Lux Alptraum | The Verge

LLMs are optimizing the adult industry

2025-06-25T11:35:58-04:00

When Ela Darling began performing in porn at the tail end of the 2000s, tube sites like Pornhub were relatively new, and major studios like Vivid and Digital Playground still dominated the market. For performers, the job was straightforward: show up to set, turn in a good performance, and collect a check. Everything else — from scripting the scene to editing and marketing to makeup — was generally handled by the studio’s team of professionals.

Fast forward to 2025. Vivid and Digital Playground are distant memories. Sites like OnlyFans — and competitors like JustForFans, Clips4Sale, and ManyVids — now rule the roost. And while that shift has empowered many performers to create careers that would have been unimaginable in earlier eras, it’s also come with a cost. While some jobs, like broadcasting and distribution, are now handled by third-party platforms like OnlyFans, a great deal of the work that used to be handled by a studio is now the performers’ responsibility. In addition, these new sites heavily encourage interaction with fans. The most successful creators aren’t just turning out hot porn scenes. They’re constantly chatting with their subscribers and creating custom scenes for high-paying clients. None of that was part of the job description in the VHS/DVD eras, when performer-fan interaction was largely limited to quick exchanges at trade shows like the Adult Entertainment Expo.

If you’re a top performer bringing in an enviable income, you might be able to hire a team of people to manage all the work you don’t want, or don’t have time, to do. But not everyone has the money to bring in outside editors and administrative assistants. For some of these creators, AI has become a crucial tool for tackling all the work required in the creator-centered adult industry.

For Darling — a tech-savvy performer whose career has included pioneering work with VR cam platforms — the decision to explore AI’s potential to optimize her workflow was a no-brainer. From the early days of ChatGPT, she’s been exploring ways to make the platform work for her. Early on, she looked into the possibility of making her own AI chatbot by feeding ChatGPT her own writing samples from anonymized chats with clients in order to teach it her voice and style. While she didn’t wind up with a convincing Elabot, she did manage to train ChatGPT to help her generate responses to client messages that are in her voice, providing assistance on days when she’s creatively drained. “It lets me operate at 90 percent when I’m at 30 percent,” she says, helping her to conquer the massive pile of client messages that can be the most intimidating part of the job.

Darling isn’t alone in turning to LLMs for creative inspiration. Staying afloat in a crowded marketplace like OnlyFans requires constantly churning out new content, and creating custom photos and videos tailored to a variety of fan interests — interests that you, personally, might not know much about. Erika Amore, who’s been on OnlyFans since 2020, says that fans often request very niche content without providing much of a story or vision for their custom clips. “I need some kind of creative component,” she says — and ChatGPT can provide that, creating scripts and scenes and even shot lists for, say, a sexy giantess roleplay.

Of course, there are limits to what mainstream LLMs will allow, and most of the people I spoke with had run into warnings that they were asking a service to do something that would violate its TOS. OnlyFans creator Max Steele has told ChatGPT that he needs sexual-sounding content because it’s for an erotic scene in a play, or “academic psychology research.” Amore has gotten sexts to send clients by asking for a response to “flirty conversation via text with my boyfriend.” Most creators found that, after a little training, ChatGPT would offer up sexual content with little resistance.

But there are also adult-specific LLMs popping up as well, like GPTease, an AI chatbot by sex workers, for sex workers. Founded by longtime adult creator MelRose Michaels, GPTease promises to handle a wide array of behind-the-scenes work so that creators can maximize the amount of time they’re spending in front of the camera (and thus making money). Although Michaels won’t share her training data, she told me that GPTease wasn’t trained on creator data — unless you count the data sets that she, as a creator, wrote herself. When I created a free trial account with GPTease, it asked me to tell it more about my specific content niche and type of client. From there, it was able to generate sexy DMs, shot lists, scripts for scenes, and more — and if I wanted, it could even give me suggested prices for everything I created. GPTease, Michaels says, was specifically built to meet a wide range of sex worker needs, and to support the community of creators that she is proud to be a part of.

Not that every adult creator is enthusiastic about bringing AI into their work. Mistress Lark, an independent professional dominatrix working out of Hollywood, is generally an enthusiastic LLM fan. She’s used ChatGPT to create calendars that map out her work schedule for an entire year. When she was moving her website off of Wix, Gemini provided her with much-needed advice and tutorials. And many of her newsletters and ad copy began as ChatGPT drafts. But when it comes to using it to shape her interactions with clients, she’s more hesitant. “I enjoy getting to know how people’s brains work,” she says. Outsourcing her end of the conversation to AI would make chatting with clients far less fulfilling.

There’s also a larger, more existential concern when it comes to adult content and AI. While no one I talked to worried about chatbots and AI clones replacing flesh-and-blood adult models, “most of my clients are white-collar professionals,” says Princess Fawn, a fetish model and dominatrix. “I’m concerned that AI is going to potentially displace their work, and then they won’t have the money to pay me.”

Sex workers are the unlikely beneficiaries of Twitter Blue

2023-05-12T10:01:20-04:00

On April 20th, as Twitter finally lived up to its longstanding promise to abolish legacy verified accounts, many users started categorizing the last remaining “blue checks.” There were the Elon fanboys, who angrily badgered formerly verified users about their unwillingness to pay $8 a month for a new checkmark. There were sheepish Twitter Blue subscribers who appreciated its extra features. There were celebrities puzzled to find they’d retained their verification despite (or, sometimes, because) of their vocal unwillingness to pay for Twitter Blue.

But there was also another, far less discussed group. When I clicked the Verified tab in my mentions, I’d once been greeted with a variety of journalist friends, activists, and the odd celebrity. Now there was only one kind of user populating the tab: sex workers.

Twitter has long been one of the friendliest, or perhaps just least hostile, social media platforms for sex work. As it launches into a slow death spiral, many sex workers are still paying for the platform. And that’s created a new kind of friction — as prominent accounts like Dril have urged fellow Twitter users to “Block the Blue” by mass-blocking subscribers. “I feel like my interactions have been dipping as Twitter gets less good overall but also have no choice but to attempt to keep the account verified,” says porn performer Vanniall.

It’s hard to say precisely how many sex workers are signed up for Twitter Blue, but it’s a sizable number — and to anyone familiar with the dynamics of modern sex work, it makes perfect sense. Where many professionals once worked for an agency or porn studio, a vast contingent are now independent. That leaves them a great deal of freedom but also new responsibilities. Whether you’re doing in-person work or modeling on OnlyFans, you — and pretty much you alone — are responsible for attracting clients to your metaphorical storefront. And while people have experienced a similar shift across the creator economy, sex workers’ options for social media are far more limited than most.

Past sex workers had a number of options for advertising, from the literal back pages of alt weeklies to the now-shuttered Backpage.com. But the current alternatives are fairly sparse. “The entire world has changed,” says Michael Stabile, director of public affairs for the adult industry trade group the Free Speech Coalition. Print publications aren’t a feasible advertising option anymore, and most online ad markets (including Google and Facebook ads) explicitly ban advertising for even legal adult services. Laws like FOSTA-SESTA have made mainstream platforms less tolerant of sexual content. Even big-name adult platforms like OnlyFans and Pornhub don’t do much to promote individual performers.

Twitter has long been one of the most XXX-friendly, or perhaps just least hostile, social networks

That leaves social media — and social media is not particularly XXX-friendly. Meta’s properties have hardline policies against nudity and explicit content, though many porn performers still use Instagram, hoping to fly under moderators’ radar and avoid a ban. While the buzzy platform Bluesky is currently quite notorious for its nudes, it’s tiny, and its future remains unpredictable. And as for TikTok — well, a site where users have to say “le$beans” instead of “lesbians” to get around content filtering isn’t likely to be a haven for sex workers.

But since its inception, Twitter has had a relatively hands-off attitude toward adult content. Posting porn clips may not be encouraged, but unlike nearly all other big platforms, it’s not explicitly banned. As a result, sex workers have flocked to it. “Most of my marketing is done on Twitter, Instagram, and several of the free porn channels,” says JW Ties, a longtime southwest Florida-based performer and producer. Lyrik Allure, who’s been using Twitter for sex work for 11 years, estimates that about 60 percent of traffic to their various pages (including a Fansly page and a Premium.Chat account) comes from Twitter. “It’s my main platform because a lot of platforms don’t support sex work,” says Allure.

Marketing isn’t the only benefit that Twitter brings to the table. Twitter also offers the chance to build community, organize political initiatives around anti-sex work laws, and connect with journalists (who, Stabile points out, are a group that’s equally dependent on Twitter). It’s hard to overstate how crucial the site is. Twitter, Stabile explains, is “almost universal in its adoption [among sex workers]. You can’t say that about any other platform. It just is the place, one of the first stops you make in terms of setting up a business.”

Which brings me back to Twitter Blue.

A number of Twitter Blue perks have obvious appeal for sex workers. Some of these aren’t unique to their industry, like getting prioritized in ranking, being able to upload longer and higher-quality videos, and being able to include more links in their bios. But Twitter Blue offers an aura of legitimacy that’s particularly valuable to people who are used to a precarious existence online. For one thing, paying for a service should theoretically make its staff less inclined to boot you off — an obvious boon for sex workers, who live in constant fear of their social media accounts getting shuttered without warning. “I haven’t had one violation since I signed up,” says Allure, who received frequent policy violation notices and believes their account’s visibility was limited before signing up.

“I feel like my interactions have been dipping as Twitter gets less good overall but also have no choice but to attempt to keep the account verified.”

Likewise, while Twitter Blue hasn’t stopped people from impersonating high-profile celebrities and politicians, it does add an extra barrier for catfishing and impersonation, problems that sex workers are particularly vulnerable to. Vanniall told me that she’s long been plagued by scammers using fake accounts to trick her fans out of money and even blackmail her. Before Twitter Blue, very few sex workers were deemed eligible for verification. After its introduction, she says “some fans have told me specifically they realized this was the real account” — though sadly, the main thing preventing impersonator accounts from signing up for Twitter Blue as well is a scammer’s own willingness to shell out $8.

Some sex workers feel confident that the Twitter Blue signup process has enough safeguards to prevent someone from impersonating them. During our phone call, Allure told me that they feel like the Twitter team is doing their best to stop fraudsters from using the service to run scams, noting that there is at least a nominal attempt to confirm that no one is using Twitter Blue for impersonation purposes.

But determined scammers have impersonated people in other fields where it’s worth the cost. And notably, when I recently searched for a sex worker friend on Twitter, her Twitter Blue-verified account was still completely absent from Twitter’s search results. Instead, I saw a bunch of imposter accounts pretending to be my friend — although so far, none of them were subscribed to Twitter Blue.

Twitter isn’t the only website offering paid verification. Meta recently announced a similar system for its sites, and some sex workers I spoke with are definitely considering signing up. But Instagram remains a much riskier bet for anyone talking about sex. At the end of the day, “Twitter is the biggest adult-friendly platform out there,” explains Ties.

Of course, there’s a trap here, too. Part of Twitter’s appeal is that it’s a mainstream platform that happens to be sex work friendly. If it’s no longer appealing for anybody else, that cuts off a huge amount of the audience sex workers are trying to reach. There’s a reason why porn-focused social media sites like Xdigg, a XXX Digg clone, never actually took off.

But for now, sex workers are drawn to Twitter Blue for the same reason they’re on Twitter in the first place: in a precarious industry, any potential leg up is well worth trying. $8 a month is a minimal price to pay if it helps sex workers maintain a constant flow of traffic — or, like Vanniall, helps them beat back scammers and catfishing. “Sex workers have always been incredibly resourceful,” says Stabile. “If they see a tool that’s going to be useful, they’re going to use it.”

Why did images of early pregnancy cause such a social media firestorm?

2022-11-03T08:00:00-04:00

An image of early pregnancies from five weeks (bottom left) to eight weeks (top right). The tissue has been rinsed of blood and the menstrual lining has been removed, leaving only the gestational sac. | MYA Network/Dr. Joan Fleischman, MD, MPA

When Jessica Valenti first decided to share photos of what an early pregnancy looks like on TikTok, she knew that the images would cause a stir. Since the official fall of Roe v. Wade, Valenti has become a devoted abortion rights commentator, offering daily updates about the current state of abortion rights through her newsletter, Abortion Every Day. Over the course of the project, Valenti has attracted her fair share of trolls and angry commentary — but none of it prepared her for the response to her TikTok on early pregnancy on October 19th.

She expected that she’d get some right-wing pushback — maybe some anti-abortion types who’d insist that if you zoomed in on the photos of amorphous pregnancy tissue, you’d actually get a glimpse of a tiny person. What she did not expect was how many people — many identifying as pro-choice — would flood her comments insisting that the photos she’d shared were fake, that they’d been digitally altered to look less human, and that she was spreading misinformation that would only hurt groups that support abortion rights.

@auntiekilljoy
#greenscreen they need to show these images at every political debate about abortion #feminism #abortion #fyp
♬ original sound – Jessica Valenti

The photos weren’t fake. The images, showing small white blobs in petri dishes set against an aqua blue background, came directly from abortion providers: specifically, from clinicians associated with the MYA Network, an organization working to normalize abortion care. In both The Guardian and on their own website, MYA Network representatives explained the origin of the photos: these were actual pregnancies removed from abortion patients with a process called manual vacuum aspiration. They’d been rinsed clean of blood in order to make the pregnancy tissue more visible. But other than that, there’d been no alteration or manipulation. These little white blobs were, as Valenti noted in her video, what the law had deemed more valuable than the life of a pregnant person.

Over at The Guardian, Poppy Noor — the journalist who worked with the MYA Network to publish the photos — experienced something similar. In the fact-checking process on her story, she encountered a shockingly high number of editors — even editors who supported abortion rights — who doubted the veracity of the photos. “At the beginning, everybody was like, ‘Are we sure?’ If this really was what it looked like, how come it doesn’t look like that online?” Noor recalls, describing it as a moment where no one was quite sure whether they could believe their own eyes.

“The level of misinformation is so high that people on all different sides have been confused,” she said.

Ultimately, what won Noor’s team over was trust in the experts. ”You speak to the doctors and they’re like, ‘No I literally removed this from somebody. I haven’t doctored it. I haven’t changed it. This is what an abortion looks like at five, six, seven, eight, nine weeks,’” Noor explains.

“The level of misinformation is so high that people on all different sides have been confused.”

But most people don’t have an abortion provider on call to answer questions about what an early pregnancy looks like. On top of that, many people will never experience an early miscarriage or see the products of an early abortion firsthand. As a result, the general population has limited access to information about fetal development. There are, of course, the photos wielded by anti-abortion protesters, many of which depict fetuses from well into the second trimester of pregnancy in the hopes of deterring potential abortion patients. But even ostensibly politically neutral sources come with a bit of a bias: information about early pregnancy is often designed with expectant parents in mind — people eager to bond with and humanize the cells that are rapidly dividing inside of them. As a result, there’s an incentive to create fetal development charts that don’t depict the proportional size of an embryo, exaggerating an early pregnancy’s resemblance to a fully grown baby. There’s a tendency to anthropomorphize the cluster of static in an early ultrasound or talk about a “fetal heartbeat” when nothing resembling a heart has actually been built.

For Renee Bracey Sherman, the founder and executive director of the abortion storytelling organization We Testify, it’s understandable that people who want children would be eager to see a tiny cluster of cells as protohuman. The problem is when that perspective is foisted on people who don’t want to be pregnant, when one pregnant person’s excitement is used to warp the information given to abortion seekers — or, for that matter, the medical information provided to the public at large. “It’s not the existence of the images themselves, it is how it is used to coerce people,” says Bracey Sherman.

That’s probably why these photos caused so much of a stir. Most images of pregnancy are packaged in a way that highlights the humanity of a fetus: doctors decode blurry ultrasounds by pointing out the beginnings of heads, hands, and torsos; we’re trained to see future people in the earliest stages of fetal development. The images supplied by the MYA Network strip away all the magnification, and all the storytelling that goes with it, to reveal an unvarnished picture of a literal clump of cells.

For those who feel invested in the specialness, the sanctity, of human pregnancies, it can feel disturbing to see the beginnings of human life presented in such a bare-bones fashion. But for others, these images bring tremendous relief. Amid the harassment and angry emails, both Noor and Valenti have gotten messages from many people who took great comfort from the photos. In some cases, “they carried huge shame and these images have been really helpful,” says Noor. “Being able to see this imagery has helped them to make sense of their own experiences.”

Discussions of pregnancy and abortion will always be fraught. In addition to the fact that questions like “when does life begin?” are better left to philosophers than scientists, there’s also the reality that a wanted pregnancy will always feel different from an unwanted one — that the potential life represented by a six-week gestational sac will feel more human, more like a person, to someone who is eager to welcome a child into their home.

“Being able to see this imagery has helped them to make sense of their own experiences.”

Valenti, who has terminated both a wanted and an unwanted pregnancy, is deeply familiar with the difference in these experiences. “I had one early abortion when I was in my late 20s, before I met my husband, and that was not emotional for me. It was a very easy decision,” she says. “And then I had another early abortion when my daughter was 3.” This time, Valenti opted to terminate due to health risks. During her first pregnancy, she developed severe preeclampsia and almost died. The idea of going through that again was terrifying, even though, as she says, “I really did want to have another baby, and I really wanted my daughter to have a sibling.”

That second abortion gives her some empathy for those who see a tiny human in that clump of cells. “It didn’t matter to me how early the pregnancy was; it didn’t matter to me how visible or invisible this embryo was,” she says. “It was about this promise of a life I had in mind. And so that’s what made [the abortion] difficult for me.”

But even as those first few weeks of human development can feel dramatically different to different people — or even the same person in different circumstances — the one thing that shouldn’t be up for debate is what actually exists in the uterus in the early weeks of pregnancy, when the vast majority of abortions take place. It’s a tiny ball of tissue, small enough to fit in a petri dish. If we can’t accept that fact, then how can we begin to have an honest conversation about pregnancy and abortion?

“Everybody thinks they know everything they need to know about abortion when, in fact, they actually know nothing,” says Bracey Sherman. “And that’s what’s really hard.”

Update 11/3 9:22 PM ET: A line has been adjusted to better clarify Noor’s recollection of what it was like verifying the photos.

The human threat to abortion seekers

2022-10-15T09:00:00-04:00

In the years before Roe v. Wade, an anonymous group of Chicago-area women known only as The Janes came together to provide safe, clandestine abortions to pregnant people in need. Over the course of several years, the group provided over 11,000 abortions. When they were finally busted by the police in 1972, it wasn’t because of police surveillance or the group’s anti-war activism or even their willingness to provide abortions to the pregnant family members of police officers. It was a family member of a Jane patient who tipped off the police.

“Some nosey bitch tried to snitch on someone who needed an abortion,” says Renee Bracey Sherman, founder and executive director of the abortion storytelling organization We Testify.

Fifty years later, the threat that took down The Janes still looms large for people seeking abortion under criminalization. While activists rightly warn about text messages, browser histories, and other digital evidence trails, it’s low-tech — and human — security breaches that often pose the greatest risk.

It’s low-tech — and human — security breaches that often pose the greatest risk

“The biggest threat to the privacy of abortion seekers is other people,” says Laura Huss, a senior researcher at If/When/How, a legal organization dedicated to protecting the rights of abortion patients. “People’s private information — like what they search for on the internet or text messages that they’ve sent to others — have come into evidence in cases where people have been charged with a crime for self-managing an abortion. But again, the precipitating factor has most often been someone else reporting them to law enforcement, who then have the power to seize people’s devices.”

In their research on adults who’ve been criminally investigated or arrested for allegedly self-managing or assisting an abortion, If/When/How discovered that a full 45 percent of cases were brought to the attention of the police via a healthcare professional like a doctor, nurse, or social worker. Another 26 percent of people were reported by friends or family members. (Eighteen percent came to the attention of police in other ways, like police recovery of fetal remains, anonymous tips to police, or a 911 call. In the remaining 11 percent of cases, If/When/How could not identify how police were initially alerted.) These findings are consistent with cybersecurity generally: more often than not, it’s other people who are the weakest link in the chain.

The most effective security solution is also an incredibly isolating one

But if human informants are the biggest threat to abortion seekers, that means the most effective security solution is also an incredibly isolating one. Perfect security would mean keeping the procedure and even your pregnancy a complete secret, shutting out friends and even primary care providers. But for most people, that kind of complete lockdown isn’t practical — and might be too painful to bear. Terminating a pregnancy can be a fraught, emotional experience, even when the abortion is a wanted one. Going it alone can be really tough, particularly for people who are self-managing at home with abortion pills and without the assistance of a medical professional.

“I’m not a total ‘don’t tell anybody’ sort of a person,” says Bracey Sherman, noting that her stance is closer to “be careful of who to trust.” In her experience, “it’s not a surprise for people — usually — where their family members stand on abortion.” That basic information can be a pretty reliable guide for who is, or isn’t, safe to open up to.

But, she notes, this isn’t always foolproof. In her own life, Bracey Sherman has seen multiple instances of an avowed abortion supporter changing their tune once the reproductive rights battle pops up in their own backyard. “Somebody’s super, super pro-choice until they realize someone in their family needs an abortion,” she says. “Then all of the assumptions they have about who has abortions and why come to the surface” — and things can get ugly fast.

As long as abortion is viewed as shameful and dangerous, the people who need abortions will be unsafe

If you don’t want to chance it with friends and family, a number of abortion rights organizations are committed to helping people navigate the abortion process — including providing emotional support — without compromising their safety or privacy. Some, like Reprocare and the Miscarriage and Abortion Hotline, have been explicitly set up to help people through the process of self-managed abortion. Others, like local abortion funds and doulas, might not explicitly advertise their support services but can be useful (and confidential) all the same. “I’m somebody that you would call,” Bracey Sherman adds. “A lot of us [in the abortion space] are just there for you. It feels weird to trust a complete stranger and not your best friend. But that’s the life that we live right now.”

Friends and family aren’t the only people you have to worry about reporting you; healthcare providers are also a risk. Although abortion is incredibly safe, even when it’s done at home alone with pills, some people still experience complications that require medical attention. And others simply want to get checked out by a doctor for their own peace of mind. Whatever your reason for seeking medical assistance, it’s crucial that you don’t mention your abortion to the doctor, receptionist, nurse, or anyone else you might encounter during your appointment. Instead, most abortion organizations recommend telling doctors and other care professionals that you had a miscarriage since there’s no medical way to distinguish between miscarriage and abortion with pills.

But this is hardly foolproof: if a doctor doesn’t think you’re sad enough about your miscarriage, they may flag you as someone who had an abortion anyway, particularly if you’re a member of a group that’s routinely policed and criminalized, like people of color and low-income folks. So another option is to simply act surprised and confused, as though you had no idea you were pregnant in the first place. Unlike a miscarriage after a known pregnancy, there’s no “correct” way to respond to the spontaneous end of a pregnancy you weren’t even aware of. (Under no circumstances should you ever mention illicitly acquired abortion pills to doctors. They do not need to know!)

Yet fundamentally, the only way to truly protect the privacy of abortion patients is through widespread education focused on destigmatizing abortion. In the long run, that work will lead to better abortion laws. But even in the short term, teaching people that abortion is safe reduces the incentive to report abortion seekers to the police. As Huss and Bracey Sherman both note, many people who report a self-managed abortion to the police aren’t acting out of malice but, rather, a misguided desire to help. As long as abortion is viewed as shameful and dangerous, the people who need abortions will be unsafe. Building a world where abortion is recognized as a fundamental part of reproductive healthcare — and, most importantly, a private medical decision — is the best way to protect the security and safety of abortion seekers.

“We Testify started with the slogan ‘Everyone loves someone who had an abortion’ because we’ve always known that it’s the people closest to you that are the ones who hurt people the most,” says Bracey Sherman. Working to get those people on board with abortion rights isn’t just politically savvy; it could literally save your life if you ever need an abortion yourself.

The ‘abortion pill’ could also be birth control — and activists are trying to prove it

2022-07-23T09:00:00-04:00

Imagine a totally new form of contraception. It’s a pill, but instead of taking it every day at the same time, you only take it once a week — or, potentially, even less frequently. If you’re not having regular sex, you can stop and start this pill as needed or just take it after you’ve had sex since it also works great as a “morning after” pill. It doesn’t contain the hormones estrogen or progesterone, so many of the side effects commonly associated with current birth control pills (including weight gain, mood swings, acne, and decreased libido) aren’t an issue. And if you wind up taking it long term, it thins your uterine lining, eliminating your period. More amazingly, it also has the potential to treat endometriosis and fibroids and maybe even prevent breast cancer.

Sound too good to be true? Here’s the best part: this hypothetical birth control pill already exists, has been extensively researched for both safety and efficacy, and, even better, is an FDA-approved medication. The catch? It’s mifepristone, better known as the “abortion pill” that Republicans around the country are currently trying to ban. At a moment when abortion access feels newly precarious, abortion advocates are hoping that a focus on mifepristone’s contraceptive properties will help tear down the artificial wall between “abortion” and “contraception” in the process — and help secure mifepristone access around the globe.

The same mechanism that makes mifepristone work for abortions could prevent ovulation altogether

Mifepristone’s contraceptive properties aren’t actually news. Throughout the 1990s and 2000s, researchers like Kristina Gemzell Danielsson, a professor of obstetrics and gynecology at the Karolinska Institutet, examined the compound’s efficacy as both emergency contraception and a birth control pill. Though there was some debate over whether mifepristone worked best as a weekly or monthly contraceptive, the general consensus was that it showed great promise as a non-hormonal birth control pill. The same mechanism that it uses to halt fetal development — blocking the release of progesterone — can also be used to prevent ovulation and thin the uterine lining, making pregnancy impossible.

But about a decade ago, research interest in mifepristone seemed to dry up — largely, Gemzell Danielsson thinks, because of abortion stigma. Another compound, ulipristal acetate, held similar promise as an emergency contraceptive and fibroid treatment without the baggage of abortifacient branding. “It was sort of decided that [ulipristal acetate] should be developed more for contraception while mifepristone should be developed for abortion,” says Gemzell Danielsson, noting that ulipristal acetate went on to become a common emergency contraceptive (sold as Ella) and fibroids medication (under the brand name Esmya).

But ulipristal acetate has risks mifepristone doesn’t. Notably, there have been rare but serious instances of liver damage when taken regularly to treat fibroids. In contrast, mifepristone has largely been found to be safe, even when taken in large doses on a daily basis (Cushing’s syndrome patients routinely take 300-1200mg of mifepristone daily, vastly more than the 25-50mg a week required for contraception). Researchers have also found it’s a safer alternative to current endometriosis medications as well as a safe and effective fibroids treatment — and though it’s still early in the process, Gemzell Danielsson has been involved in studies that show promise for using mifepristone for breast cancer prevention.

Over two decades after she first studied the possibility of using mifepristone for contraception, Gemzell Danielsson is working with Dr. Rebecca Gomperts — best known as the founder of abortion access organizations Women On Waves, Women on Web, and Aid Access — on a new study aiming to conclusively prove that mifepristone can, and should, be used as a primary contraceptive.

Seven hospitals are on board to participate in a study on the pill’s reliability

As a first step, Women on Web has convened a team of medical, scientific, and ethics experts from around the globe to conduct a year-long clinical trial involving nearly 1,000 women in the Netherlands and Moldova, using weekly mifepristone for a year. The study was designed in keeping with FDA and European Medical Agency protocols and has already recruited seven hospitals as participants and secured all the necessary clinical and ethical approvals to begin the study in Moldova. Through it, Women on Web plans to pick up where Gemzell Danielsson’s research left off, determining the most effective dosage for contraceptive use, as well as any unforeseen complications and side effects that might arise from weekly use of low-dose mifepristone.

If the study conclusively determines a safe and effective dosing regimen for a prophylactic formulation of mifepristone, Women on Web will register the medication as a contraceptive with the European Medicines Agency. A number of organizations have already committed to distributing the medication as well. The study could also open doors for the FDA to approve a low-dose mifepristone contraceptive pill alongside the 200mg abortion pill and 300mg Cushing’s medication.

That distinction could allow mifepristone to be more widely — and more affordably — distributed. While the Affordable Care Act currently requires insurance companies to cover contraception, abortion is not necessarily covered. Additionally, providers who wish to distribute the abortion formulation of mifepristone are bound by regulations that aren’t applied to the Cushing’s formulation (and, potentially, the birth control formulation).

“It’s a very steep mountain to climb”

That outcome isn’t guaranteed. Beverly Winikoff, president of Gynuity Health Projects, is skeptical that the end results of this study will be significantly different from others that came before. “It’s a very steep mountain to climb,” she says. The FDA’s requirements can be incredibly challenging to meet, even in a case where the compound has already been approved for other uses. In the best-case scenario, a contraceptive version of mifepristone would still be years away from market — and there are several hurdles to overcome along the way.

One of those hurdles is funding. Because contraceptives are generally cheap and mifepristone specifically is out of patent, there’s no major profit incentive behind this study — so pharmaceutical companies haven’t been particularly eager to get on board.

Grants have proven challenging to secure as well. When Women on Web applied for funding through ZonMw’s Goed Gebruik Geneesmiddelen (Good Use of Medicines) program, their application received pushback. One response from the application committee was particularly telling. “According to the committee, repeated prescriptions run the risk of saving up and illegal resale to induce an abortion,” it said, translated into English. “You are requested to explain how the drug remains within legal abortion practice and how this risk is mitigated.”

It was a comment she found bizarre given that abortion is legal in the Netherlands and — at least according to the Dutch government — readily accessible to all who need it. “If you really analyze those kinds of arguments, it’s not really about the medication — it’s about the mistrust of women,” she says. There are plenty of easily accessible items — including everything from Tylenol to bleach — that can be harmful if used improperly. Why is mifepristone viewed so differently? (Notably, it’s only funders who’ve had this concern: the European Medicines Agency and Dutch Pharmaceutical Agency expressed no such concern when advising on the study. “It just seems that giving money to things is so much more political,” says Dr. Gomperts.)

Mifepristone offers new options that other birth control methods don’t

In the meantime, Women on Web is pursuing a novel funding strategy for a scientific study: crowdfunding. Dr. Gomperts has set up a GoFundMe campaign with a goal of €500,000 — the amount needed to kick off the initial phase of research. It remains to be seen how successful the strategy will be, but Dr. Gomperts is still excited by the idea of putting her study’s funding directly in the hands of the people who could benefit from its findings the most.

This isn’t the first time medical research has turned to the people when traditional funding sources have come up short. About a decade ago, the oncologist and cancer researcher Dr. Jim Olson launched Project Violet, a platform where anyone could kick in cash to support research into projects like Tumor Paint. Although Project Violet did spark some discussion about the ethics of using crowdfunding for medical research, it was also a significantly different premise than what Women on Web is doing. Unlike Dr. Olson, Dr. Gomperts and her team are researching a well-studied, out-of-patent medication that anyone can manufacture and profit from, so there’s little concern about Women on Web enriching itself through research. Their use of GoFundMe is, in some ways, not significantly different from the donation requests used to fund a number of research organizations.

Should the study prove successful, it’ll hopefully break down some of the stigma around mifepristone and allow it to be seen not just as an abortifacient but as a powerful medication with a range of uses. “There is so much potential in [mifepristone],” Gemzell Danielsson says. “The potential has been known — it’s the connection to abortion that delayed further development.”

What does the future of abortion look like?

2022-05-05T14:00:33-04:00

After nearly 50 years of relative stability, the future of abortion in America is suddenly very uncertain.

On Monday night, a leaked draft opinion showed the Supreme Court is preparing to overturn Roe v. Wade, the 1973 decision that secured the right for people to terminate their pregnancies across the United States. In a matter of months, many common abortion procedures could become illegal in the 22 states that have passed laws in anticipation of such a ruling. Even in states without those laws, access will likely grow more precarious as state legislatures respond. The new laws won’t stop abortions from happening; instead, they’ll force them underground, adding legal and medical risks to what was once a safe and standardized procedure.

But while criminalizing abortion will have dire consequences, it doesn’t necessarily mean a return to the dangers of 50 years ago. New pharmaceuticals have made surgical abortion less necessary, and new resources have sprung up to help people obtain and self-administer those drugs. It’s not the same experience as what you would get from Planned Parenthood or other medical providers, but it’s a far cry from the worst-case-scenario options of pre-Roe America. Instead, it’s a new kind of digital underground, with providers, volunteers, and pregnant people all taking calculated risks to stay safe in the chaotic new system.

“The future of abortion is increased knowledge about abortion pills,” says Susan Yanow, the US spokesperson for Women Help Women, an abortion access organization. “Abortion will not stop and those of us who support the right to bodily autonomy will continue to work to put these pills into the hands of those who need them.”

“The future of abortion is increased knowledge about abortion pills.”

We can see hints of that system in states where abortion rights have already been heavily restricted. “We’re already in a post-Roe world in places like Texas,” says Elisa Wells, co-founder of Plan C, an online abortion resource, noting that expansive bans like SB 8 have rendered abortion functionally illegal in much of the South. In places where abortion is all but inaccessible, there are some echoes of an earlier era, like well-off abortion seekers heading to “safe” states like New York and California for their procedures. But Texas as well as places outside the US where abortion is currently criminalized don’t look like 1970s America.

These days, most abortions are no longer surgical or necessarily require going to a doctor’s office. Instead, they’re performed with a combination of two drugs: mifepristone and misoprostol. The first pill, mifepristone, blocks the hormone progesterone and stops the pregnancy from developing further. The second pill, misoprostol, triggers contractions that expel the contents of the uterus. Together, these pills are incredibly safe and extremely effective. Misoprostol can also be used on its own, and because it has other uses like treating ulcers and inducing labor, it can be found in places where mifepristone is criminalized — sometimes even over the counter.

Although many people still turn to surgical methods like vacuum aspiration or dilation and curettage (also known as a D&C), abortion with pills (also known as medical abortion or medication abortion) has become an incredibly popular method around the globe. In some European countries, over 90 percent of abortions are performed with pills; in the United States, over half of all abortions performed in 2020 were medication abortions.

Any underground abortion is far from an ideal scenario

Unlike surgical abortion, terminating a pregnancy with pills does not require any special skills or the assistance of another person. People can safely take mifepristone and misoprostol all by themselves in the privacy of their own homes. And that has radically upended what it means to have an underground abortion.

While any underground abortion is far from an ideal scenario — people who need abortions shouldn’t have to jump through hoops, and patients should be able to openly speak with their doctors about their reproductive health needs — a self-managed abortion with pills from a covert source isn’t drastically different from a medication abortion using pills from a doctor.

An advertisement for Plan C in the New York City subway. | Image: Plan C" data-portal-copyright="Image: Plan C" />

Pills aren’t a viable option for everyone who needs an abortion (including people with bleeding disorders, people with IUDs, and people who need abortions late in pregnancy), but for those who can use the method, safely terminating a pregnancy in a place where abortion is illegal doesn’t require finding someone willing and able to perform a safe abortion in secret. It just requires getting pills.

Which brings us to the other thing that’s changed since the 1970s: the internet. As a sprawling, decentralized, and often ungovernable information platform, the internet has made it easier for people to buy drugs, distribute blueprints for 3D printed guns, and even organize insurrections. It’s also made it vastly easier to access both information about safe self-managed abortion — and abortion pills themselves — than would have been possible back in the pre-Roe era.

Over the past few years, as it became clear that Roe’s fate was sealed, an entire infrastructure has been built to help Americans self-manage abortions. Plan C maintains an extensive database of both telemedicine abortion sites and online pharmacies that ship abortion pills, with information on which services operate in all US states and territories. Websites like How to Use Abortion Pill and Self-managed Abortion; Safe & Supported (SASS) offer detailed guides on everything people need to know when using pills to terminate a pregnancy without a doctor’s support.

While abortion with pills is vastly easier for people who live in, or can travel to, states that are served by fully legal telemedicine services like HeyJane or Carafem, it’s possible to get abortion pills even in places where it’s illegal. The European site AidAccess connects patients in states where abortion is criminalized to Indian pharmacies. Because getting the pills can take several weeks, AidAccess also offers “advance provision” — basically, they’ll provide access to abortion pills before you get pregnant just so you have them on hand. And people are definitely using these sites to navigate a post-Roe world. After abortion was criminalized in Texas this past fall, AidAccess requests from that state dramatically increased, a significant jump that wasn’t mirrored in other states during the same time period.

You don’t even have to go online to get abortion pills

You don’t even have to go online to get abortion pills. Because misoprostol has multiple uses, it’s more readily available than medications that are primarily abortifacients. Doulas have access to it. Doctors can prescribe it off label — as they already do when prescribing it as part of a mifepristone-misoprostol combo or when using it to induce labor. In countries like Mexico, it’s available over the counter. If someone is sufficiently motivated (and has access to a lab and knowledge about chemistry), they could even make misoprostol themselves: the chemical structure is readily available online.

Even though modern self-managed abortion is physically safe, it still comes with major risks. In an era where pills make safe self-managed abortion an accessible reality, the biggest danger isn’t septic shock: it’s prison.

“People have been unjustly arrested, prosecuted, or even jailed”

The legal landscape of self-managed abortion is complicated and confusing. In addition to outright abortion bans, like Texas’ SB 8 and similar laws that have popped up across the South, people have also been prosecuted under fetal endangerment laws or laws that restrict people from practicing medicine without a license — all while Roe v. Wade is still the law of the land. “Even though having an abortion is currently legal in every state in the US, some people have been unjustly arrested, prosecuted, or even jailed for causing their own abortion. Those who assist them have been criminalized as well,” says Melissa Grant, chief operations officer of Carafem operator FemHealth USA. Last month, a Texas woman named Lizelle Herrera was jailed for three days after being accused of self-managing an abortion. Although the charges against Herrera were dropped, they’re a chilling warning of things to come.

When people do get pulled into the legal system, it’s often because they went to a doctor in one of the rare cases when a self-managed abortion has complications or is incomplete. Other times, people mention the pills during a check-up, as happened in the case of Jennifer Whalen. “Providers may mistakenly believe that they have mandatory reporting obligations for a self managed abortion, and that is not correct,” says Sara Ainsworth, senior legal and policy director at If/When/How. “There’s no law that requires people to report self-managed abortion.”

Additionally, because there’s no way to physically distinguish between a miscarriage and medication abortion, doctors often report people who come in seeking care post-miscarriage simply because they suspect that they’ve had an abortion. Not surprisingly, it’s the most marginalized — like people of color and low-income people — who are the most likely to be swept up in these criminal cases.

Ainsworth points out that prosecution often occurs even when no law has been broken. States like California have also punished people for miscarriages and stillbirths in addition to self-managed abortion. And the more stigmatized abortion becomes, the more likely it is that law enforcement and prosecutors will pursue criminal charges against not just people who’ve self-managed abortions but also people who’ve experienced miscarriage.

In anticipation of this, If/When/How has created the Repro Legal Helpline and Repro Legal Defense Fund. The first is set up to provide advice on navigating the legal risks of self-managed abortion; the second provides financial assistance for people who’ve been criminalized for the outcome of their pregnancy.

Even with these risks, many abortion advocates believe that safe self-managed abortion has the power to keep the “coat hanger” abortion at bay. “Our research has shown that medication abortion self-managed in this way is safe and as effective as visiting a clinic,” says Abigail Aiken, an associate professor at the LBJ School of Public Affairs at the University of Texas, Austin. “This is such an important option to prevent a return to the unsafe abortions of the pre-Roe era.”

Porn companies are embracing crowdfunding

2019-04-03T09:15:00-04:00

The flood of free porn online has made things hard for professionals who are looking to make a living. For every video-on-demand service, there are dozens of free alternatives and outright pirated films to choose from. Facing the new reality of their industry, many pornographers have gotten creative about how they bring in the bucks, enlisting crowdfunding sites like Indiegogo and Patreon as a new way to make money in the porn business.

Over the past 14 years, Pink and White Productions has established itself as one of the leading voices in San Francisco’s queer porn scene. Its flagship site, The Crash Pad Series, has a thriving, enthusiastic membership base. The video-on-demand site PinkLabel.TV partners with a number of notable directors to provide easy, low commitment access to high-quality smut. The company’s features routinely garner high praise and have won multiple awards. And yet, despite Pink and White’s numerous bona fides and loyal fans, this past February, it set up shop on Indiegogo.

For some users, a crowdfunding platform feels more intimate and direct

Pink and White’s monthly revenues are enough to fund regular updates and the occasional small side project, but the crowdfunding push let it get more ambitious. The campaign served as the first round of funding for a new feature film, Chemistry Eases the Pain, while generating press and PR for the project. As many production houses have discovered, it’s easier to get people talking about your big new project than the same thing that you’ve been doing for the past 14 years.

There’s another, more complicated reason why Indiegogo is such an important resource for a company like Pink and White. Some fans are squeamish about typing in their credit card number on an explicitly adult site like The Crash Pad. When they can pay through a mainstream venue like Indiegogo or Patreon, the number of people who are willing to shell out increases substantially. That gives Pink and White access to a whole new group of funders, ones who would be difficult to reach any other way.

Some fans worry that a porn site might rip them off or continue to rebill them without their consent — a notion that stems from the early days of online porn when shady billing practices were commonplace. Others say going through something like Indiegogo or Patreon often ends up being a better deal. “The prices are much more reasonable; the tier I chose is only $3 a month / $36 a year,” one person told me about their favorite erotic Patreon, noting that at Kink.com, where a year’s membership runs to $240, “the prices are really too much for my underemployed blood.”

Consumers want a different experience of paying for porn

Still, other customers noted that a crowdfunding platform felt more intimate and direct — as though they were paying their favorite performers and creators instead of some faceless corporation — and they saw their contributions as a way to fund work they care about, rather than just lining a wealthy pornographer’s pockets.

This is a familiar approach for independent artists. Pink and White made its name with arty, queer films that are significantly different from the typical fare found on Pornhub. From the beginning, their fans have been excited about supporting indie artists who showcase different kinds of bodies and different kinds of sex than the bulk of mainstream porn. But providing a different porn-watching experience isn’t always enough. In order to shell out cash, some consumers need a different porn-paying experience as well.

The shift to crowdfunding has risks. Mainstream spaces have long been uneasy about allowing pornographers to use their services; payment processors like PayPal have refused to process porn-related payments since the early aughts. In an era when it was easy to get consumers to pay for porn, those barriers were a minor annoyance. But in recent years, losing out on access to mainstream platforms has become a major problem.

There are also deplatforming concerns. A few years ago, venues like Tumblr and Patreon were relatively friendly to adult content, allowing porn creators to exist on their platforms — and, in Tumblr’s case, even proudly advertising their presence at one point. But now, both sites have cracked down on adult content. On Tumblr, there’s been a total ban on anything resembling porn. Patreon users are theoretically able to use the platform if they mark their content as “adult,” but there’s an uneasy sense that one’s position on the site isn’t particularly secure. Four Chambers, an independent erotic film production collective that had a thriving membership through Patreon for several years, had its account suspended last summer with no notice and no real explanation.

Four Chambers frames its financial ask in terms of patronage and “support”

There are signs that porn sites are adapting their sales pitches in the hopes of capitalizing on the legitimacy that Indiegogo and Patreon have brought to their projects, helping potential consumers rethink what it means to pay for porn in the process. Four Chambers is now set up as a standalone membership site. Because mainstream payment processors like Stripe and PayPal won’t work with adult content, Four Chambers’ new site runs membership payments through porn-friendly payment processors, rendering it functionally the same as any other adult project.

Rather than imploring browsers to “join” or unlock access to a wealth of amazing content, Four Chambers frames its financial ask in terms of patronage and “support.” “The Four Chambers project raises money to fund new projects, pay performers and make new films through ongoing community crowdfunding,” the site declares, encouraging fans to pledge $9 / month to help the project survive. It’s not the only porn site framing membership this way: Spark Erotic invites browsers to become patrons, and Aorta Films describes its revenue as “community crowdfunding.”

Pink and White Productions is also shifting toward the language of support. In this era of bountiful free porn where everyone is looking at tube sites, “we’ve tried to hit hard the idea that this is benefiting the creators,” Jiz Lee, the marketing director for Pink and White Productions, tells me. Lee notes that, on PinkLabel.TV, every video comes with a note reminding consumers that by paying for porn, they’re directly supporting the people who make it.

It’s a different mindset from the early days of online porn when X-rated content didn’t have to prove its worth or make such a concerted sales pitch. But Lee, who has a background in arts fundraising, says that it’s not that different from the way the arts have always funded themselves.

The internet may have made pornography more accessible than ever, but if we want our favorite pornographers to stick around, we’ll need to get over our sense of stigma and remember that, at the end of the day, porn is just another art form that requires money to create. “As someone who values the arts and freedom of expression,” Lee says, they appreciate the way that this new model of porn funding reminds people that porn “does require the participation of people who want to see it prosper.”

At-home HPV tests attempt to reduce cervical cancer rates

2019-02-14T13:55:56-05:00

Getting screened for strains of the cervical cancer-causing human papillomavirus (HPV) can be difficult for many women, but not getting tested can have deadly consequences. In 2019, an estimated 4,250 women will die from invasive cervical cancer — a number that, the American Cancer Society notes, has not changed much in 15 years. To bring that number down, some companies are trying to bring HPV tests out of the doctors’ offices and into women’s homes.

“Half of the cervical cancers that continue to occur in the US are amongst women who rarely screen or have never been screened,” says Vikrant Sahasrabuddhe, program director in the Division of Cancer Prevention at the National Cancer Institute. Notably, a Centers for Disease Control and Prevention (CDC) report from 2017 found that rural areas have higher rates of cervical cancer than their urban peers, despite a lower incidence of cancer overall.

In 2019, an estimated 4,250 women will die from cervical cancer

For Jessica Horwitz, the clinical development director for telemedicine company Nurx, there’s a simple solution to this persistent problem: enable women to test themselves at home. After finding success using the telemedicine model to increase access to both birth control and drugs that reduce the risk of HIV infection (also known as Truvada or PrEP), Nurx recently launched a new at-home HPV testing service that should be relatively easy for patients to use.

“It’s a vaginal swab,” Horwitz explains over the phone, noting that after the user swabs their vagina, they are directed to break the tip off the swab off, insert it into a container that’s provided with the testing kit, and mail it back to Nurx for analysis.

At-home sexually transmitted infection (STI) screenings have been a part of the reproductive health landscape for years: in 2012, the Federal Drug Administration approved an at-home version of the OraQuick oral swab HIV test, enabling consumers to quickly determine their HIV status in the privacy of their own home. Similar at-home tests are marketed for other STIs, including chlamydia, gonorrhea, and trichomoniasis. Although not all at-home tests provide the instant results generated by OraQuick (many at-home tests, including the HPV test distributed by Nurx, require the user to send the kit to a lab for testing), they all come with the guarantee of discretion and flexibility, which Nurx hopes will attract clients who might have otherwise passed on a cervical cancer screening.

Nurx is just one of many companies entering the HPV-testing space. Let’s Get Checked, Everly Well, Private iDNA, and Self Collect are some of Nurx’s competitors in the home testing market. In countries like Canada, Australia, and the Netherlands, self-tests have been available for several years.

at-home screenings are not a panacea

These at-home screenings are not without potential risks, however. User error can lead to false negatives. “Somebody who gets a result that’s negative from a doctor’s office, it’s guaranteed,” says Sahasrabuddhe, but with an at-home test, there’s more uncertainty. A false negative could result in someone confidently skipping out on screening for several years only to discover they have cervical cancer once it’s too late to effectively treat. But Sahasrabuddhe is quick to note that there’s not enough data to assess whether false negatives are a major problem.

Additionally, at-home screenings are not a panacea unto themselves. If someone tests positive for one of the cancer-causing strains of HPV, the test will not prevent them from developing cancer. For that, patients will need to undergo follow-up tests and, potentially, a colposcopy, biopsy, and removal of any abnormal cells found on the cervix. But Horwitz hopes that it will serve as an entry point to care — one that Nurx is happy to facilitate. “We have a very robust RN team that has a large referral network,” Horwitz explains. “If someone tests positive for HPV, they’re going to do everything within possible range to find someone in their community that they can refer them to for in-person care.”

“you’ve given someone power and information.”

And when a referral isn’t possible — perhaps because the person lives somewhere remote and far from Nurx’s referral network — “the worst outcome is you’ve given someone power and information,” Horwitz says.

For health professionals, at-home HPV screenings, along with other home STI tests, offer an opportunity to extend reproductive health care to populations that aren’t currently getting access to it. Hopefully, that will help to further reduce rates of cervical cancer and other illnesses in the process. “From a public health point of view, we do recognize the importance of bringing in women who would otherwise be missed,” Sahasrabuddhe says, a point Horwitz emphatically agrees on.

“If traditional brick-and-mortar medicine was meeting the needs of every single woman in America, then home HPV screening wouldn’t need to be a thing,” Horwitz says. “But it’s not.”

Campus vending machines offer emergency contraception without the stigma

2019-02-11T12:37:13-05:00

Thirteen years after a heated battle resulted in over-the-counter approval for emergency contraception, the product is finally shedding some of its stigma, and college campuses are leading the charge toward normalization.

In the fall of 2018, Yale’s Reproductive Justice Action League proposed a new plan to improve the health and wellness of its student population: emergency contraception vending machines. They wanted to join the dozens of other college campuses where emergency contraception vending machines have been quietly popping up for the past decade, making it significantly easier for students to take action in the wake of a broken condom or forgotten pill.

Unfortunately, Yale will not be joining this cohort. Last month, the university announced that it was scuttling the plan, not because of moral qualms or backlash from conservatives, but because of a little-known state law banning vending machines from being used to distribute over-the-counter medications. Similar laws exist around the country and are currently being challenged. This week, a bill was introduced in Maine at the request of students at the University of Southern Maine that would allow some over-the-counter medications — including emergency contraception — to be sold in vending machines.

emergency contraception is now available at health clinics, drugstores, and, yes, in vending machines.

But even as students at Yale and in Maine have to wait on this discreet and easy method of access to emergency contraception, there’s no denying that our national conversation about the product has undergone a major shift toward normalization: emergency contraception is now available at health clinics, drugstores, and, yes, in vending machines.

Emergency contraception, like Plan B, can prevent pregnancy if taken within 72 hours of having unprotected sex. It has been available without a prescription for people above 18 since 2006, and it’s been available to people of all ages without an ID since 2013.

But in some pharmacies, emergency contraception is still kept behind the counter, which can be a major hurdle for anyone who feels awkward or anxious about purchasing the pill. The barriers to access are even higher for people who live in a place where pharmacists can refuse access to emergency contraception as they see fit. Buying online is another option (assuming you manage to locate the genuine article rather than a cheap knockoff), but when the clock is ticking down, you’re probably going want access that’s a little more immediate than Amazon Prime.

On rural campuses, access to pharmacies can be even more limited.

For students on isolated college campuses, distance is an additional hurdle, says Rachel Samuels, the Stanford alumna who led the charge for more accessible on-campus emergency contraception. At Stanford, Samuels says, the nearest pharmacy is about a 25-minute walk away (10 minutes by bike), with no guarantee that emergency contraception will actually be in stock. On rural campuses, access to pharmacies can be even more limited.

That’s why when Stanford students began petitioning for on-campus access to emergency contraception a few years ago, they looked to vending machines as a solution. The vending machine trend started at Shippensburg University in Pennsylvania, which stocked emergency contraception in vending machines in 2012. From there, it spread across the country. Samuels got the idea from her brother, who helped get the product stocked in the existing vending machines at Pomona College.

The result of her work is a small, high-tech vending machine called a Vengo that is located in the all-gender restroom in Stanford’s student center. It allows students to confidentially get access to My Way brand emergency contraception (and condoms) at any hour of the day. The pill costs $25, which is less than the $26 that the student health center charges or the $40 or $50 Plan B tends to retail for at pharmacies, though that’s more than twice what the same brand retails for on Amazon.

In 2018, the machines sold 329 units of emergency contraception

According to Shanta Katipamula, the president of the Associated Students of Stanford University, the machines have been extremely well-received and heavily utilized by students. In 2018, the machines sold 329 units of emergency contraception; due to student demand, plans are in place to install a second machine at the Li Ka Shing Center.

Since the Stanford machines debuted in October 2017, Vengo Labs began stocking emergency contraception at Columbia University and George Mason University. At Columbia, which is located in New York City, sources report that the machines were well-received but haven’t gotten much use, perhaps due to the campus’s close proximity to multiple pharmacies.

Vengo Labs founder Brian Shimmerlik is thrilled that the machines stocked with emergency contraception have been well-received by student bodies, but he says there’s no active plan to aggressively market the offering to additional campuses. Many of its machines sell snacks or small electronics, not medications. At the end of the day, “we are not an emergency contraception company,” says Shimmerlik. “We provide access to products.” For Vengo Labs, emergency contraception just happens to be one more product that its customers want to buy.

In a space that’s long been dominated by reproductive rights activists and public health advocates, it’s strange to hear an emergency contraception vendor discuss the product as though it’s no different from a candy bar or pack of dental floss. Yet, it’s somewhat refreshing, too. Access to emergency contraception has been made overly complicated by stigma associated with sex-related products. Now, in some places, it’s as simple as a swipe of a credit card and the push of a button.

The secret censorship holding back the sex toy industry

2019-01-22T14:26:31-05:00

Earlier this month, thousands of vendors exhibited at the tech trade show CES. But notably absent was the sex toy startup Lora DiCarlo, whose invitation to exhibit at the show was rescinded after CES changed its mind about awarding an Innovation Award to the company’s Osé vibrator.

For some, the decision to revoke the award was a sign of pervasive sexism and a discomfort with female pleasure, particularly given CES’s long-standing tolerance of sex robots, VR porn, and, until recently, booth babes. But vibrator company OhMiBod has been a longtime CES exhibitor, and even won a CES Award in 2016. Alexandra Fine, co-founder of sex toy company Dame Products, was a speaker on the CNET stage this very year.

The “only options are porn networks and Google Adwords”

If anything, the back and forth over Osé is an indication of a broader confusion over whether sex toys count as wellness devices or something obscene. That confusion impacts nearly every aspect of how pleasure product companies do business, from fundraising to retail to advertising. While crowdfunding and online retail have been eager to court the business of other gadget manufacturers, sex toy companies still struggle to navigate content regulations and figure out whether their business counts as “obscene” in the eyes of payment processors, banks, and advertising platforms.

When Fine first launched Dame Products with co-founder Janet Lieberman, she assumed the world would welcome their company, and its thoughtfully designed hands-free clitoral vibrator, with open arms. “I didn’t realize how many no’s I was going to get,” Fine told me.

She was stunned to discover how many doors would slam in her face the second she revealed what products, exactly, Dame was putting out in the world. Kickstarter refused to host the crowdfunding campaign for Dame’s first product, Eva, relegating them to Indiegogo instead (Kickstarter later amended their content policy to be more welcoming of sex toys; Dame’s second product, Fin, was their inaugural sex toy campaign). An application for a government-funded loan from the Small Business Administration was denied due to the “prurient” nature of Dame’s products. Fine has never had any difficulty with third-party payment processors, but some of her colleagues in the sex toy space have had trouble finding a platform that’s comfortable processing their product sales (Dame’s payment processor, Stripe, notes that sex toy companies are occasionally rejected by the platform when they’re deemed to be a “brand risk”).

“Ads must not promote the sale or use of adult products,” says Facebook

Advertising poses the biggest problem. Many companies find that when they go online to advertise, their “only options are porn networks and Google Adwords,” says Brian Sloan, the inventor of the Autoblow. Facebook refuses to run sex toy-related ads, even if the ads are set to display to adults only or link to completely SFW content. “We tried just linking an ad to a Buzzfeed article about Autoblow,” Sloan explains, but even that was considered too spicy to be a Facebook ad. When Dame wants to advertise on Facebook, they have to promote articles about their products through Fine’s personal account.

Even companies that have broken through into mainstream brick-and-mortar stores often find themselves stymied by content restrictions online. The recently launched brand plusOne — the first sex toys to be stocked in-store at Walmart — has been restricted to text-only online ads, “even though these are items that are selling at the largest retailer in the world and one with a specific reputation of being conservative,” says plusOne’s CEO Jamie Leventhal.

Although the advertising regulations for these platforms have gone through several revisions over the years, Facebook’s now makes clear that sex toys are not considered a respectable business: “Ads must not promote the sale or use of adult products or services, except for ads for family planning and contraception,” declares the company’s advertising policy.

Google is a little more lenient, filing sex toys under Adult Content and restricting ads rather than prohibiting them entirely. Still, the rules for what’s acceptable are rather vague. “Some kinds of adult-oriented ads and destinations are allowed … but they will only show in limited scenarios based on user search queries, user age, and local laws where the ad is being served,” the policy explains. (When contacted for comment, Google directed queries to the same policy.)

Adding to the headache is the fact that these regulations aren’t always consistently enforced. Despite the troubles that Sloan and Leventhal have had getting approved for display ads, Dame routinely runs them, albeit under some restrictions: “We cannot retarget on Google display ads,” Fine tells me, adding that if the ads are marked by Google as “not safe for family” — which they sometimes are, and sometimes aren’t — their range becomes limited, with ads blocked from display on sites that are marked as “family” or for users who are under 18 or 21, depending on the user’s location.

At the root of this confusion is the fact that most of these companies have no problem with sex as long as it’s packaged as part of health and wellness, rather than something “prurient” like pleasure. But where the line between personal care and obscenity falls, exactly, is entirely up to individual administrators. The telemedicine company Hers routinely markets the libido-enhancing medication Addyi on Facebook; what makes Addyi okay and the Eva vibrator obscene isn’t entirely clear.

For now, the main recourse sex toy companies have is to keep making their case, and hope that whoever’s making the decision will have a change of heart. “We need to keep knocking on doors,” Fine says. After all, Dame only secured approval from Kickstarter after making a direct, personal appeal to colleagues they’d befriended through the Brooklyn startup scene — a strategy that Fine is all too happy to use in the future.

It’s not an ideal situation, but Fine still holds out hope that with enough time and effort, sex toy manufacturers will be able to firmly establish their products as just one more part of personal care and wellness. “These are real tools that can help you have more pleasurable experiences in your body,” Fine says. “If you think ED medication is health… I don’t understand how you can look at me and think anything different.”