Should patients undergoing gynecologic (GYN) surgery, particularly those with a history of trauma or post-traumatic stress disorder (PTSD), be informed about the presence of male technicians in the surgical team?

Informed Consent for Male Technicians in GYN Surgery

Yes, patients undergoing gynecologic surgery should be explicitly informed about the presence of male technicians or any male personnel in the surgical team before sedation, and their gender preferences should be documented and accommodated whenever possible. 1

Pre-Operative Screening and Documentation

• Incorporate gender preference questions into routine pre-procedure screening questionnaires using non-gendered, inclusive formats that allow patients to express preferences without feeling discriminatory. 1

• Ask about provider and staff gender preferences sensitively in a private environment, providing clear explanation that this question helps ensure patient comfort and safety during vulnerable procedures. 1, 2

• Document the patient's preference clearly in the medical record where all surgical team members can access it, preventing repeated uncomfortable conversations and ensuring the entire multidisciplinary team knows the patient's wishes before arrival. 1

• Screen specifically for history of sexual trauma, abuse, or PTSD during pre-operative assessment, as these are critical factors that significantly increase the likelihood of preferring female providers and experiencing distress during intimate procedures. 1, 2

Explicit Pre-Sedation Disclosure

• Before administering sedation, explicitly inform the patient of all personnel who will be present in the operating room, including their specific roles and genders, and obtain explicit consent if the staffing differs from the patient's stated preference. 1

• This disclosure is particularly critical because patients under anesthesia cannot maintain autonomy or control, creating ethical dilemmas around delegating autonomy during amnesia, especially for individuals with sexual trauma histories. 3

• Women with history of sexual violence and PTSD report significantly higher levels of distress, fear, embarrassment, and pain during physical examinations compared to women without such history, making pre-procedure transparency essential. 2

Clinical Rationale for Disclosure

The evidence supporting mandatory disclosure is compelling:

• 90.8% of women prefer same-sex providers for intimate procedures, with embarrassment being the primary driver, 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 female providers. 1

• Respecting preferences reduces anxiety and embarrassment, which are primary barriers to seeking care for intimate health concerns and directly impacts quality of life. 1

• 16.4% of patients undergoing hysterectomy for benign disease develop PTSD symptoms post-operatively, demonstrating that gynecologic surgery itself carries non-negligible psychological risk. 4

Special Considerations for High-Risk Populations

Trauma Survivors

• Implementing trauma-informed practices is essential, including waiting to perform sensitive examinations until trust is established, using open communication, and explicitly asking permission at each step. 2

• Many chronic pain syndromes in sexual assault victims co-present with dysmenorrhea, menorrhagia, and sexual dysfunction, requiring comprehensive attention to multiple interconnected health issues. 2

• Patients with PTSD are at independent risk for emergence delirium and longer post-anesthesia care unit duration, making pre-operative psychological preparation even more critical. 5

Transgender and Gender-Diverse Patients

• Transgender and gender-diverse patients have low confidence that healthcare workers understand their needs and fear encountering prejudice and discrimination. 1, 5

• Pregnancy and gynecologic procedures can exacerbate gender dysphoria, anxiety, and depression in transgender individuals, making provider gender preference even more salient. 1, 5

• Use the patient's chosen name and pronouns throughout all interactions, and confirm preferred language and terms before discussing procedure-related information. 5, 1

Implementation Algorithm

1. During scheduling: Include gender preference questions on pre-operative paperwork
2. At pre-operative visit: Review preferences in private, screen for trauma/PTSD history, document clearly in accessible location in medical record
3. Before day of surgery: Attempt to accommodate stated preferences in staffing assignments
4. Immediately pre-sedation: Explicitly disclose all personnel present (names, roles, genders) and obtain verbal consent
5. If preferences cannot be accommodated: Inform patient of this limitation and allow them to decide whether to proceed or reschedule

Common Pitfalls to Avoid

• Do not assume preferences based on patient demographics, as approximately 46-57% of patients express no gender preference, but individual preferences vary widely. 1

• Do not omit asking simply because accommodating the preference may be difficult—documenting the preference allows for future accommodation and demonstrates respect for patient autonomy. 1

• Avoid "outing" patients by calling them by birth names in waiting areas or other public spaces, particularly for transgender patients. 1

• Do not wait until the patient is already sedated to introduce male team members, as this violates the principle of informed consent and autonomy during vulnerable procedures. 3