Authors: Rhea Manohar, MPH, Meghan Etsey, Brianna Clark, DO, MPH, CNPM, IBCLC on behalf of the AMWA Gender Equity Task Force

“Why do I pee when I laugh, cough, or sneeze?”

It’s a question countless women ask themselves—only to be met with silence, shame, or the tired excuse that “it’s just part of being a woman.” But what if it’s more than that? What if the real issue is that women’s urological health has been systematically misunderstood, minimized, and ignored? For decades, urology has been a male-dominated specialty, and the research that established treatment protocols and practices has been dominated by their effectiveness on males (Halpern et al., 2016; Bierer et al., 2022). This gender disparity has contributed to the misdiagnosis and mistreatment of women experiencing urinary issues, as the medical field has historically failed to account for sex-specific differences in anatomy, physiology, and disease presentation. As a result, women often face significant challenges in receiving accurate diagnoses and appropriate treatment, with their concerns frequently dismissed as psychological or exaggerated. For example, research has indicated that there is a significant gap in understanding and diagnosing chronic pelvic pain syndrome in women, with concerns often being dismissed as psychological or gynecological (Clemens et al., 2007).  This pattern of bias in healthcare highlights a critical gap in healthcare equity, leading to not only physical consequences—such as delayed or incorrect treatment—but also emotional and financial strain as women struggle to navigate a system that does not fully acknowledge their needs. The enduring neglect of female urological health underscores the urgent need for change in the medical field to ensure that women’s voices are heard and their health concerns addressed with the same level of care and expertise afforded to men.

Take for example, a 62-year-old woman experiencing urinary difficulties seeking care from a urologist, only to find herself on a frustrating and unnecessary detour. Despite undergoing tests that showed no obvious pathology, her male urologist dismissed her concerns and suggested, rather casually, that she might have multiple sclerosis (MS)—a life-altering neurological disease. Understandably, this suggestion was deeply distressing, as MS is a severe condition with a wide range of neurological and muscular symptoms (National Institute of Neurological Disorders and Stroke, 2025). After seeking further evaluations and receiving no definitive answers, she ultimately found relief not through a neurologist for MS treatment, but from a female OB/GYN who recommended pelvic floor physical therapy. The true cause of her urinary dysfunction? A loss of bladder suspension support that was easily managed with pelvic floor therapy. While urinary incontinence of this nature is a common condition experienced by women, especially in women who have experienced childbirth, with a viable therapy solution, it is often under-prescribed (Wu et al., 2014).  For this woman, what was initially framed as a potential neurological disease was, in reality, a mechanical issue– one that many women experience as their pelvic floor muscles weaken with age.

The experience described above is not an isolated incident. Among urological challenges faced by women, urinary incontinence, especially in women post-childbirth is very common. One systematic review reported postpartum urinary incontinence rates ranging from 7.4% to 56.9%, and stress urinary incontinence ranging between 7.4% and 93.0% (Kirik & Yildiz, 2024). Despite urinary incontinence challenges faced by a significant portion of the patient population, studies indicate that less than half of women with urinary incontinence discuss their condition with healthcare clinicians, and even fewer receive treatment (Melville et al., 2006). For women who do seek care, they often find solace in practitioners, such as OB/GYNs or primary-care practitioners, who while focused on providing meaningful care are not experts in addressing urinary challenges with the same level of expertise (Charette et al., 2023).

Studies have shown that women presenting with urological symptoms are more likely to have their concerns dismissed, misdiagnosed, or attributed to psychological causes rather than physical conditions (Clemens et al., 2007).  Women, especially people of color and those of advanced age, are also underrepresented in clinical research, making it more difficult to establish standardized, evidence-based treatments that account for sex-specific differences (Bierer et al., 2022). Furthermore, the lack of awareness surrounding female incontinence means that women often have a knowledge gap that does not allow them to recognize the symptoms or understand the treatment options. (Fante et al., 2019).

Addressing bias in urology requires systemic changes, including:

  • Enhanced Medical Education: Incorporating more comprehensive training on female urological health in medical school curricula and continuing education for urologists.
  • Increased Research and Representation: Expanding research on women’s urological conditions and ensuring female representation in clinical trials (Radzimińska et al., 2018).
  • Greater Awareness of Female Urological Treatments: Promoting non-invasive and effective treatments like pelvic floor physical therapy as a first-line intervention for female urinary issues (Fan et al., 2013).
  • More Female Urologists and Specialists: Encouraging more women to enter the field of urology to better advocate for and understand the needs of female patients (Powell et al., 2022).
  • Patient Advocacy and Education: Empowering women to seek second opinions, ask informed questions, and advocate for their own healthcare needs.
  • Billing and Reimbursement: Reforming postpartum care to cover urinary incontinence as it is often a direct consequence.

The urgent need for more equitable, patient-centered care in urology, where women’s health issues, particularly urological conditions, have long been overlooked and under-researched. Despite the prevalence of female-specific urinary disorders, such as pelvic floor dysfunction, urinary incontinence, and post-hysterectomy complications, misdiagnosis and dismissal has led to a significant disconnect between the field of urology and a substantial patient population. This is often compounded with the lack of a thorough understanding of female anatomy and needs in treatment and care protocols. While other medical fields and practitioners have attempted to fill this gap, they may fall short in understanding and addressing the breadth of urological health conditions.  This disparity not only affects the physical well-being of women but also their emotional and psychological health, as many experience frustration and distrust toward healthcare clinicians. To bridge this gap, there must be a shift in medical education, with comprehensive training on female urological health integrated into curricula for both medical students and professionals.

Additionally, fellowships and additional training focused on female urological concerns can help expand provider awareness as well as expand the availability of treatment options, such as pelvic floor therapy. Expanding research to include female-specific urological conditions and ensuring female representation in clinical trials are vital steps toward improving diagnosis and treatment. This research will also fill the knowledge gap between OB/GYNs, primary care practitioners, and urologists to better serve the female patient population’s needs. Let’s continue to shed light on these issues and advocate for change—because no woman should have to endure unnecessary suffering due to medical bias.

References

  1. Bierer, B. E., Meloney, L. G., Ahmed, H. R., & White, S. A. (2022). Advancing the inclusion of underrepresented women in clinical research. Commentary, 3(4), 100553. DOI: 10.1016/j.xcrm.2022.100553
  2. Clemens, J. Q., Link, C. L., Eggers, P. W., Kusek, J. W., Nyberg, L. M., Jr, McKinlay, J. B., & BACH Survey Investigators (2007). Prevalence of painful bladder symptoms and effect on quality of life in black, Hispanic and white men and women. The Journal of urology, 177(4), 1390–1394. https://doi.org/10.1016/j.juro.2006.11.084
  3. Charette, M., Pacheco-Brousseau, L., Poitras, S., Ashton, R., & McLean, L. (2023, November 30). Management of urinary incontinence in females by primary care providers: a systematic review. Wiley online library. https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.16234
  4. Fan, H. L., Chan, S. S., Law, T. S., Cheung, R. Y., & Chung, T. K. (2013). Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study. The Australian & New Zealand journal of obstetrics & gynaecology, 53(3), 298–304. https://doi.org/10.1111/ajo.12075
  5. Fante, J. F., Silva, T. D., Mateus-Vasconcelos, E. C. L., Ferreira, C. H. J., & Brito, L. G. O. (2019). Do women have adequate knowledge about pelvic floor dysfunctions? A systematic review. Revista Brasileira de Ginecologia e Obstetrícia, 41(8), 508-519. https://doi.org/10.1055/s-0039-1695002
  6. Halpern, J. A., Lee, U. J., Wolff, E. M., Mittal, S., Shoag, J. E., Lightner, D. J., Kim, S., Hu, J. C., Chughtai, B., & Lee, R. K. (2016). Women in urology residency, 1978–2013: A critical look at gender representation in our specialty. Urology, 92, 20-25. https://doi.org/10.1016/j.urology.2015.12.092
  7. Kirik, B., & Yildiz, H. (2024). Incidence, duration, and related factors of urinary incontinence in women after childbirth: a systematic review. Revista da Associacao Medica Brasileira (1992), 71(1), e20241054. https://doi.org/10.1590/1806-9282.20241054
  8. Melville, J. L., Newton, K., Fan, M.-Y., & Katon, W. (2006, March). Health care discussions and treatment for urinary incontinence in U.S. women. American Journal of Obstetrics & Gynecology. https://www.ajog.org/article/S0002-9378%2805%2901501-2/abstract
  9. National Institute of Neurological Disorders and Stroke. (2025, January 31). Multiple sclerosis. https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis 
  10. Powell, C. R., Cameron, A. P., Goh, M., Neal, C., Memo, R., & Richards, K. A. (2022). Gender and Racial Diversity among U.S. Urology Residency Programs and Efforts to Improve It: You Can’t Be What You Can’t See. Urology Practice, 9(5), 466–473. https://doi.org/10.1097/UPJ.0000000000000328 (Original work published September 1, 2022)
  11. Radzimińska, A., Strączyńska, A., Weber-Rajek, M., Styczyńska, H., Strojek, K., & Piekorz, Z. (2018). The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clinical interventions in aging, 13, 957–965. https://doi.org/10.2147/CIA.S160057
  12. Wu, J. M., Vaughan, C. P., Goode, P. S., Redden, D. T., Burgio, K. L., Richter, H. E., & Markland, A. D. (2014, January). Prevalence and trends of symptomatic pelvic floor disorders … : Obstetrics & Gynecology. Wolters Kluwer. https://journals.lww.com/greenjournal/abstract/2014/01000/prevalence_and_trends_of_symptomatic_pelvic_floor.20.aspx 

About the Authors

Rhea Manohar, MS2
Rhea Manohar is a second year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology, Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed and implemented hands-on workshops to further reproductive health issues and bolstered medical students abilities to navigate physician-patient communication. Prior to medical school, she was a Research Associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also a member of the Gender Equity Task Force and Reproductive Health Coalition within the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.

Meghan Etsey, MS3
Meghan is a third year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.

Dr. Brianna Clark is a proud osteopathic physician.  She has completed fellowships in Breastfeeding Medicine at the University of Rochester Lessons in Lactation Advanced Curriculum ( LILAC) and Climate Health Equity Fellowship ( CHEF) through the National Medical Association ( NMA). She spends her spare time thinking about innovative ways to provide equitable health care to all and create sustainable advocacy.

 

Formatting, publication management, and editorial support for the AMWA GETF Blog by Vaishnavi J. Patel