My dad has spent the last 4 years getting his PhD while working two full time jobs. He did it because he didn’t want me to be the only Doctor in the family. At the age of 65, world, meet Dr. Emmanuel Uloko 😭 my father, my biggest cheerleader and who I compare every man to.
As a board-certified urologist that specializes in sexual health for ALL sexes... I mean this when I say "medical sexism is real." Men and women are not getting the same level of care, access to care or even scientific integrity in their care.
2. Vasectomies are done under local anesthesia/sedatives as standard practice. An IUD placement however is done without medication despite the immense pain that can be associated with it. It's so prevalent that articles have been written about this experience.
Wow, you all thank you so much for the kind words on my father. He’s floored and overwhelmed by the support. Never in his wildest dreams would he think he’d get such a response! If you loved this story, check out my podcast
@BattleCryPod
for more stories of diversity in STEM!
It is so deeply ingrained in our system that we don't even notice it. So let's give some very obvious examples.
1. Hormones are celebrated for men's health and fear mongered in women despite both potentially causing cancer and side effects.
When I told my medical school appointed advisor that I was in my second term of being our medical school class president- "It's so hard being a white male in medicine now that they are giving away our leadership spots to people like you"
#BlackintheIvory
3. When we do cancer surgeries for men (prostate/bladder) we have therapies invented to address the potential quality of life issues afterward. It wasn't until 2024, that the AUA had a course addressing sexual health for women after urologic cancer surgeries
4. We have so much data that HRT is a safe and most effective way to prevent diseases for menopausal people like heart disease, Alzheimer's disease, colon cancer, gynecologic cancers, debilitating symptoms etc. Yet many people experiencing menopause can't find doctors to go to.
7. When a man comes in with bothersome urinary symptoms we have a whole protocol that helps guide us to get down to the root cause. When women present with bothersome urinary symptoms we call it a UTI and give them antibiotics without exploring other options.
5. We perform open abdominal surgery on pregnant people (C-section) without general anesthesia- I can't imagine how well this would go with if these were male bodies. I am not a gambler but I would bet we would have created new protocols/research to enhance the experience
6. We overwhelm our OB/GYN colleagues with non-sensical consults whenever we have a pregnant person because we feel so uncomfortable. We have so sequestered all of women's health to one specialty despite women making >50% of the population.
This one is wild. I found that up to 88% of people that initially came to my clinic for recurrent UTIs were actually a vulvar condition. We treated their vulva we stopped the infections.
10. My men's health clinic was high fives and smiles but my women's health clinic was always tears. ALWAYS. These tears were caused by a system that has neglected them. Told them diseases that are easily treated are chronic or have your experience dismissed, you would cry too.
12. We analyzed PubMed articles and the number of articles published on penises was >53,000 and vulva research ~2500. Yall, this is bad. Just very bad.
8. 1 in 4 women/vulva owners will have chronic pelvic pain. Yet it takes 7 years on average to get a diagnosis. I can diagnose these patients in 30 minutes (give or take 10-15 minutes) and that's because I got additional training to learn it.
You can't watch a sporting event without hearing a commercial for testosterone therapy for low T. When they decide to go to a doctor to discuss this, they are rarely dismissed AND there are even whole clinical guidelines on how to make sure they are safe while taking it.
9. 100% of vulva owners will experience dysfunction and yet most physicians including gynecologists are not taught about the vulva especially as it changes throughout the lifespan
To get vulvar research funded, I have even applied for penile research funding opportunities and tied in why caring about the vulva helps the penis owner.
11. Let's not even go into research funding. On average, the NIH has spent roughly less than a dollar/person with pelvic pain. As a researcher of all genitals/sexes, I've never had to worry about finding funding for any study i want to do with men or penises.
We can't start addressing these issues if we don't start naming it. We need better funding for women's health, we need better protocols for diagnosis and treatment, we need better training for doctors, we need education reform for students, we need better research.
This is not something that gynecologists should just handle on their own. Every physician that took the hippocratic oath should care about this. First do no harm....and the stats are showing that we aren't doing that.
If we want to talk about increasing diversity and inclusion in surgery, (a triggering 🧵) we have to normalize female surgical residents having children and lose the antiquated patriarchal idea that we as women are privileged to be joining the “boys club” of surgery so we must
These are just a few examples that come to mind immediately but there are so many more. Being able to take care of the sexual health of all sexes, has given me a unique perspective of how people access care, who is valued, and who is believed/prioritized.
✔️Med school by 17, med school grad by 23, urologist by 28
✔️First black woman from my medical school to match into urology
✔️First black woman to graduate from the University of Minnesota urology program
🔲Hug Oprah
🔲First of many- make sure I'm not the last
I started med school at 17 and I am now 30 years old. I’ve spent almost half of my life in medicine. In all that time, I have seen more unprofessional behavior in people wearing button downs below knee dresses, and Dockers than people with braids, pink hair, piercings or tattoos
To all the people sharing their story I see you and hold space. To those taking offense to calling for medical equality, not sure who hurt y’all. My job is to help everyone have better sex lives and healthy genitals. Sex is often a team sport and I want all my players healthy!
If women knew how little the medical field is trained about their bodies- all the poor health stats you see would start making sense. Women are not “difficult” or “challenging” the healthcare system is just largely ignorant and we blame you instead of addressing our ignorance.
Pro tip: when recruiting a Black woman who addresses her safety concerns about moving to your city - don’t lash out AGGRESSIVELY with “I don’t see color” which I replied “That’s a dangerous rhetoric that will get people killed. Also you may not see color but your patients will”
LAST DAY OF TRAINING EVER! 13 years of brutal sacrifice to achieve this dream. I started this journey as a naive 17 year old immigrant kid unaware where it would take me. Grateful for the lessons I’ve learned through it all. The most important one: I am so much more than medicine
Let’s talk about care delivery gaps in women’s health.🧵 This tweet sums it up perfectly. The focus of Ob/GYN is reproductive health. Full stop. Yet they are tasked with taking care of the whole patient without getting that formal training.
Wait till she hears about perimenopause….
All these symptoms - all the time for ~4-8 years. BUT ALAS there is a way to get rid of these symptoms and stop the suffering but most doctors refuse or discourage you from taking them bc of bad interpretation of research/data. 🙃🙃
Periods are so shocking every time. What do you mean blood? What do you mean cramps? Back ache? Boob ache? Head ache? Digestive issues? Wanting to cuddle and wanting to kill and craving this one dessert you had at an all-inclusive with your family years ago when you were 8
My goal in academia is restructuring how the external vulvar exam is taught. We spend so much time in medical school on anatomy and yet a majority of graduating medical students/residents do not know how to examine the vuvla. We need to do better for our patients.
Hi, I’m Dr. Maria Uloko! I’m a urology fellow at San Diego Sexual Medicine/Scripps specializing in male and female sexual medicine, infertility and prosthesis! I am part of the 1% of black female urologists and strive to increase that number!
#blackinurologyrollcall
#blackinuro
We uphold traditions as a sign of toughness and prestige. “I did it, and so should they”. We have to start questioning an archaic system that upholds a one size fits all model that is often to the detriment of those that do not fit the mold of the stereotypical surgeon.
This is, in part, is due to the disproportionate burden that women bear of pregnancy and care giving responsibilities. This is something near and dear to my heart-I had three miscarriages during residency-each time on 72 hour call or while operating.
“HOW DO WE NOT KNOW THIS YET?!” A venting session on *one* of the many inequalities in sexual health turned into this project. This was a passion project in every turn of phrase. A urologist, gynecologist and gender affirming surgeon got mad and did science. Research is advocacy.
I share this story not for sympathy-I don’t need nor want it. That’s what my therapist and God are for. What I want is change. We have to start normalizing these experiences. In surgery, we wear our suffering with pride and as a badge of honor.
Deny, hide or be ashamed of our biology. There have been numerous research studies and articles on how the rigidity of surgical training disproportionally affects female surgical trainees despite the number of female medical students now surpassing that of males.
I “chose” to want to have children. My program was very family friendly yet my male colleagues never experienced the mental, physical, logistical and emotional acrobatics that their female colleagues experienced. Yet we say surgical training is “fair”.
I completed the case, put my orders in and walked up to OB before the next case. I completed my call weekend all while scheduling a DNC for an afternoon I had no cases or clinic. I prioritized my patients and my responsibility over myself because this was my cross to bear
The idea that penises, unlike the rest of the body, are supposed to function optimally up until death is so toxic. The shame from this is a huge barrier to treatment for many patients. We don't shame people for needing a hip or knee replacement. We should not shame people for ED.
Do not attack me for making your recruiting process more inconvenient for you by addressing real issues when there are people being killed?! This is a woman who did not come to play. Your delusion of the world is not my burden to entertain.
I’m all about educating and furthering the advancement of future generations. It is a passion of mine. But a last minute ask because you can’t fill the slots on a topic I don’t even know? After a week like this? I respectfully decline. Mood fo Eva.
#MedTwitter
#nahfrommedog
For my recurrent UTI, chronic pelvic pain, post sex UTI, recurrent vaginal infections, IC peeps- if there was a tool you could use to find the root cause, learn how to get diagnosed and treated quicker, and track symptom progress- like this post. I’m tryin to see something👀
During residency, I remember turning off the microphone on the robotic console so no one could hearing me crying while listening to the OR staff make light of the George Floyd murder. Fast forward to fellowship-
the entire office had open discourse about the horror of today’s events. Being in inclusive safe spaces is a gift in medicine and one I don’t take lightly.
I could write a book on how many of these stories I’ve heard. It makes it hard not to speak up and start saying the quiet part out loud. ALL specialties need to know how diseases can present differently in women and how to treat it. This affects us all.
That means things like brain health, heart health, mental health, gut health, metabolic health, post partum health, sexual/vulvar health, menopause are just falling through the cracks. Why do women have more fatalities in heart attacks than men?
On National Women’s Physicians Day, let’s steer the conversation to how we can make medicine/surgery more feasible for birthing people by creating comprehensive and fair maternity leave policies that support our workforce. There’s no way we can change the landscape without it
One reason is bc they are misdiagnosed at higher rates bc their symptoms present differently than we were trained in medical school to observe. I had a patient recount her story of having a heart attack and the EMS person told her she was just having a panic attack.
This should be standard education for anyone who sees patients. There are too few doctors with the training to start filling the gaps in women’s health care but there aren’t enough of us. Thankful for
@jjfitzgeraldMD
for saying the quiet part out loud and starting the convo.
She ended up needing a heart transplant bc her heart was so damaged by the time someone believed her. She had been symptomatic for weeks leading up to it and had even gone to her doctors who told her it was just stress and referred her to pelvic floor PT. PT for a heart attack.
I find it wild that we continue to uphold traditions in surgical training that numerous studies have shown negatively affect women and minorities solely because it's "tradition". Fun fact: Many said traditions were created by a man deep in the throes of drug addiction.
Hey Millennials & Gen Z- did you know that menopause affects everyone with ovaries? Yet <10% of docs are trained on it. That's means 90% of doctors will not know how to treat or mange your symptoms. Let's bring the energy we have for reproductive rights to menopause access! 🔥
Happy Monday! Today feels like a great day to start vaginal estrogen for your peri-menopausal/menopausal patients with vaginas and recurrent urinary tract infections! Really any day is a great day to start! Everyone will thank you. Trust me. Love, your urologist
Hot take: We need to uncouple the idea of sex and reproduction in medicine especially when it comes to people with vaginas. Urology has done a great job of this for people with penises. We have infertility specialists + sexual med specialist +clear cut curriculum in our trainings
The more I learn about the history of OB/Gyn, the more I directly see how medical education has failed people with vulvas in their sexual health. Of course, a practice rooted in misogyny and racism will not prioritize sexual health and the quality of life of their patients.
Fun fact you didnt learn in health class: the human vulva literally starts to shrink without hormones. These changes happen starting ~ perimenpause and continue to get worse. The changes are silent until they aren’t. It leads to UTI’s, painful sex and vaginal infections.
QT with a black and white photo of you.
Right after I left med school and returned to my best friends from college to be a bridesman and start residency.
There was a puppy playpen at the wedding.💖
This structure is the vestibule. This is the location of pain in 90% of patients with vulvodynia. Yet, it’s barely mentioned in gynecology or urology. Make that make sense?🤔 We need to change medical textbooks and curriculums ASAP! (Also stay out of our uteruses)
#AUA22
Hello, new followers- let me introduce myself. My name is Maria Uloko, MD. Yes, I did graduate from medical school at 23. I completed a very competitive 6 year BLA/MD program at UMKC in Kansas City. I am the first Black person from my medical school to match in urology
Dr. Denise Asafu-Adjei is currently a Fellow in Andrology at UCLA. She completed urologic residency at Columbia University. She obtained her B.S. from Carnegie Mellon University and her M.D. from the University of Michigan. She also has a MPH from Harvard School of Public Health.
Dr. Bernice King asked me “aren’t you that urologist they were talking about?”
I can officially cross that off my bucket list. 😱An honor to meet Dr. Martin Luther King’s daughter
@berniceking
and listen to her recount her legendary parents and how she is carving her own legacy.
Man on plane: what are you studying for?
Me: my urology oral boards
Man on plane: oh cool, are you a nurse?
Me: No, women can be surgeons now too.
One day my genitalia won’t make people have selective hearing.
and the first Black resident to ever graduate from the University of Minnesota urology program. These "historic moments" drive my activism to make urology more inclusive and diverse. I've also combined my love for STEM and narrative story telling to create,
@BattleCryPod
.
We love a sex med cross over. Getting to do research with my dear friend,
@queersurgeon
is made even better when you win an award for it. Thank you
@SMSNA_ORG
@ISSM_INFO
for the honor.
Medicine is a privilege, a passion and I can’t believe I get to do what I love. But the most pride I have is never losing my humanity, finding my voice and defining what is important me even if it went against “tradition” or prestige. All before 30. (Small flex)
The best lesson I’ve learned as a chronic pelvic pain specialist- when a patient comes to see me it’s not my job to decide if their pain is real. My only job is to figure out why. We are taught to not believe patient’s pain unless we as the doctor think it’s valid.
Time is the most precious resource we have. Last week reminded me how much of a commodity it is. My dad had a medical complication that almost ensured we would no longer have time together. His chances of survival/recovery were not in his favor. I knew that and was prepared.
Next step in this journey: clinical professor at
@UCSD_Urology
and first ever fellow hired on as staff
@SDSexualMed
! I get to continue working with my fave mentors, research, and teach the next generation of urologists and gynecologists all in a city I love.
Real talk, the way women are treated in medicine is one of the most deplorable and things I’ve witnessed is an understatement. Lack of research, lack of science, continued traditions that are rooted in racism and sexism and barely anyone questioning it. It has to end.
Jessica Pettway died of cervical cancer at age 36. She had 3 hospitalizations in 7 mos requiring 18 blood transfusions before anyone did a pelvic exam. Our tendency to dismiss women’s symptoms, especially if the women are Black or other WoC, literally kills.
#MedTwitter
Thank you
@SWIUorg
and
@shene11e
for the platform to talk about “the Dangers of Colorblindess”. I find these talks so rewarding and tear up every time. The things I used to shrink down or hide about myself to fit what I was told a urologist was, have now become my strength.
We need to stop framing sexual health for people with vulvas as a “niche”. If you are a health care provider who sees people with vulvas, you should have a differential diagnosis ready to go. It’s not only just but good patient care. Thank you for coming to my Ted Talk.
Was my fellowship graduation delayed because I insisted it be at Drag Brunch? Yes. Was it the most fun graduation ceremony I’ve ever had despite being an attending for two months? Also yes! Thank you
@SDSexualMed
for indulging me and helping me find my passion in urology!
Didn’t think I’d make friends on the internet growing up and yet here we are. Sex med and gender affirming surgery cross over. ❤️❤️ Happy early birthday
@queersurgeon
!
Thank you
@NationalMedAssn
and
@rfrankjones_uro
for the opportunity to present on the overlap of urinary symptoms and vulvar pain conditions. We need to restructure our approach of “recurrent UTIs” and IC by thinking outside of the bladder. Vulvar health is urinary health.
#NMA22
Fun fact that I love sharing: If you’re getting UTI’s immediately after sex (less than 48 hours) it’s mostly not your bladder. There are several other things that can mimic UTI symptoms and many stem from the vulva/pelvic floor.
Being told I "speak English really good" by my patients or hospital personnel when I tell them I'm Nigerian. British common wealth + several degrees = "I think you mean, I speak English really well...."
#BlackintheIvory
When Trump won, my white male co-resident said to me. “Why are you so upset, he never said anything bad about Black people. He’s not that bad” I just stared in disbelief and uttered “Tolerating hate is never okay and so dangerous”. I’ve thought about that convo everyday since.
It feels a little futile to study metabolic stone disease in the aftermath of a fascist coup made up of white supremacists and NEO-Nazis, a global pandemic that has been politicized with death tolls rising every day. 🤷🏿♀️ Welp, back to the books. Urology boards T-minus 4 days
#blackmedtwitter
Are you a Black palliative care provider or do you know of one? If so, would you be interested on being interviewed for a NYT story on the health disparities in palliative care? If so, DM me!
My dad showed me articles about my himself getting his PhD on several Nigerian based websites. This makes me so happy that my dad got this recognition for all his hard work but also explains the uptick in Nigerian princes sliding into my DM’s. 🤔