Why assign a male technician to assist in gynecologic surgery for a female patient with a female gynecologist/surgeon without requesting the patient's explicit consent?

Why Assigning Male Technicians to Gynecologic Surgery Without Explicit Consent is Problematic

Patients undergoing gynecologic surgery should be explicitly informed of all operating room personnel—including their roles and genders—before sedation, and explicit consent must be obtained if staffing differs from any stated gender preference. 1

The Core Ethical and Legal Issue

The assignment of any operating room personnel without explicit patient consent for intimate procedures violates fundamental principles of patient autonomy and informed consent. This practice is particularly problematic because:

• Unconsented intimate exams and procedures on anesthetized patients—regardless of the gender of personnel involved—constitute a breach of patient autonomy and contribute to moral erosion within the medical profession. 2

• Patients do not view intimate body regions in a detached or neutral way, and intimate procedures require special protections beyond standard consent processes. 2

• The landmark case Schloendorff v Society of New York Hospital demonstrates the perils of implicit consent and inadequate communication about who will be involved in surgical procedures. 3

Evidence-Based Approach to Gender Preferences

Patient Preference Data

• Among women expressing a preference for gynecologic procedures, 90.8% prefer same-sex providers for office visits and 92.3% for procedures like colonoscopy. 1

• History of physical or emotional abuse significantly increases the likelihood that patients will prefer female providers, making this a critical safety and trauma-informed care issue. 1

• Embarrassment is the primary driver for women's gender preferences, particularly among those with higher education levels. 1

Implementation Requirements

Gender preference questions must be incorporated into routine pre-procedure screening questionnaires in a non-gendered, inclusive format. 1 This should occur during:

• Pre-operative assessment in a private environment 1
• With clear explanation for why the question is being asked to increase patient confidence 1
• Documentation in the medical record accessible to all relevant team members 1

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

Special Considerations for Vulnerable Populations

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

• Gynecologic procedures can exacerbate gender dysphoria, anxiety, and depression in transgender and gender-diverse patients, making provider gender preference even more salient. 1

• The patient's chosen name and pronouns must be used throughout all interactions, and transgender status should only be shared with the patient's consent and when relevant for safety. 4

Trauma Survivors

• Both men and women with a history of physical or emotional abuse are significantly more likely to prefer female providers, making gender preference screening a trauma-informed care essential. 1

• Creating an open and inclusive environment during surgical procedures is critical, as undergoing surgery represents a vulnerable time for any patient. 1

Institutional Policy Requirements

Healthcare institutions must establish clear policies that include:

• Routine incorporation of gender preference questions into pre-operative screening to avoid non-disclosure and repeated uncomfortable conversations. 1

• Documentation systems that allow future healthcare staff to access gender preferences without requiring patients to repeatedly disclose sensitive information. 1

• Information about gender preferences should only be shared with those for whom it is relevant and with patient consent. 1

• Policies for managing situations where accommodating gender preferences is not immediately feasible due to staffing constraints. 5

Clinical Outcomes Impact

• Respecting gender preferences reduces anxiety and embarrassment, which are primary barriers to seeking care for intimate health concerns. 1

• Female physicians conduct longer visits, use more patient-centered approaches, and are more likely to discuss emotional issues—factors that increase patient satisfaction. 1, 6

• When patients receive care that respects their preferences and autonomy, they experience improved mental health outcomes and are more likely to continue seeking necessary care. 1

Common Pitfalls to Avoid

• Do not assume that because the surgeon is female, the patient will be comfortable with male support staff in the operating room—explicit consent is required for all personnel. 1, 2

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

• Do not rely on implicit consent or assume that general surgical consent covers the presence of specific personnel during intimate procedures. 2, 3

• Avoid "outing" patients by using legal names that differ from preferred names in waiting areas or other public spaces, particularly for transgender patients. 1

The Bottom Line

Respect for patient autonomy is a compelling ethical reason to honor gender-based requests for healthcare personnel, and efforts should be made to accommodate these requests whenever possible. 5 While institutions are not legally obligated to have gender-concordant providers available at all times, patients must be explicitly informed of all operating room personnel before sedation and given the opportunity to consent or decline. 1 This is not merely a courtesy—it is a fundamental requirement of informed consent for intimate procedures. 2