Vulvodynia's $18,000 a Year Cost + a Mini Interview With Origin CEO Carine Carmy

What does it actually cost to get taken seriously when you're in pain? For the average woman with vulvovaginal or pelvic pain in the US, it's about $18,000 a year - paid entirely out of pocket.

Today I'm speaking with Carmen Rising, a Brooklyn-based writer whose reporting on vulvovaginal pain has recently run in The New York Times and The Guardian. She came to this as a patient herself, and in this episode we get into the real economics of chronic pelvic pain, why the insurance system fails these conditions almost by design, and how an unregulated wellness industry has rushed in to fill the gap medicine left wide open.

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Thank you to our sponsors for making sure these conversations stay free for everyone:

Pelva: https://lddy.no/1pmrf?afmc=TWTC10 Use code TWTC10 at checkout to receive 10% off your first order.

Origin: http://theoriginway.com/twtc Use promo code TWTC to get your first month of Origin's On-Track membership free.

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*Links:*
https://www.nytimes.com/2026/05/19/well/vaginal-health-wellness-products.html?
https://www.theguardian.com/wellness/2026/jun/12/pelvic-pain-costly-expense

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Timestamps:
(00:01:22) How Carmen got into this world — her own decade-long diagnosis journey
(00:03:15) Overview of her NYT and Guardian pieces
(00:03:38) The Guardian piece: unpacking the $18,000-a-year figure
(00:04:16) Where the $31–72 billion economic burden actually comes from
(00:06:00) Diagnostic delay as the biggest cost driver
(00:06:55) Paying cash — Stephanie Berman's $40,000 story
(00:07:50) Diagnostic trial-and-error, and the burden beyond dollars
(00:08:51) "A dumpster fire of brokenness" — how insurance fails these conditions
(00:11:42) Hysterectomy reimbursement vs. a knee replacement
(00:12:27) Mathilde's own insurance dispute in the UK
(00:13:46) Grassroots efforts: Tightlipped and the Aziza Project
(00:14:47) What it would take to close the gap
(00:17:36) The US healthcare system and the policy-level problem
(00:18:11) "A wealthy white woman's problem"
(00:20:03) Why "pain during sex" undersells the whole picture
(00:23:35) Sponsor: Origin, with founder Carine Carmy
(00:31:18) Sponsor: Pelva
(00:33:04) The Vaginal Wellness Boom
(00:33:32) Noticing targeted ads
(00:37:01) "OBGYN backed" and "evidence based"
(00:37:51) The core critique: wellness fills the gap medicine leaves open
(00:41:15) Wellness companies' profit motives vs. big pharma
(00:42:23) The counterargument: could market demand drive real research?
(00:45:11) Vaginal microbiome test kits
(00:45:41) Unregulated microbiome testing and diagnostic claims
(00:48:10) Yeast infections, vulvar pain, and at-home test sensitivity
(00:48:59) PCR swabs, Microgen DX, and the repackaging critique
(00:51:07) The real issue — interpreting results without guidance
(00:53:16) Outro