Should a patient be asked about their gender preference for their healthcare provider when intimate care is required?

Should Patients Be Asked About Provider Gender Preference for Intimate Care?

Yes, patients should routinely be asked about their gender preference for healthcare providers when intimate care is required, as this practice respects patient autonomy, reduces anxiety and embarrassment, and improves care engagement—particularly for women, survivors of abuse, and transgender/gender-diverse individuals.

Evidence Supporting Routine Inquiry

Patient Preferences Vary Significantly by Demographics

• Women demonstrate strong same-sex preferences for intimate procedures: 90.8% of women prefer same-sex providers for gastroenterology office visits and 92.3% for colonoscopy, compared to 70% and 84.1% of men respectively 1
• Embarrassment is the primary driver for women's preferences, particularly among those with higher education levels 1
• History of abuse is a critical factor: Both men and women with a history of physical or emotional abuse are significantly more likely to prefer a female provider, with female gender, lower-income level, and abuse history being significant predictors of gender preference 1
• Among patients expressing a preference, 92% of women and one-third of men prefer female endoscopists 1

Gender Preferences Exist Across Multiple Specialties

• Preferences are strongest for intimate and psychosocial care: Gender preferences are more pronounced for health professions engaged in intimate examinations and psychosocial issues (gynecologists, general practitioners, psychiatrists) compared to "instrumental" specialties like surgeons or anesthesiologists 2
• The majority of patients who prefer female providers indicate they talk more easily with females and feel more at ease during internal examinations 2
• For erectile dysfunction management, 57% express no gender preference, but among those with a preference, approximately 75% prefer male providers 3

Implementation Framework

How to Ask the Question

• Incorporate gender preference into routine pre-procedure screening questionnaires in a non-gendered, inclusive format 1
• Ask sensitively and in a private environment, providing clear explanation for the relevance of the question to increase patient confidence and reduce feelings of discrimination 1
• Frame the question neutrally: "Do you have a preference for the gender of the provider performing this procedure?" rather than assuming preferences based on patient characteristics 1

Documentation and Follow-Through

• Record the patient's preference in the medical record in a way that future healthcare staff can access it to avoid repeated uncomfortable conversations 1
• Information about gender preferences should only be shared with those for whom it is relevant and with patient consent 1
• Use the patient's preferred name and pronouns throughout the interaction, particularly important for transgender and gender-diverse patients 4

Special Considerations for Transgender and Gender-Diverse Patients

Creating a Safe Environment for Disclosure

• Transgender and gender-diverse patients have low confidence that healthcare workers understand their needs and fear encountering prejudice and discrimination 1
• Routine incorporation of gender identity questions into screening reduces non-disclosure: Use a two-step question asking about sex recorded at birth and current gender identity 1
• Pregnancy can exacerbate gender dysphoria, anxiety, and depression in transgender individuals, making provider gender preference even more salient 4

Addressing Unique Vulnerabilities

• Transgender patients report frequent discriminatory experiences in healthcare settings, and gender-affirming competent care improves health and well-being 5
• Patients engage in "relational risk assessment" when deciding whether to share information with providers, weighing implicit and explicit safety cues 5
• Provider flexibility and responsiveness to patient preferences are essential for equitable, gender-affirming care 5

Clinical Outcomes and Quality of Life Impact

Benefits of Respecting Gender Preferences

• Female physicians conduct longer visits, use more patient-centered approaches, and are more likely to discuss emotional issues and actively seek patient input 1
• Patients of female providers report higher satisfaction with their interactions, though physician gender was not associated with male patient satisfaction in some studies 1
• Respecting preferences reduces anxiety and embarrassment, which are primary barriers to seeking care for intimate health concerns 1, 2

Impact on Care Engagement

• Privacy during discussion of intimate issues is very important to patients and influences willingness to seek care 3
• When transgender persons receive medically appropriate, affirming care, they experience improved mental health, reduction in suicide rates, and lower overall healthcare costs 6
• Failure to accommodate preferences may result in delayed or avoided care, particularly for procedures like colonoscopy where embarrassment is a significant barrier 1

Common Pitfalls to Avoid

• Do not assume preferences based on patient demographics: While patterns exist, individual preferences vary widely and approximately 46-57% of patients express no gender preference 1, 3
• Do not omit asking simply because accommodating the preference may be difficult: Even if the preferred gender provider is unavailable, documenting the preference allows for future accommodation and demonstrates respect for patient autonomy 1
• Avoid using legal names that differ from preferred names during clinical interactions, particularly for transgender patients 4
• Do not "out" transgender patients by calling them by birth names in waiting areas or other public spaces 1
• Never assume that younger women prefer female providers while older women prefer male providers: While older women may care less about gender, this is not universal and individual preferences should always be elicited 1

Age-Related Considerations

• Older patients (>65 years) interact with physicians in a more patient-centered manner regardless of provider gender 1
• Younger patients may be more familiar with technology and prefer digital communication, but this does not negate the importance of asking about gender preferences for intimate procedures 1
• Older women may have implicit bias that male physicians are more competent, but this should not prevent asking about preferences 1