Trends in Female Representation in Urology Fellowship Subspecialties

Background: Recent studies have shown growth in the number of female residents and fellows in urology, a field that has historically been male dominated. Yet, the impact on subspecialty fellowships has not been well described. Objective: To analyze trends in female representation across American Urological Association (AUA) fellowship subspecialties. Methods: Fellowship match data (2014-2025) for Society of Urological Oncology (SUO), Endourological Society (EUS), American Society of Andrology (ASA), Society of Genitourinary Reconstructive Surgeons (GURS), and Society of Pediatric Urology (SPU) were analyzed. The primary analysis assessed trends in female-matched fellowship slots. Secondary analyses examined trends in female applicants, their proportion among matched applicants, and their distribution across all matched slots. Spearman correlation (ρ) measured monotonic trends. Results: Of the 2531 applicants, 437 (17.2%) were female, increasing from 13 in 2014 to 53 in 2024 (ρ = 0.92; P < .001). Overall, 358 (81.9%) women matched, with a significant rise from 9 in 2014 to 49 in 2024 (ρ = 0.84; P = .001). This increase was driven by SUO (ρ = 0.78; P = .003), EUS (ρ = 0.76; P = .004), and GURS (ρ = 0.67; P = .017), while SPU showed a nonsignificant decline (ρ = −0.58; P = .061). The proportion of women among matched applicants rose from 11.4% in 2014 to 30.6% in 2024, with SUO showing a significant increase (ρ = 0.73; P = .007). Within the matched female cohort, SPU proportions declined sharply from 52.2% in 2016 to 18.4% in 2024 (ρ = −0.9; P < .001). Conclusion: Female-matched fellowship slots significantly increased, driven by EUS, SUO, and GURS. SPU demonstrated a decline, whereas ASA showed no significant changes.