While many urologic cancer can occur in both sexes, bladder cancer has the most unique sex-specific differences. Despite lower incidence of bladder cancer in females, these patients experience a worse prognosis compared to their male counterparts. Importantly, to decrease delays in care, bladder cancer should always be considered in the differential of those with hematuria. The hematuria evaluation involves imaging studies and direct visualization of the bladder with a camera, known as cystoscopy. Bladder cancer can be divided into two categories of disease: non-muscle invasive (NMIBC) and muscle invasive bladder cancer (MIBC). NMIBC may be treated with endoscopic resection and intravesical therapies, with ongoing need for cystoscopic surveillance. MIBC often requires removal of the bladder (cystectomy) and urinary diversion with or without systemic chemotherapy or immunotherapy. Historically, removal of the uterus, fallopian tubes, ovaries, and anterior vagina have occurred in conjunction with cystectomy for MIBC. Recent research and expert opinion suggest that removal of all gynecological organs is unlikely to be necessary in many cases. In addition to common surgical complications and quality of life disruptions of cystectomy, gynecologic-specific complications include vaginal closure dehiscence, prolapse, dyspareunia, iatrogenic menopause, and vaginal fistula.