Urology discovers it, too, has a feminine side

The urology rotation during my third year of medical school might best be described as a boys' club, often characterized by infighting, one-upmanship and sexual humor. It was a little off-putting to many students, but always entertaining.

So imagine my surprise when a female medical student recently told me that she loved her urology rotation, in which she found the doctors to be especially humanistic and caring. A big part of the reason, she believed, was the growing presence of women among her teachers. It turns out that the field is undergoing a gender transformation.

Urologists, who are specialists in the organs that produce urine, have always cared for women. After all, as Dr. Jennifer Gruenenfelder, a urologist in Laguna Hills, California, reminded me in an e-mail message, "Women have kidneys and bladders and urethras and ureters, too."

Yet even as more and more women entered medicine in the late-20th century, urology continued to overwhelmingly attract male applicants.

Not until 1962 did a woman - Dr. Elisabeth Pickett - become a board-certified urologist. By the mid-1980s, the United States had only 22 female urologists.

There were several explanations. For one thing, the stereotypical urology patient has always been a man, suffering from an enlarged prostate, prostate cancer or erectile dysfunction. The demanding hours of surgical fields like urology probably discouraged many female medical school graduates from applying, and the lack of female mentors and role models did the same.

Finally, when women did express interest, they were often met with little enthusiasm. In a 1997 survey of female urologists conducted by Dr. Christine L. Bradbury and colleagues at the University of Utah School of Medicine, 44 percent of respondents reported having been discouraged from entering urology because of their sex. Gruenenfelder said that a female dean at her medical school had told her that applying for a specialty in urology was "a bad idea."

At the same time, some urologists eagerly supported the entrance of women into their field. Dr. Harriette Scarpero of Vanderbilt University, the president of the Society of Women in Urology, said her urology mentors were superb doctors and excellent teachers. "My choice of urology," she told me, "had as much to do with the influence of those special teachers as it did with my love of surgery."

And once the pioneers arrived, more women followed. The Society of Women in Urology has more than 300 members, and Scarpero estimates that 20 percent of urologists in training are now women. A female urologist who calls herself Dr. Keagirl has even created a Web site, UroStream (urostream.blogspot.com), that discusses the "ever humorous field of urology."

But old barriers and stereotypes do not simply disappear. Dr. Kristin Kozakowski, now a pediatric urology fellow at the University of Toronto, was one of three women who made up the entire recent graduating class of urology residents at Columbia University Medical Center. Though she praised the professionalism of her senior male colleagues, she said she still felt awkward around them. "It is as if they still want to engage in bathroom humor but cannot do so around women," she said.

And she reports resistance from another group of males: certain patients who either thought she was a nurse or asked to see a male urologist. Gruenenfelder recalls being called "babe," "sweetheart" and "honey" during her training.

Both doctors acknowledge that special issues of modesty exist when they examine male patients. It is difficult for many men to undress in the presence of a woman and then submit to an examination of their private parts.

But just as there have been male gynecologists for decades, there are now female urologists. As Kozakowski politely tells reluctant patients, "I'm the doctor who is here."

source: herald tribune