Karen Boyle Men: Meet Your Urologist This Hopkins-trained physician sees plenty of women, too. Here, she talks about what sparked her interest in the field.

You’re one of only two women practicing urology in Maryland and the third to complete the Brady Institute program. What made you pursue this specialty?
Actually, as an undergrad at Harvard, I’d planned to go into pediatric oncology. But a urology rotation my third year at Albany Medical College made me change course. I had an amazing mentor who later became their dean. He helped me appreciate the diversity of the surgeries one performs as a urologist. In urology you can develop a long-term bond with patients because you treat them both medically and surgically. I also enjoyed the technology, like minimally invasive surgery, and the diverse patient population.

Was Hopkins your first choice for your internship and residency?
Absolutely. If you know you want to do urology, your dream is to work with former director Patrick Walsh, so I worked hard for that opportunity. He has arguably contributed more to the field than anyone else.

During your training, did the men give you any grief?
I was lucky. I was one of only two women in my intern class, but I was always treated fairly. My co-residents were like brothers, and I think it was they who had to put up with me since I’m such a girlie-girl. Also, I’ve always been comfortable around men. I’m a huge sports enthusiast.

Your specialty is male infertility. What’s the most common problem in that regard and how do you address it?
Surprisingly, men lose 1 percent of their testosterone every year after age 30. That can affect sperm count, sex drive and erections. In fact, 30 percent of the time when couples can’t conceive, the sole problem is male infertility. Usually there’s either an obstruction or low sperm count. I’ve developed some microsurgical techniques to search for more sperm and then extract them.

But often the woman has infertility problems too. To what extent do you involve the female partner?
Very much so. I treat male and female sexual dysfunction. I make a point of treating couples together and try to identify contributing barriers to both reproduction and sexual fulfillment. Most urologists focus just on the man or refer the couple to a psychiatrist. Since I treat both male and female sexual dysfunction, I can coordinate care with
colleagues in gynecology, reproductive endocrinology or psychiatry.

How many of your patients are women?
About half of my general practice. As a woman in urology, I naturally attract female patients. Many see me about bladder and voiding dysfunction.

Do you ever feel awkward discussing the most personal matters with your male patients?
The way I look at it, if you’re comfortable with yourself and can speak frankly about intimacy, your patients will be comfortable talking to you. And I’ve found that, in general, men have no trouble talking to me about their sexual problems.

You also treat prostate disorders and perform adult circumcision and vasectomies. Ever had a male patient who was uneasy seeing a female urologist?
Actually, only once—when I was a medical student rotating on urology. I went in to examine a 90-year-old native Irishman. He took one look at me, and, in a charming, thick brogue, said, “There are two women in my life who have seen me down there. One is my mother and one is my wife. You’re not about to be the third!”

Do you think Viagra is as effective as the commercials claim?
It’s revolutionized male sexual dysfunction and allowed us to talk about impotence. Before that, men probably felt like they were all alone. Now commercials for Viagra are on TV constantly—even during the Super Bowl. I look forward to the FDA approval of a drug that could help women with arousal and orgasm problems.

Would such a drug enable women to be more open about their sexual problems?
I would hope so. Women still aren’t comfortable talking about it, even to other women.

But, given the media’s obsession with sex, shouldn’t it be easier for women to have that  conversation?
True, we can speak more openly about sexual fulfillment, but the media have also been a big cause of the problem because they feed on women’s insecurities about body image. At a recent Hopkins conference, “A Woman’s Journey,” I held up a picture of the cast of Sex in the City and found that many in the audience felt inadequate when compared with those actresses.

As you build your practice, what are your goals?
To take the very best care of my patients, to become a leader in my field both academically and clinically and to encourage men and women to seek my help for infertility and sexual intimacy troubles together.

—Judy Minkove