Studies show that many patients have strong convictions regarding their rights and values. Some avoid or delay life-saving medical procedures due to modesty concerns, which can stem from religious, cultural, or personal reasons, or anxieties from previous bad experiences in medical settings. Some patients even travel to another state or country to seek medical care. Others who have been diagnosed with PTSD from abuse in medical settings avoid medical care completely, as documented in Voices in Bioethics. All health care providers and facilities should realize that disregarding patients’ request for an all-same-sex team for intimate procedures or if staff perform intimate procedures without express consent could cause lifelong trauma, possibly resulting in an increased number of deaths due to these harmed patients avoiding medical environments in the future.

An example of violated patient wishes

One man with bladder cancer was so distressed over staff at the VA ignoring his wishes for no female medical personnel that he no longer wanted to undergo bladder cancer screenings (cystoscopies). He shared that at one time he would rather die than endure female nurses viewing and handling his private parts. Even though he made it clear that he accepted female nurses performing non-intimate procedures, he continued to receive opposition. Some medical professionals even labeled him mentally ill because of his convictions. He and his wife were so frustrated with the lack of respect for his wishes in the U.S. that they decided to move to Panama. He ultimately had heart bypass surgery in Colombia and medical staff honored his request for an all-male team.

In his article “Patient Gender Preferences in Healthcare,” Dr. Joel Sherman argues that “Modern medicine is assumed to be gender neutral, that is providers, nurses and assistants are equally able to offer their services to all comers no matter the genders involved.” While it may be true that either gender can provide the mechanics of medical care to all patients, many patients have preferences for same-sex providers for intimate care. For example, there are many all-female OB/GYN practices in the U.S., especially bigger cities because so many women prefer female gynecological providers. Many men have expressed distress over how urology practices often do not employ male nurses or assistants. Sadly, most urology practices in the U.S. still do not have an adequate number of male nurses and assistants. Information detailing how urologists can be more sensitive to male patients is available.

In 2019, I had the privilege of meeting an orthopedic surgeon, Dr. Bruce Levy, who grew weary of seeing his hip surgery patients unnecessarily exposed because the drapes fell off, leaving their genitals exposed. This inspired him to invent special garments that would allow access to the hip and groin for procedures while covering the genitals. These garments have helped ease the anxiety in patients who might not have otherwise undergone cardiac procedures, thus possibly saving their lives. It was encouraging to see how much Dr. Levy cared about protecting the dignity of patients. Society needs more health care professionals like him.

Examples of successful patient advocacy

• One man with a severe case of aortic stenosis only had a 50 percent chance of surviving another year without a valve replacement procedure. He traveled to a facility in another state that was willing to accommodate his request to wear the aforementioned special garments invented by Dr. Levy. This man had a successful procedure and shared that he faced no embarrassment.
• One man was able to find a facility willing to accommodate his wishes for an all-male team and to be able to wear special shorts for a colonoscopy. Many people avoid these humiliating procedures due to dignity concerns.

Tips for health care professionals

• Respect preferences: Never try to convince patients to abandon their preferences for a same-sex team for intimate procedures. If your facility cannot accommodate their wishes, suggest another facility.
• Avoid downplaying wishes: Never talk about how skilled and experienced you are. Keep in mind that many patients have gender preferences for intimate care. Some men who contacted Medical Patient Modesty were upset about how female staff at urology practices would downplay their wishes for a male nurse by trying to talk about how their female nurses have many years of experience.
• Use sensitive language: Never make any insensitive comments such as “I’ve seen many private parts.” It is about your patients’ comfort and autonomy.
• Avoid labeling: Never label patients who care about their dignity as mentally ill.
• Obtain express consent: Do not perform any intimate procedures and tasks such as pelvic exams, urinary catheterizations, shaving of pubic and groin areas, etc. without a patient’s knowledge and express consent. More information on non-consensual procedures is available.
• Advocate for patients: Advocate for patients’ wishes for modesty and dignity.
• Utilize coverings: Utilize as many garments and coverings as possible to protect a patient’s dignity.
• Minimize exposure: Resort to procedures that do not expose private parts as much as possible.

Misty Roberts is a patient advocate.