There is undoubtedly an increasing trend in the feminization of the medical profession globally. Sub-Saharan Africa is not left behind in this revolution, mainly in “female attractive” specialties like pediatrics, dermatology and gynecology, but surprisingly in surgery as well. From the first African female physician (Senegalese Dr. Marie Therese Senghor Basse graduated from the Faculty of Medicine of Paris in 1957) to the first to graduate in surgery (Dr. Josephine Nambooze in 1967 from Uganda), African women are putting their marks on a traditionally male-dominated field of surgery: the urology domain. At first sight, one could think that the local environment, culture and traditional heritage might be incompatible with this evolution. But despite the odds, barriers and limits fixed by society, some incredible women are proving that gender-based bias should be banned in urology.

Urology as a specialty recently started to develop in Africa, and as a consequence most sub-Saharan African countries have access to only a handful of urologists. The most populous country in Africa, Nigeria, had 1 urologist per 3.2 million people in 2006, and in Ethiopia the first urology residency program started only in 2010. Considering African female urologists, the gap is even worse, with urology having one of the largest gender disparities in surgery. Overall, around 30 female urologists fully trained and practicing are in the sub-Saharan Africa region (Maghreb and South Africa excluded). The median number of female urologists in most African countries is 1, except in Nigeria (5), Senegal (4) and the Ivory Coast (3; fig. 1).

Figure 1. Current state of African female urologists. IP, in practice. IT, in training. Some data are missing for some countries.

The Senegalese School of Urology at Cheikh Anta Diop University played a key role in urology training in sub-Saharan Africa. The first female urologist to graduate from there was Aissatou Amy Diame, who started her residency program in 1997 and then became the first female urologist from the subregion (fig. 2). Ten years later, I became the second in the field and the first to embrace an academic career. Rosemary Nassanga from Uganda became the first female urologist in East Africa. In 2003, Dr. Moshokoa qualified as the first Black female urologist in South Africa and became head of a urology department in 2006, a great achievement in this apartheid context that she celebrates: “I don’t doubt that I am a role model; there’s no female who has headed any urology department in this country, let alone in Africa.” In October 2013, Abimbola Abolarinwa became the first female certified urologist at the West African College of Surgeons. She holds a position at the Lagos State University College of Medicine as a lecturer and is an honorary consultant to the Lagos State University Teaching Hospital, Ikeja.

Figure 2. Tribute to the pioneer “first ladies” in urology.

The number of female urologists is clearly growing, but they still represent a small portion of the field, and much of this situation is due to a misconception by most laypeople that urology treats only male problems like prostate cancer and erectile dysfunction. As in other political, scientific and technical fields that are historically male dominated, the idea of women as urologists often conjures a multitude of discriminatory questions.

Women in urology face challenges in the field, which include more limited mentorship opportunities, lack of further training in urology subspecialties, low presence at international meetings and lack of career incentives. I realize how lucky I am for being mentored in pediatric urology by Francis Schneck through IVUMed, for winning the SIU (Société Internationale d’Urologie) fellowship award and being trained by Ben Breyer at the University of California–San Francisco, but also for being introduced to international governance as an SIU academy subcommittee member thanks to Kurt Macammon and also Suzette Sutherland, who gave me the chance to deliver a conference at the Society of Women in Urology meeting. I’m genuinely grateful to Serigne Gueye, my mentor in urology but above all my model and inspiration as a person, thanks to his generosity, leadership and hard work. African urology owes him his letters of nobility. They all participated to raise the standard of urology care in Africa, but still, a large part of the developing world continues to lack access to urological surgical care, the least represented surgical subspecialty in global health.

Previous studies have found that urological diseases are responsible for over 25 million disability-adjusted life-years worldwide, with the highest overall rates in sub-Saharan Africa. The rising number of female urologists (at least 20 of them in training) can be a substantive asset in closing the gap, particularly in African pediatric urology, which suffers from a dearth of local practitioners. While the increased representation of women in urology is an ongoing process, few women serve in leadership positions in urology at the local or international level. Promoting international collaboration and institutional support, as well as facilitating access to grants for research opportunities, would significantly contribute to the shining of female urology in Africa. A formal organization of the African female urology community through the WUA (Women in Urology Africa) is to be encouraged and promoted.