In GYN surgery, should a male surgical tech be assigned to a female patient who prefers a female GYN/surgeon without her explicit consent and prior notification before sedation?

Patient Consent for Male Surgical Technicians in GYN Surgery

A female patient who has expressed a preference for a female GYN/surgeon should be explicitly informed before sedation if a male surgical technician will be present in the operating room, and her consent should be documented. While the evidence does not directly address surgical technicians specifically, the principles of respecting patient autonomy, reducing gender dysphoria and anxiety, and honoring stated gender preferences in intimate procedures apply to all operating room personnel present during gynecologic surgery.

Core Principles from Guidelines

Patient Autonomy and Informed Consent

• Respect for patient autonomy is a compelling reason to honor gender-based requests in obstetrics and gynecology settings 1
• Patients may request same-sex providers for various reasons including privacy concerns, religious or cultural reasons, and history of abuse, and should be given the opportunity to voice their reasons but should not be compelled to do so 1
• When a patient requests a female provider, efforts should be made to accommodate the request if possible 1

Documentation and Communication Requirements

• Gender preferences should be incorporated into routine pre-procedure screening questionnaires and documented in the medical record 2
• Information should be recorded in a way that future healthcare staff can access it to avoid repeated uncomfortable conversations 3, 2
• Questions should be asked sensitively and in a private environment, providing clear explanation for the relevance of the question to increase patient confidence 3, 2
• Information about gender preferences should only be shared with those for whom it is relevant and with patient consent 3, 2

Evidence Supporting Gender Preference in Intimate Procedures

Strength of Patient Preferences

• Women demonstrate strong same-sex preferences for intimate procedures, with 90.8% preferring same-sex providers for gastroenterology office visits and 92.3% for colonoscopy 2
• Among patients expressing a preference, 92% of women prefer female endoscopists 2
• Embarrassment is the primary driver for women's preferences, particularly among those with higher education levels 2
• History of abuse is a critical factor, with both men and women with a history of physical or emotional abuse being significantly more likely to prefer a female provider 2

Quality of Life and Psychological Impact

• Respecting preferences reduces anxiety and embarrassment, which are primary barriers to seeking care for intimate health concerns 2
• Patients report higher satisfaction when their gender preferences are honored 2
• Undergoing surgical procedures can be a vulnerable time for any patient, making it important to create an open and inclusive environment 3

Practical Implementation Algorithm

Pre-Operative Phase

1. Ask about gender preferences during pre-operative screening using non-gendered, inclusive questionnaires 3, 2
2. Document the preference clearly in the medical record where all team members can access it 3, 2
3. Communicate the preference to the surgical scheduling team to attempt accommodation 1

Day of Surgery

1. Before sedation, explicitly inform the patient of all personnel who will be present in the operating room, including their roles and genders 3, 2
2. Obtain explicit consent if the staffing differs from the patient's stated preference 3, 1
3. Document the conversation and consent in the medical record 1

When Accommodation Is Not Possible

• Medical professionals and institutions are not ethically obligated to have gender-concordant staff available at all times 1
• If it is not feasible to provide gender-concordant care because of staffing or system constraints, accommodation is not required 1
• However, the patient must be informed and given the opportunity to decline or reschedule the procedure 1
• Patients have the right to decline care and may choose to seek care elsewhere if their requested healthcare provider type is not available 1

Common Pitfalls to Avoid

• Do not assume the patient will not notice or care about support staff gender simply because they are not the primary surgeon 2, 4
• Do not wait until the patient is sedated to introduce male staff members when a preference for female providers has been documented 3, 2
• Do not omit asking about preferences simply because accommodating them may be difficult, as documenting the preference allows for future accommodation and demonstrates respect for patient autonomy 2
• Avoid dismissing gender preferences as discriminatory without understanding the underlying reasons, which may include trauma history or cultural/religious beliefs 2, 1

Special Considerations

Transgender and Gender-Diverse Patients

• These patients have low confidence that healthcare workers understand their needs and fear encountering prejudice and discrimination 3, 2
• Pregnancy and gynecologic procedures can exacerbate gender dysphoria, anxiety, and depression, making provider gender preference even more salient 3, 2
• Use the patient's chosen name and pronouns throughout all interactions, and ensure this is clear to the entire multidisciplinary team before patient arrival 3, 2

Institutional Policies

• Institutions and medical clinics should have policies and procedures in place for managing patient requests for gender-concordant care 1
• Patients should be made aware of these policies preemptively 1
• These policies should be accessible and familiar to physicians and trainees 1