I had reason to see a urologist when I was around 20. Back then all urologists were male in the sprawling MSA of just under 1 million. So I was evaluated by a man. But in all candor, I had not really given the option any thought. Nothing had changed by the time I was 29 and by then I definitely would have considered it. By the time I was 38 the specialty had matured and I had the option. I chose a woman.
Urologists don’t narrowly treat penises and prostates. Urology starts with the kidneys and proceeds all the way south. Man or woman, got a kidney stone? See a urologist. Urethral stricture? See a urologist. Recurrent urinary tract infections? See a urologist. Bladder or urethral cancer? See a urologic oncologist (a urology subspecialty). Clitoral or penile phimosis? See a urologist. Genetic male with prostate issues? See a urologist, Torsion, varicocele, or cyst? See a urologist. Want a vasectomy? See a urologist. Genetic female with reproductive organ problems? See a pelvic floor surgeon (which can be a gynecologist or a urologist).
Just as there are women who adamantly insist upon a female gynecologist, there are also women who will only see a male gynecologist. The preference is about comfort, not heterosexual normativity (though orientation could be a discomfort factor). Why should that be any different for men?
Female urologists are still fairly uncommon. It has always been a male-dominated specialty. When it comes to kidney stones, no patient in acute crisis will care one iota if the practitioner is a well trained circus animal, much less whether male or female. But given the choice, patients might have a preference for follow-up care. Some women might be more comfortable with a female urologist just as they might feel more comfortable with a female gynecologist. That might be true for many men and that might not be true for many men. Some men just don’t want another man examining his junk (just like there are men who do not want an airport pat-down from a man). It isn’t necessarily fragile masculinity. Some men experienced physical or emotional trauma from men and are averse to male touch. Other men might be petrified by the thought of an involuntary autonomic response. Some men would consider it less embarrassing with a man (who really understands the involuntariness) and some men would consider it less embarrassing not with a man (because even it’s still forbidden to sport wood in the locker room). Some men might feel that another man understands the equipment on a deeper level. Some men might want a woman’s subjective assurance that a condition really isn’t so grave or fatal to pleasing a partner.
In this line, a person with a curved or smallish (or even micro) penis might feel more comfortable being examined by a woman. Boys hear all manner of platitudes from fathers and uncles. Rather than further pithy dismissiveness, a young man might want the disinterested and subjective medical opinion of a woman who understands what would or would not be adequate, and whether straightening or enlargement or reduction merits consideration.
To add another wrinkle, men and women alike might find it uncomfortable to admit incontinence issues to a younger practitioner—man or woman—and want to see someone of similar age. That could limit selection. In some markets it is easier to get an appointment with a nurse practitioner or physician assistant—both of which skew heavily female. That could limit selection. A patient’s religion and matrimony are still further considerations.
Apart from all the psychological factors, there is one absolute and least debatable reason that make women preferable urologists…smaller hands! Smaller hands have smaller fingers and smaller fingers do better prostate exams. And that raises another psychological apprehension for some men. Some men just do not want to be penetrated by a man and some men would not want to be penetrated by a woman. Each carries its own shade of weakness or submission.
The final reason that women might be preferable urologists involves transgender and genderfluid individuals, and these considerations transcend sexual orientation. Whether the person is male-to-female or female-to-male or day-to-day, a female urologist could be more affirming and less awkward than the cis hetero anglo andro counterpart. Ancient eastern philosophy holds that every self contains a part of its opposite otherness (yin-yang, for example). I think that women understand this on a deeply internal circuit and are innately more comfortable with an imprecise continuum.
I don’t mean to suggest that either gender is more capable than the other. But I do think that, as with every field, diversity benefits everyone. I also think that market forces work in medicine as much as in any other industry. If the demand for female urologists increased, perhaps more women will pursue the specialty. Imagine being a med student knowing that the demand for female urologists creates perpetual waiting lists. She could retire her student loans in a snap!
I have encountered many extraordinary male physicians, but these might be exceptions or regional aberrations. Maybe, but maybe not. My pediatrician was awesome, but one time he was away and another man covered his patients. I was thirteen or fourteen at the time so I was able to recognize the substitute as an unmitigated douchebag. Both of these were cis hetero anglo and andro; one was great, one was terrible. A coin toss.
The American physician pool is overwhelmingly CHAA—a demographic with a long history of dismissiveness. Imagine finding a listening ear from Donald Trump, John Edwards, Tom Cruise, George Bush, Sean Hannity, Rush Limbaugh, Chris Hansen, etc, etc. In other spheres, isn’t it always the CHAA police committing the most outrageous atrocities? George Floyd, Elijah McClain, Rodney King, Abner Louima, Amadou Diallo, Tyre Nichols, Michael Brown. Stonewall Inn, Edmund Pettus Bridge. Very often, the further one can get from CHAA…the better, the safer, the wiser. I think women and minorities are more likely to understand how dismissiveness feels and are less likely to perpetuate it. (But of course, it’s not an absolute bright-line because there are some arrogant and entitled bitches out there—Nancy Grace, Marjorie Taylor Greene, Alexandria Ocasio Cortez. There are some minority menaces too—Clarence Thomas, Sean Combs, O.J. Simpson.) I suppose the same can be said of pharmacists. I have encountered some extraordinary male and female pharmacists (both R.Ph. and Pharm.D.), but every terrible pharmacist was white. The absolute worst was an old white man who chose graveyard shifts because he hated interacting with people. (Dude, wrong profession.) Another was an arrogant white female who swore that I could not have experienced the food interaction that I experienced. (A year or so later a food advisory issued which just goes to show that an experience trumps an argument.)
It seems to me that if half of the population is male and half is female, then the urology practitioner ratio should reflect the demographics. The supply will respond the to demand and the demand flows from the consumer patients. So my suggestion to everyone is this: man or woman, be intentional in selecting a practitioner and try something new. Every human system perpetuates its own implicit biases. A disruption to status quo can be useful.