Although urology remains a male-dominated specialty,¹ it has had the highest rate of growth in terms of female residents compared with other surgical specialties.² Beyond gender, racial and ethnic diversity among urologists lags behind what is seen in the general US population.^3-5 Nevertheless, diversity does not equal inclusion. Therefore, it is critical to both integrate diverse perspectives and promote equity in the urological community.

In July 2021, the Society of Women in Urology (SWIU) created a census task force aimed to survey women in urology, both in training and practice, in the US and its territories, with the goal of describing the demographics, practice patterns, and needs of women in urology. Our published findings showed several key facts.⁶ First, more than half of the women in the urologic force are in academia. Second, although there is marked underrepresentation of minorities, the discrepancies are less stark among women compared to the existing overall AUA Census. Third, most female urologists work full time, but compensation patterns vary among academic and private practices.

These findings demonstrate that even though there is improved representation of women in urology compared with several decades ago, a lag in a diverse representation and equal opportunities persists. Further investigations should be aimed at identifying the causes of gender disparity and systemic barriers to gender equity in the urologic workforce, and the development of intentional diversity-focused interventions to promote diversity among the urological community.

Importantly, the census also collected information about the unique challenges faced by women urologists, including challenges surrounding reproduction, childrearing, and other family responsibilities, as well as experiences of sexual harassment.

Of 379 respondents, 69% reported having children, and 36% reported complications during their pregnancy. Respondents also reported inconsistent accommodations related to pregnancy and child-bearing across training programs and healthcare organizations.

With regard to sexual harassment, 63% of all respondents reported having experienced sexual harassment. A staggering 65% of trainees reported having experienced sexual harassment, but only 15% were comfortable reporting it. These findings are worrisome at all levels and reflect the existing barriers such as shaming among colleagues, decreased self-worth, and worry for being troublemakers.⁷ The SWIU Census findings highlight the persistent need for a supportive institutional culture with zero tolerance for these behaviors, and the need to create training and work environments in which women feel safe to report without repercussion. As the number of women practicing urology increases, it is essential to first identify the needs and barriers, promote leadership engagement to protect their trainees, as well support women in urology who choose to build a family, as this will be vital to the upcoming generation of women in urology.

In conclusion, as the number of women urologists continues to increase, their needs and professional satisfaction must be taken into consideration as they will constitute the future urologic workforce. The SWIU Census is part of a continuous effort to address the unmet need for gender-specific information from urologic surgeons.⁶ SWIU, as an organization, is critical in encouraging and identifying the specific needs of its membership. Moving forward, it will be important to further engage female urologists from diverse backgrounds to further promote inclusion and representation in our field and to develop future interventions directed to their specific needs.⁶

Disclaimer: The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.

Acknowledgments: We thank Jessica Dai, MD, and Kelly Harris, MD, for their participation in the census task force.

Support: The census task force project is supported by the Society of Women in Urology.