Mistreatment and sexual harassment of women in surgical fields is pervasive and remains a troubling reality. Studies of female surgeons have noted that nearly 60% report having experienced sexual harassment in the past 12 months,¹ with the vast majority of these episodes not being reported. While women in urology have traditionally represented less than 10% of the practicing urologists, this demographic is rapidly changing. In the most recent Match cycle for 2024, 45% of applicants who matched were female, and the match rate for female applicants was higher than that for males.² Ensuring that female urologists have a safe space to train and practice medicine is vitally important, particularly as studies have shown that surgical trainees experiencing gender discrimination, abuse, or sexual harassment are 3 times more likely to report burnout.³

The Society of Women in Urology conducted an anonymized census of female urologists between February and May 2022. In addition to demographic data, information was collected regarding experiences of sexual harassment including free-text descriptions of any such events.

There were 379 total respondents, which represents an estimated 27% response rate based on the AUA Census numbers. Of these, 75% were urologists in practice, 15% were residents, and 10% were fellows. Full demographic details are available.⁴ Overall, 63% of the respondents responded that they had experienced sexual harassment during training or in practice. Of these, 84% did not report the event.

Of the 94 residents and fellows who responded to the census, 65% reported experiencing sexual harassment during their training. Similarly to the aggregate population, 85% of these individuals (n=52) did not report the sexual harassment. The sources of harassment included patients (77%), male colleagues (36%), and other colleagues (15%). Multiple respondents reported more than 1 source of sexual harassment, and 7% of individuals chose not to disclose the source of harassment. Common reasons that trainees did not report the sexual harassment fell under the general themes of fear of retaliation, feeling too busy, unsure if reporting would make a difference, and that reporting was too much trouble. Examples of harassing behavior included inappropriate physical touch, sexual comments and advances, and inappropriate remarks on physical appearance and clothing.

Of note, the study was limited by a lack of a clear definition of sexual harassment, and it is unclear if having a set definition would have impacted the results of the study. Additionally, the study did not clarify when a power dynamic was in place between respondent and perpetrator.

While the overall rate of sexual harassment among female urologists is unacceptable at 63%, the fact that 65% of contemporary trainees continue to experience sexual harassment is exceptionally concerning. Even more disturbing is the fact that only a small minority (15%) felt comfortable reporting the events, and that those who did not report failed to do so due to a fear of retaliation and concern that reporting would not make a difference.

As urologists, we have a duty to train the future generation of urologists, which includes females. Part of the implicit contract made when agreeing to train residents and fellows is that the trainees will be granted a safe training environment. As a field, we are failing to uphold our obligation to trainees. If unsure if a female trainee is comfortable in a situation, then it is necessary to ask and offer support. It is incumbent on urologists, particularly program directors and those engaged in training the next generation, to actively intervene when patients or colleagues are making inappropriate advances, statements, or comments. Policies need to be generated, disseminated, and enforced to ensure the safety of urologic trainees.

Both male and female providers should feel supported at work and empowered to address inappropriate behaviors. Organizations such as the AUA and academic institutions have the ability to generate and enforce no-tolerance policies. Taking active steps to address sexual harassment is necessary to ensure that we have a healthy, diverse population of urologists for years to come.