the white spaces in women’s health and the life sciences — as well as the people, products, and companies working to fill those gaps. The name “Under the Microscope” refers both to our extensive due diligence process and our investment focus on healthcare and the life sciences.

“Ladies, admit it. You’re doing Kegels right now.” An advertisement with these words appeared on the Long Island Railroad in March 2013: one of a series of ads promoting Veria Living, a health-based channel launching in New York. The Kegels ad was controversial — some thought it was tongue-in-cheek, some thought it was inappropriate, some didn’t know what Kegels even were — but it did make a reference to an exercise that has been a quintessential part of women’s health for the last 75 years: Kegel exercises.

Kegel exercises, also known as pelvic floor exercises, involve relaxing and contracting the pelvic floor muscles: the muscles that form part of the pelvic floor. Arnold Kegel first described Kegel exercises in 1948; since then, Kegels have been recommended to women — and even to men — to strengthen the pelvic floor muscles and prevent pelvic floor disorders.

A woman performing pelvic floor muscle training. Source: Getty.

Across their lifetime, 32% of women, especially those who have vaginal childbirths or are post-menopausal, will experience a pelvic floor disorder (PFD): when the pelvic muscles (which span the bottom of the pelvis and support the internal pelvic organs, such as the bladder, bowel, rectum, and uterus) or connective tissues of the pelvis are torn or are weakened. PFDs include pelvic organ prolapse (when one or more of the pelvic organs slip down from their normal position), loss of bowel control, and urinary and fecal incontinence — and can only worsen if left untreated.

Kegels are the first line of treatment for — and, as a result, “among the most popular therapies” for strengthening the pelvic floor and even treating pelvic floor disorders. Other options include injections, medications, nerve stimulations, or a vaginal pessary, which is a supportive device inserted into the vagina to support the bladder. Surgical treatments — in the case of pelvic organ prolapse, bowel control, or incontinence — include bladder slings to prevent leakage and various suspension surgeries. Kegels, in contrast, are non-invasive and can be implemented “as a daily routine”. In fact, Kegels can theoretically be performed anywhere: including while waiting in line at a grocery store, sitting at a desk, or waiting for a train.

The treatment options for urinary incontinence. Source: Axena Health.

Despite this ubiquity and convenience, however, Kegels are not always performed — much less performed correctly. As few as 25% of women with a pelvic floor disorder perform Kegels, and, of that already-small fraction, fewer than 25% perform the exercises correctly. Put another way, for every 100 women with a pelvic floor disorder, fewer than seven of those women perform Kegels adequately.

Axena Health, a women’s health startup, is first addressing pelvic health, which includes Kegel exercises.

Axena’s first product is the Leva® Pelvic Health System: an FDA-approved, at-home, clinician-prescribed solution to help women strengthen their pelvic floor to treat urinary and fecal incontinence. More than 60% of adult women in the United States experience urinary incontinence and about 7–15% experience fecal incontinence (though that percentage becomes 25% for women who have given birth and who are over 40). Yet as few as 25% of women with urinary incontinence and fewer than 30% of women with fecal incontinence seek treatment. For urinary incontinence specifically — which is a strong correlate for fecal incontinence — women wait an average of 6.5 years from their first time experiencing symptoms to receiving their diagnosis.

We invested in Axena Health because it addresses the challenges of Kegels; it enhances these exercises to make them effective in treating a pelvic floor disorder, such as incontinence. For example, studies have shown that “brief verbal instruction may not be adequate” for those new to Kegel exercises and that supervised Kegel exercises are more effective than unsupervised ones; the supervised group showed “better outcomes of pelvic floor function, including improvement of quality of life, decreasing urine leakage, and higher satisfaction rate” than its unsupervised counterparts. Axena Health believes that women deserve treatments that are backed by credible scientific data; thus Leva is backed by clinical trials that establish its superiority over usual care as well as the durability of the symptom improvement after using the solution.

The Leva® vaginal wand and corresponding smartphone app. Source: Axena Health.

The Leva® vaginal wand, which is one part of the Leva® Pelvic Health System, builds on this data, offering real-time feedback without the inconvenience of having a medical professional present. The wand detects and measures movement when the pelvic muscles contract — like during a Kegel exercise — while the corresponding smartphone app will first show that the wand is in the correct position and will then guide the user through lifting, holding, and relaxing her pelvic floor muscles. Leva® also provides real-time digital feedback, tracks progress, and offers as-needed clinical support — allowing users to reap the benefits of correct Kegel exercises, overcome the emotional, psychological, and social challenges of a pelvic floor disorder, and avoid invasive and expensive surgeries or medicines.

Axena’s CEO, Eileen Maus. Source: Eileen Maus.

Axena Health is, consequently, addressing a problem that women with pelvic floor weaknesses or disorders have faced for the last three quarters of a century: doing Kegels well. Now women who use Axena’s Leva® Pelvic Health System and who may be reminded of Kegel exercises — whether from their doctor or from an ad on the railroad — will know that they’re not only performing Kegels but also are doing them effectively and correctly.

At Avestria Ventures, we look for early-stage women’s health and female-led life science companies with products or technologies that improve healthcare quality and/or access, lower costs, induce clinical or behavioral change, are evidence based, have scalable commercialization plans, and have a sustainable competitive advantage. Know one? Contact us via our website, LinkedIn, or Twitter.



Avestria Ventures

Investing in early-stage women’s health and female-led life sciences companies.