Urology is a historically male dominated field.¹ The male gender’s dominance in the area of urology has been demonstrated, as seen by the high number of male urologists compared to female urologists in all urological facilities throughout the whole world.¹ The gender gap between men and women is very high in urology education.^1,2 This is no exception in Indonesia, where there are much fewer female urologists than male urologists.³ However, the gender gap that has existed so far is gradually narrowing, with the number of female urology doctors in the world (as a whole) starting to increase, even reaching 10% of all urology doctors in the world.⁴

The growth rate of women applying to and entering urology residency programs especially in Universitas Padjadjaran, West Java, Indonesia, was lower than other specialties, indicating that a problem of recruitment and retention exists (Figure 1).⁵

Figure 1. The gender distribution of residency programs, showing urology was the least studied program with female residents.

Nongender discrimination environment in urology education began to develop rapidly in various developing countries. Indonesia has come a long way in improving gender equity in urology residency access.^1,3 A review of US public databases revealed a 104% increase in the number of female urology trainees over that time.⁴ In Indonesia, something similar is taking place. There are only 5 urological centers around Indonesia, including Universitas Padjadjaran, Universitas Indonesia, Universitas Brawijaya, Universitas Airlangga, and Universitas Gadjah Mada. Indonesia currently has 635 urologists as of early 2024. In March 2024, there were 7% female urologists in Indonesia from 5 urological centers; this percentage was higher than the previous year, which revealed < 6% female urologists in Indonesia, as Universitas Padjadjaran has 10 female residents of urology out of 63 residents, Universitas Gadjah Mada has 1 female resident of urology out of 60 residents, Universitas Brawijaya has 1 female resident of urology out of 50, Universitas Indonesia has 11 female residents out of 73, and Universitas Airlangga has 1 female resident out of 56. Although the total amount of female urologists globally is rising, the actual gender gap is still remarkable.

Figure 2. Total urology residents each year from beginning, showing fluctuating amounts of female urology residents.

In order to overcome the large gender gap, this can be done by increasing the percentage of female students in the field of urology. The urology residency program at Universitas Padjadjaran/Hasan Sadikin Academic Medical Center has demonstrated a progressively increasing number of female residents admitted in each intake per year and became the urology center with the most female students in Indonesia. Since opening in 2007, starting from 2011, the department of urology at Universitas Padjadjaran accepted 1 female resident. Initially, each intake accepted 1 female resident; however, the number has increased as currently the program accepted 3 female residents in this batch (Figure 2).

Men and women go through the same student selection and recruitment process. All residency program admission steps are identical. The explanation for the low number of female urology residents is not that they are “not accepted,” but rather that only a few female general practitioners apply to become urology residents at our center. Statistically, in our center, the backgrounds of male and female residents do not show differences in education and in terms of the number of gap years (duration from graduation as medical doctor into acceptance in residency program). One study marked the only factor that shows the differences is the experience of publication. In contrast, about 33% of the female residents in our center have publication experience compared to male residents at only about 20%. Until this year, women made up 64% of medical students, so it is a crucial time to connect with them about pursuing careers in urology.^5,6

Introducing urology as a gender-friendly specialty is the key to make women more familiar to this field, which may have an impact on their decision to pursue it as a career.¹ To increase gender equity in urology, straightforward exposure is required to ensure that the concerns raised above are trustworthy, as well as justification that there are no genuine differences between female and male urologists.⁵ Support and mentoring are important factors to career advancement and protection for women in urology.⁷ The solution is that we need a platform for sharing and advancing this gender equity. Therefore, it is hoped that the establishment of an organization for female urology residents can be set as a first step to achieve gender equity in the future. We have to ensure that there is a bright future for women in urology and woman are also suitable in the urology field.