A few months back, I delivered a lecture on genitourinary syndrome of menopause (GSM) to the urology residents at our institution. I kicked off the lecture by polling the residents on whether they had inquired about erections or treated erectile dysfunction in the previous 2 weeks. Nearly all hands shot up in response. Then came my follow-up question: “In the past 2 weeks, who has asked a female patient if she has had discomfort or lack of pleasure with sexual activity?” Each resident kept their hands neatly in their laps.

As urologists, nearly 30% of our patients are female.¹ Despite our ease in discussing intimate matters with male patients such as erections, ejaculations, libido, and penile curvatures, we often find ourselves at a loss when broaching the subject of sexual function with female patients. Yet sexual dysfunction is widespread across women, with up to 44% experiencing issues like decreased libido, decreased lubrication, painful intercourse, and difficulty achieving orgasm.² These issues only become more pervasive after the onset of menopause.

During my urology residency, and likely in many others nationwide, there was a noticeable gap in preparing residents to address the sexual health of women. It wasn’t something taught at grand rounds, focused on at our weekly didactic meeting, or something that we had to learn for in-service exam testing. It wasn’t until I started following several urologists on social media platforms like Dr Rachel Rubin, Dr Kelly Casperson, and Dr Ashley Winter that I delved into all of the unfamiliar terms that pertain to female sexual dysfunction. These include persistent genital arousal disorder, hypoactive sexual desire disorder, and vestibulodynia. I started to learn more about the female anatomy including the vulvar vestibule and its dependency on both estrogen and androgens, which is something that had never been pointed out in any anatomy lecture I had attended before. Through social media and podcasts, I also learned about the various forms of vaginal estrogen, and the benefits of vaginal estrogen administration in the treatment of GSM.

I commend these female urologists for bringing to light these widely prevalent issues that women face and equipping the next generation of urologists with the tools and knowledge to assist them. I also applaud the AUA for the development of a guideline panel on GSM, which I hope will fuel the momentum for a growing community of urologists dedicated to screening for and treating women’s sexual dysfunction. I would encourage all residency programs to begin to incorporate women’s sexual health in your curriculum. In the words of Dr Rubin, “As board-certified urologists, we are supposed to be taking care of men AND women. We have the tools to take care of women. It is just that oftentimes no one taught us how to use them.”³

Implementing specific educational programs within urology residency programs can help address the gap in women’s sexual health knowledge among urology residents. One effective strategy involves integrating 1 to 2 didactic lectures annually covering topics such as GSM or female sexual dysfunction. Encouraging residents to explore these subjects through accessible online platforms like podcasts such as BackTable Urology and You Are Not Broken can enhance their understanding without the need to utilize dedicated residency education time. There are also yearly courses put on through the International Society for the Study of Women’s Sexual Health and instructional courses at the AUA Annual Meeting. Furthermore, engaging residents in research projects can deepen their involvement in advancing women’s sexual health. By integrating tailored educational initiatives into urology residency programs, future urologists can develop the competence and confidence needed to effectively address the sexual health needs of female patients.

Since 2002, the AUA Residents and Fellows Committee has represented the voice of trainee members. The Committee’s mission is to address the educational and professional needs of urology residents and fellows and promote engagement with the AUA. The Committee welcomes your input and feedback! To contact us, or inquire about ways to be involved, please email rescommittee@AUAnet.org