Never did I imagine that the word “clitoris” would grace a New York Times headline, let alone be accompanied by a candid critique of the scant scientific exploration surrounding it.¹ The New York Times article tells the story of Gillian, who experienced loss of clitoral sensation following a vulvar biopsy and encountered the alarming gaps in medical knowledge and practice concerning female sexual health as she searched for answers. As someone interested in sexual and gender inequities in health, I clicked on that article faster than a medical student grabs free food at grand rounds.

During my third-year rotations, I noted how women’s sexual concerns were often dismissed or ignored. I saw physicians hesitate to prescribe vaginal estrogen due to a misplaced fear of breast cancer development, even with clear evidence of its safety.² Women’s health practices routinely screened for sexually transmitted infections and asked about sexual activity to guide contraception management, but rarely discussed pain or satisfaction related to their patients’ sexual experiences. So it was less surprising, and disheartening, to learn that approximately 40% of women worldwide experience some form of sexual issue, like Gillian in the New York Times article.³ Each time I read the story, a different emotion swept over me: devastation for Gillian, whose ability to orgasm was impacted from a routine procedure, anger at the medical community for sidelining women’s sexual needs, and inspiration from the physicians raising awareness about women’s sexual health. It was abundantly clear that the sexual health of women was a vital issue relevant to several specialties, yet it seemed like unclaimed territory.

However, one consistent theme emerged—urologists are catalyzing change.

As I reflected on the male sexual medicine clinics that I observed during my third- and fourth-year rotations, I recognized urologists’ unique approach. They cultivated an open and comfortable environment that encouraged patients to voice their concerns. They delved deeper, asking questions beyond the generic “are you sexually active,” and were equipped with resources such as a list of sex therapists and patient advocates to support every aspect of their patients’ sexual lives. It got me thinking: What if all women could access this level of care?

From these encounters, it is evident that urologists possess a specialized set of skills that can significantly impact the understanding, treatment, and advancement of women’s sexual health. Urologists are:

1. Leaders in Sexual Medicine
   Urologists have a long history of leading the field of sexual medicine, particularly male sexual health.⁴ From pioneering the surgical and medical management of erectile dysfunction to managing complications of procedures that treat prostatic diseases, urologists are the go-to experts for men’s sexual health issues. Given the training that urologists and urology residents already receive in male sexual medicine, it is logical to expand their skill set to incorporate the sexual health of women and gender minorities. Taking a more inclusive approach would not only enhance expertise in sexual medicine but also ensure a more comprehensive delivery of care for all patients.
2. Experts in Navigating Sexual Health Discussions
   Due to the nature of their practice, urologists skillfully navigate and normalize the discussion of sensitive health topics such as sexual dysfunction and urinary incontinence. Evidence supporting this is present in a study that assessed patient satisfaction after bilateral nerve-sparing radical prostatectomy, which demonstrated that urologists’ comfort with discussing sexual health significantly improved patient outcomes.⁵ Similarly, another study evaluating the needs of women after radical cystectomy echoed this finding. Women are most satisfied when their urologists initiate discussions about sexual health, and provide adequate counseling.⁶ The ability to engage in open, comprehensive dialogue about sexual health makes urologists especially useful for this area of care for women.
3. Pioneers in Pelvic and Perineal Surgery
   As genitourinary surgeons, urologists operate on pelvic structures that are involved in human sexual function. This surgical expertise allows for urologists to innovate new surgical approaches and conduct research on preventing postoperative sexual dysfunction. Urologists have already pioneered procedures such as nerve-sparing prostatectomies and reproductive organ-sparing radical cystectomies to preserve the sexual function of their patients. In addition, their knowledge of pelvic anatomy can advance inquiry into potentially beneficial and understudied procedures. Some of these procedures may include lysis of clitoral adhesions, where adhered tissues around the clitoris are separated to relieve pain and restore sensation, or vaginal laser treatment to alleviate discomfort from genitourinary syndrome of menopause.^7,8 Therefore, urologists have the ideal surgical background to make strides in the treatment and prevention of female sexual dysfunction (FSD).
4. Regularly Encountering FSD
   In their everyday practice, urologists already see a high volume of patients who may have sexual function concerns. Conditions such as urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, and recurrent urinary tract infections are highly associated with sexual dysfunction.^9-11 FSD extends across urological disciplines, impacting women with congenital differences in sexual differentiation, postradical cystectomy patients, and those with indwelling ureteral stents, among others.^12-14 As a result, FSD is relevant to the practice of all urologists, which emphasizes the importance of being proficient in its diagnosis and treatment.
5. Skilled in Interdisciplinary Collaboration
   Urologists already collaborate with specialists from various fields, such as gynecology, endocrinology, and oncology. Most importantly, they often refer to sexual health professionals such as sex therapists. Embracing this partnership can foster a comprehensive approach to care that addresses the biopsychosocial spectrum of women’s sexual health. Recommended by the AUA, this multidisciplinary approach to managing sexual health issues broadens their understanding and equips them to address women’s sexual health concerns.

I am encouraged by the work urologists are doing to bridge the gap in women’s sexual health care. However, there is still so much work to be done. All individuals, regardless of their gender identity, deserve comprehensive urological care that includes attention to their sexual health concerns. While the role of urologists in addressing these gaps in women’s sexual health is undeniable, the conversation must also extend to medical students. Medical students can start by advocating for a more comprehensive curriculum that includes women’s sexual health. By engaging in outreach, research, and advocacy, we can help change the priorities of health care to be more inclusive of women’s sexual health needs. This groundwork can make a significant difference, shaping future physicians who are well-equipped to tackle the complexities of female sexual health concerns and contribute to a more holistic, gender-inclusive health care system. As a future urologist, I look forward to the day when I can follow in the footsteps of the urologists who had such an impact on me. When that day comes, I can finally ask my female patients, “Tell me more about your sexual health,” knowing that I have the tools and training to help them.

Where women can find a sexual health specialist: the International Society for the Study of Women’s Health.