Sexual health isn’t just physical; it’s emotional self-care
By Clara How, Nov 19, 2020
Before Xi Liu entered our virtual chatroom, I didn’t know what to expect. On paper, she sounded pretty formidable, and more than a little intimidating.
A young woman who graduated from the prestigious Carnegie Mellon University with a Master’s degree, her resume includes being a product designer for Adobe and a product manager for Amazon. She left it all behind to come to Singapore and launch a female healthcare online service called Ferne Health, which provides a range of home-based screening kits. Customers will be able to test for sexually transmitted infections (STIs), cervical cancer and the like in the privacy of their bedroom.
All this, at 28. I expected someone ambitious, someone deeply passionate about female healthcare — someone on a mission to problem-solve. Xi is all that, and she’s also a ball of fun. She’s bubbly and disarming, and her earnestness comes through, whether it’s apologising for rambling, or about her lack of sex education growing up.
Her enthusiasm is important, because so much of healthcare feels factual, weighed down with dos and don’ts. It’s prescriptive, and for a reason. But while Xi acknowledges the physicality of female healthcare, she believes that it is just as emotional as it is physical. She wants women to know that understanding your body helps you see yourself, and the world, through a new lens.
If you were to ask if I had an epiphany to become an entrepreneur in the female healthcare field, to be honest, there was no such light bulb moment for me. What it was, rather, was a gradual change in mindset, brought about by a change in environment, meeting new people and learning about my body and sexuality.
There is, however, a moment that stands out. I had been working in the United States for some time before returning to my home country of China for a visit. My mum insisted that I attend a full-body health check, and wanted to come with me.
When it came to the gynaecologist section of the check-up, my mother told the doctor, “She doesn’t need to do these tests because she’s not married.”
The doctor proceeded to cross out the section where the tests were stated. I protested that not only did I need to do them, I wanted to. It was three of us in a small room, all protesting. My mother and gynaecologist were of the opinion that since I wasn’t married, I didn’t need to do the tests. I kept insisting that I could.
I was so insistent partly because of wanting to rebel, and partly because of what I thought was a ridiculous expectation of women. It is not uncommon for women to be sexually active in their 20s, and the fact that I was discouraged to take an examination that I knew is recommended to women over 21 in the United States made me very uncomfortable. I don’t think my mother or the doctor meant any harm, but it felt like they were sending me a message that being sexually active is bad, and I needed to cover it up with denial.
This feeling of unacceptance was particularly upsetting, because for so many years of my life, I was uneasy in my own skin. I might be outspoken about sexual health now, but where I grew up, it was just not something we spoke about, whether it was with friends or family. My mother cares greatly about my health and feels strongly about regular check-ups to prevent breast cancer, yet somehow gynaecologist examinations were too taboo to mention.
I can’t speak for everyone in China, but I personally did not receive any sex education in school — the little I knew came from what I read online, or in books.
I was acutely shy about my body, especially when it came to talking about it. I recall that in design school, my group was working on a project that focused on bathroom grooming products. When a male classmate asked me about my shaving habits as part of a brainstorming session, I felt so uncomfortable. Even though it was a product range that I had chosen for us, I still felt like the question was too intimate to answer.
I didn’t know much about my body, and felt too awkward to try to find out for myself. The result was an emotional struggle, especially when I started dating. I wondered if certain parts of my body looked good, or if I had more body hair than other girls. When I was intimate with a partner, I always felt like I was being held back. My behaviour was often perceived as me sending mixed messages, when in truth, I found it hard to speak up about my needs.
It felt like there was a sense of deep-rooted shame around the subject. No one said outright that sexual health is shameful, but it was definitely how I felt. For many women, we have expectations placed upon us from childhood: girls are told to play with certain toys, to dress “like a girl” and act “like a girl”. The problem was that this phrase had certain limited connotations, such as being demure and looking traditionally feminine. As we grew older, this fed into what our bodies look like. Are we too dark, too hairy, not skinny enough? We have beauty products to slim our face, to have a fairer complexion. We are encouraged to look as young as possible.
There is so much negativity centred around the way our body looks that it has fed into our sexuality. And in turn, it affected the way that I saw myself, and my confidence.
The catalyst that sparked my decision to take more control over my health and body, ironically, had nothing to do with sex. I had moved to San Francisco for my first job in 2015, and given that I had never taken an active interest in healthcare, didn’t bother to get health insurance or attend medical check-ups. I figured, since I was healthy, why bother?
It was when I was hit with a nasty bout of oak poisoning (I must have come into contact with a poison oak plant) did I frantically try to look for help. By the time I found myself a dermatologist, the stress I went through convinced me that establishing a network of medical professionals was something I needed, regardless of whether I was sick or not. I never again wanted to be in a situation where I didn’t know who to call for help.
My first visit to a gynaecologist was brought about because I had contracted a Urinary Tract Infection (UTI). I had chosen him because he was conveniently located in the same building as my regular doctor and had great reviews online, but he turned out to be passionate about health education, especially in Asia. I later learned that he was touring China to give talks and raise awareness about the importance of medical check-ups. He would become one of my go-to people for advice.
The mindset shift from knowing so little about sexual health to being an advocate definitely didn’t happen overnight. It started with my network of personal doctors, and I began speaking to more friends about sexual matters in my mid 20s. We spoke about our health check-ups and our sex lives, and the more I spoke, the more I realised how normal it was, and that there was nothing awkward about it.
I realised that sexual health wasn’t just about doctors and check-ups — it is also self-care. Practicing safe sex is one huge factor of sexual health that so many are still not doing, but it’s so important because it protects you from unnecessary hurdles such as unplanned pregnancies or diseases. It’s also about consent. I hear comments from women saying that they had sex because their partner wanted it, or they felt like they had to take the next step. I’ve also heard that the only way for sex to end is when the man orgasms.
I was brought up to believe that a woman’s body is the most valuable thing that she has, and once she gives it away her value becomes diluted. I would unconsciously project this insecurity onto my partner or in my relationships.
But the thing is that our body is designed for ourselves, and not to serve other people. We should understand our body, and be in control of it.
Once I understood this, I began to learn that women’s desires are no different than men, and female desire doesn’t change one’s value or reflect negatively on a person. In accepting this, I began to also accept my own imperfections. I no longer felt uncomfortable sharing my feelings, or even embarrassing little stories about myself. In short, I felt empowered.
So when I was advised against medical check-ups in China for the reason of not being married, it felt like this new, confident version of myself was not accepted, and it hurt. In that moment I felt like I had to express the values that resonate with me now: that I wanted ownership over my body.
I got my way and went through the tests, but the experience was unpleasant and physically painful. Not only did the doctor not explain to me in detail what the tests entailed, but she went about things in a very clinical manner, such as inserting the speculum into the vagina before I was ready and relaxed.
When I returned to the States, I complained to my friends about what had happened. My friend, who also grew up in Asia, said that she wanted to avoid such scenarios and would rather wait until she was back in the States to go for check-ups. But that shouldn’t be the case — we should be able to see a doctor when we need to, and not feel like we have to wait until the circumstances are more suitable. The more I thought about it, the more I realised that female health was something that I wanted to get involved in.
At the time, I was a product manager for Amazon in Silicon Valley. I had a good career there, and I knew that I could stay where I was and live a comfortable life. But I always knew that I have always wanted to start a business of my own, and I was at the age where I had nothing to lose. I was also inspired by many stories I heard of senior staff returning to their community to be mentors — I realised that if I was going to have my own business, I would want it to make a social impact and enact change.
So I decided that if I wanted to be an entrepreneur to help the Asian community, I would have to leave the States. It was a huge gamble, but I decided to quit my job and relocate to Singapore to attempt to build a company from scratch.
Even though the negative experiences I faced took place in my home country, I decided to make Singapore my first choice because of its diversity. Taboos about sexual health aren’t China-specific — it’s a pain point many women face across Asia, and my dream was to build a brand that can represent modern women, and not just Chinese women. Singapore, with its mix of Asian cultures and its smaller market size, made sense as a place for a young start-up to learn.
So I moved to Singapore, a place I had only visited once before! It was February 2020, and I only had a concept in mind of what I wanted to do. I hit the ground running to gather insights, and set up meetings with people I met through LinkedIn or through my network. I met people from start-ups, people who worked in the medical space, doctors and female entrepreneurs, and I loved every second of it. Once the Circuit Breaker measures kicked in, I continued initiating conversations, but of course, they were all online.
Together with a business partner who is also based in Singapore, we assembled a panel of doctors and hired people to run operations. All our plans were delayed because of COVID-19, and while initially it was hard to transition to virtual meetings, once we got used to it this wasn’t an issue. It was challenging for sure, but you just come to terms that this is an unusual time for everyone, and you just have to adapt. There are more serious problems in the world out there, and we focused on getting things ready once restrictions were lifted.
We officially launched our bootstrapped company, Ferne Health, on 27 September. Our first product range consists of home-based self-test kits that screen for cervical cancer and common STIs. Customers are able to go through the entire screening process at home, and all our testing protocols and sampling tools are clinically approved and HSA registered respectively.
As far as we know, we are the first company in Singapore who are trying to deliver a service of this kind. But we don’t want to be limited to just these products — in the long run, the goal is to build a women’s brand, and provide services that assist women and their lifestyle. That being said, we do have self-test kits for men, because we believe that sexual healthcare is for everyone.
There are so many aspects of female healthcare that I could have gotten involved in, but it was the terrible experience of that gynaecologist check-up that made me want to make the process more accessible and pleasant to more women.
There are obviously many medical checks that still require a physical examination, but I wanted to find an alternative for those that can be done remotely. The tests we provide undergo the same laboratory procedures as those taken in a clinic. If any tests come back positive, we require the customer to book a consultation with our doctors so they can explain the results and recommend follow-ups if necessary.
Perhaps there are women who feel uncomfortable undressing before a doctor, or prefer a female doctor and find the search difficult because of demand and supply, or are just too busy to carve out the time. These are problems that I have heard everywhere, be it the States, Europe, China or Singapore. We hope that having a home-based screening kit means there will be less people who put off a health check for these reasons.
Of course, it’s early days to determine customer response. But I’m happy that I made this career transition. It feels like a bittersweet journey — being an entrepreneur is very different from what I used to do, and it’s almost like having to take care of a baby. Even if your child is annoying you, you still have to take care of it! But most of the time, it’s a joy, and you feel so proud.
I think back to when I was 20, and remember how uncomfortable I was in my own body. I was nervous about how I looked, I wondered if I was pretty, and was apprehensive about sex because of how I would be perceived. Now, I look at my body and think, “This is mine.” I make educated decisions about what I do with it. I no longer care so much about what people think about what I look like.
This is what I hope to help women in understanding: you don’t have to be an advocate, but you should try to understand your body, how it behaves and feels, and respect it.
If you feel like you need or want something, whether it’s sex, beauty products, or medical check-ups — go for it. You don’t have to say yes if you don’t want to. And that’s what I believe sexual healthcare is.
Photos provided by Xi Liu.
For more information about Ferne Health and their products, visit www.fernehealth.com.
My name is Clara, and you can find me at @clarahow on the Dayre app. On my personal account, I’ve written about my personal experiences dealing with stigma surrounding contraception and sexual health. I’ve also shared about sex education, and platforms that make female healthcare more accessible.
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