Urogynecology—it’s what happened after urology went on a date with a gynecologist!

Not that long ago, in 2011, the specialty of urogynecology was officially born in the United States. This was the year that the American Board of Medical Specialties (ABMS) recognized it as a certified subspecialty. This was an exciting milestone for women’s pelvic health because for many years, urology (the specialty that treats urinary tract issues) had typically emphasized men’s health and also, most urologists were male. But women have urinary tracts too—we know this since so many of us can have problems with our lady plumbing! Just a couple of years later the first few physicians took their subspecialty exams and board-certified urogynecologists came into existence in 2013.

It’s been more than 10 years, but urogynecology is still a relatively new subspecialty. So, people are still understandably confused about what this new breed of doctor does and how we are different from our parent specialties. Our “dad” was a urologist, and our “mom” was an ob-gyn—so what are urogynecologists about? Well, a urogynecologist is a surgeon who focuses on procedures that evaluate and treat urinary and pelvic problems. As surgeons, we are also the best physicians to counsel women on how to avoid surgery. We do not deliver babies, administer vaccines, and don’t usually do routine well woman checks like pap smears. While important, those services would be more appropriate for a primary care doctor. Urogynecologists are pelvic floor support specialists that see women for bladder leakage, peeing too often, fecal accidents, recurrent UTIs, complications after cancer treatment or childbirth, sexual problems like pain, prolapse, bladder pain, pelvic floor muscle problems, trouble with emptying the bladder and bowel issues. The ultimate foundation of our specialty is a fusion of plumbing skills from urology with women’s health expertise from ob-gyn and then bring that to each woman that we see. I sometimes jokingly say that this is how urology received a much-needed girly makeover!

Since the early years of 2013, the specialty has grown, and we have even had a couple of different names which has created confusion at times. The official terminology to describe this specialty is “Urogynecology and Reconstructive Pelvic Surgery” (URPS). But because no human wants to spit out all those words or say URPS, we call it “urogynecology.” To become a board-certified urogynecologist, a whopping 7-8 more years of training must be completed AFTER medical school.

Here is how it typically works. Once a doctor graduates from four years of medical school, they typically go on to complete a “residency.”  This is where a physician specializes and spends time training in their chosen medical field. If a person wants to be a “board certified” urogynecologist, they must complete a residency in either urological surgery or obstetrics and gynecology. These are separate educational tracks that can get to the same outcome of being a urogynecology specialist. After the residency training in urology OR ob-gyn, the budding urogynecologist then completes about 2-3 more years of surgery training in a program called a “fellowship.” That sounds a little like a church, but I am not aware of the origin for this terminology. However, I can say for certain that surgical training did not have a church vibe! Also, it is funny that during the fellowship portion of our education, they call us “fellows” regardless of our gender!

As for my own training track, I decided that I would pursue a residency in urological surgery after medical school. Urology, to this day, is the medical specialty with the lowest number of women represented. Only about 10% of all urologists are female and that number has not improved very much in my career. But I felt drawn to the specialty and believed it was necessary to increase female representation in urology. There are just a few urologists like me who end up sub-specializing in urogynecology. And nationally, we are significantly outnumbered with roughly twice as many ob-gyn doctors than urologists. As of now, there are only 356 board-certified urologists who are also board-certified urogynecologists, in the entire country. So, I’m in a very tiny group of specialists who are board certified in two areas- our colleagues sometimes refer to us as unicorns! Each year we add new ones, but the specialty is still small which means women sometimes wait months to consult with a urogynecologist. Because there are too few urogynecologists, there are primary care providers that offer treatments for pelvic health. There are also general urologists that treat female pelvic health problems since there are so many women in need. But it is important to know that not every physician providing care for pelvic health is board certified. According to the American Board of Medical Specialties website, board certified doctors are skilled experts who meet a higher standard and have better results and improved patient safety. Specifically, we participate in assessments and training beyond that required of our peers, deliver high-quality care, and we are held to a standard of continual professional improvement through our own education and peer review. Our board certification and credentials are displayed prominently since we have done extra work for this designation! It is also something you can look up for any doctor providing your care through the ABMS website.

People might wonder why anyone chooses to pursue the longer and more demanding path to board certification. For me personally, the answer is simple! I did the extra years of training and participate in all that is required for my board certification because I am passionate about women’s health care. My desire is to bring the very best of myself clinically to each case I review and for each woman that I care for. Because of our high need and how specialized urogynecologists become, we no longer do general practice or things like deliver babies. Even the physicians who trained in obstetrics on the way to becoming a urogynecologist retire from the birthing suite.

But still, our specialty name can be confusing to hear, and so people often assume that I go around delivering babies! This always gives me a little laugh because in medical school I delivered just ONE baby which was the requirement to successfully complete my obstetrics clinical. Let’s just say I handed the little guy off fast—he was slippery! Being a part of this experience was beautifully messy, but I was more interested in what happened to his mom’s body after his birth. How would she heal? Would she go on to have problems with her pelvic floor and need some rehabilitation for a couple of months or maybe a minor procedure to help get back to normal? And of course, pelvic health problems aren’t just for pregnant people—they occur in women of all ages. They even occur in children. So being able to help people suffering from pelvic health problems allows me to help women of all ages and many have never even been pregnant!

I have now practiced as a urologist-urogynecologist for over 15 years, and treating pelvic health issues is extremely rewarding because they are often very “fixable.” At the very least, pelvic symptoms like bladder leakage, pain or chronic bladder infections can be improved or resolved, which leads to better quality of life. Women can suffer both physically and emotionally if they have pelvic health problems, but they deserve so much more. When a person has pelvic health issues, there is an incredible opportunity for me, as a specialist, to truly help and give each woman I take care of a chance to live her best life!

April 22, 2025