Women’s health is critical to the effective treatment of many female urological conditions but why urologists are struggling to address it?
“The medical knowledge that we have is just skewed towards knowing more about men’s bodies and the conditions that disproportionately affect them,” states Maya Dusenbery in her provocative book “Doing harm” reviewed by NY Times.
Urology proves Maya’s point better than any other health specialty.
Originally a field that studies the urinary tract, urology morphed into a specialty that focuses on men’s health. Unfortunately, this also frequently means inadequate urological care for women.
“In urology, it is certainly true that the sun, stars, moon revolve around the almighty prostate, erectile dysfunction, and low testosterone. Women’s issues are under-taught, undertreated, underappreciated,” remarks Dr. Lisa Hawes, a practicing urologist.
— Anastasia Visotsky (@ZeroTaboos_com) May 18, 2018
Women’s Health Matters
“Indeed vaginal health is critical to UTI, incontinence, and IC. Pain with sex from vaginal issues also affects the pelvic floor and therefore the bladder,” remarks Dr. Hawes.
Take urinary tract infections (UTI), for example.
UTI is dubbed as a female issue since it happens to women so often. Every fourth woman will experience a UTI at least once in her lifetime and an estimated 1% of women (70 million worldwide) suffer more than six recurrent UTIs (rUTIs) each year and are referred to a urologist for further treatment.
The disease is not only excruciatingly painful when acute but also has a serious psychological burden on the patients. Many completely avoid sex in hope to escape another recurrence or can’t keep a job due to frequent infections.
However, when chronic UTI female patient turns to a urology specialist, she is hardly ever fully evaluated, the conversation rarely goes beyond urinary tract symptoms. For example, in a recent poll conducted among my readers, 87% of responders indicated that their urologist never asked them about vaginal health.
At the same time, several lines of evidence link vaginal health and UTI recurrence. As Ann Stapleton, Ph.D. puts it: “The vagina is a key anatomical site in the pathogenesis of urinary tract infection (UTI) in women, serving as a potential reservoir for infecting bacteria and a site at which interventions may decrease the risk of UTI”.
If vaginal health is important for a comprehensive UTI-prevention plan, why it’s almost never included in a routine urological assessment of female patients? At the same time, all guidelines insist on prostate evaluation when it comes to UTI in males.
Urology: Driven by Men and Studied on Men
It’s hard to know for sure why a branch of medicine that studies the urinary tract is dominated by male doctors and male health concerns.
We know that historically, most of the physicians were men, and it was easier for male doctors to learn on and experiment with male patients.
Even physicians as early as in the 10th century CE recognized this as a problem. Albucasis in his famous work “Surgery” indicates the difficulties that arise through “oriental customs in the treatment of women by men in the region of genitalia”.
You could also argue, that urologists stepped into the role of a “man’s doctor” because men do not have any other specialty to turn to. “Today, without a men’s health specialist, urologists often end up filling this role by default, publicly perceived as the “man’s doctor” insofar as the obstetrician-gynecologist serves as the specialist for females”, suggests a recent study.
As the result, there is a popular misconception that “urology tends to deal with male issues,” says Dr. Oberlin the author of a study that looked at the impact of surgeon gender on practice patterns in urology.
Subsequently, urology attracts more male physicians: only 8.8% are females among urologist population (as of 2017, in the USA).
— Rachel S. Rubin, MD (@rachelsrubin1) May 12, 2017
Therefore it’s easy to see why the aspects of female constitution receive less attention when it comes to research, training, and practice.
On the bright side, “We are now writing the development of guidelines for recurrent urinary tract infection. The AUA has invested great resources to determine that if you are going to treat UTI in women you need to look at their entire health. You have to do the exam. You have to make sure they have appropriate vaginal health. You have to make sure they’re not using certain contraceptives that may increase their risk for UTI. You have to ask about their bowel symptoms and assess whether they have chronic constipation or diarrhea,” says Dr. Melissa Kaufman, former president of the Society of Women in Urology, “so guidelines absolutely are going to help the general urologist out there to understand what needs to be done to help his patients.”
Moreover, the number of female urologists is growing every year. “For the first time, the rising number of women in urology surpassed 20 percent of all practicing urologists under the age of 45”, according to AUA 2017 census results. We can hope that this trend will create more interest in female-specific urological solutions.
The growing field of urogynecology is another possible way to introduce understanding and concern for female-specific aspects of urological diseases.
At the same time, while female patients deserve equal interest from urology as male patients, the healthcare industry also needs to consider men health clinics as a dedicated option to focus on male-specific health issues.
However, the most immediate step could be raising awareness of the issue at hand. Coming to terms with the reality without assigning the blame is a great way to start the conversation and brainstorm possible solutions.
As NY Times concludes, “best remedy is calling for women to keep sharing their “doctor stories,” keep putting pressure on medical professionals to study women’s health and, in the meantime, for women themselves to learn how to advocate for their own care”.