Surgery and Your Modesty

Surgeons, nurses, and other medical professionals rarely talk about patients’ modesty for procedures. However, with proper communication and education that patient can have maximum modesty for many procedures. For example, during a colonoscopy procedure specially designed shorts can be worn and only part of the buttocks will be exposed.

It is the doctors and their assistants’ jobs to make the patient feel as comfortable as possible. Medical professionals often skip over details of the procedure and/or try to make the procedure sound as clinical as possible. In that effort, many times patients are not told about prepping/positioning for surgery and during surgery or what parts of their bodies might be exposed. Maintaining modesty in these instances is paramount for the patient’s well-being. Wearing underwear and/or a bra (for women) can effectively ensure this modesty especially if routine surgical procedure is for the patient to be stripped naked such as during shoulder surgery.

It is possible for a woman to wear a specialized bra that covers the breasts but allows full access to the shoulder being operated on. One Illinois orthopedic surgeon invented a special bra for his female shoulder surgery patients after he received concerns from his own employee who felt uncomfortable letting him operate on her shoulder due to exposure of her breasts. Watch a video of this orthopedic surgeon who invented the Modesty Bra.

At many hospitals once the patient is in the operating room his or her gown will be removed or pulled up depending on what parts of the body are being operated on. If a patient does not have surgery shorts and/or underwear on under his or her gown the genitals will be exposed for these surgeries (ex: knee replacement surgery).

Sadly, many people are completely unaware that their bodies are unnecessarily exposed for surgeries; surgeries which don’t even involve the patient’s private parts. Some medical facilities routinely require patients to remove their underwear for all surgeries. This is ridiculous. Check out our article, Unnecessary Underwear Removal For Surgeries.

For example: think about a patient who wears no underwear under his/her gown for knee surgery; when the gown is lifted the genitals are exposed. Some patients are stripped naked for surgeries involving a finger, hand, arm, etc. Some surgery patients found out because they woke up naked before medical professionals could redress them. A nurse who worked in surgery for many years made this confession a number of years ago: “They will wait until you are asleep to remove your gown and place the catheter and when you wake up you'll have that gown back on like nothing ever happened.”

When a patient is under general anesthesia and/or does not have a personal advocate present, such as a spouse, it is very common for medical professionals to ignore patient's wishes for a same gender medical team for surgeries. Multiple medical professionals representing a gender different than the patient’s gender are often brought into the OR while the patient is under general anesthesia and his or her private parts are exposed. There have been some cases when patients were deceived by medical professionals that their wishes would be honored and weren’t. This is unethical. Some examples include: removing a patient’s underwear and gown while under anesthesia and then redressing him/her before he/she wakes up; promising a patient a same gender medical team and then not actually honoring that.

A patient can often find out if his or her wishes for a same gender team were respected by getting an operative report after the surgery. This report lists all of people (ex: surgeon, anesthesiologist, circulating nurse, medical student, etc.) who were present for the surgery. Also, look at the facility’s Patient Bill of Rights to learn what rights patients have. One right is: Know the names, positions and functions of any hospital staff involved in the surgery/hospital care and refuse their treatment, examination or observation. This means that a patient can refuse opposite sex medical professionals or even intimate exams.

It is common for surgeons to arrive after patients have been prepped, draped and readied. Sometimes surgeons do multiple procedures a day—one after another—and they don’t pay specific attention to prep procedures; they depend on the OR staff to handle that. A patient may make his or her wishes known to the surgeon and that surgeon may agree with the patient keeping his or her underwear on, for example, but then this request is never communicated to the OR staff. Therefore, when the patient arrives for surgery prep, if nothing is in writing, their conversation with the surgeon is often forgotten. The OR staff then proceeds to prep the vulnerable and scared patient as usual. This is why we recommend that a patient get a surgery agreement in writing and also, that a personal advocate be present in pre-op, surgery, and post-op to advocate for all patient's rights and requests. Keep in mind that the surgeon will be busy operating and may not pay attention to who will be on the OR team. Often the hospital assigns the OR team rather than the surgeon choosing it.

Check out the blog of this photographer who took pictures of patients who were naked for surgeries. One man had hernia surgery. The other man had surgery on his arm. The man undergoing the arm surgery was not allowed to wear underwear and surgery shorts. We find this a ridiculous requirement. Check out the picture of the man with arm surgery. Notice that a gown on the man has been removed and placed over his genitals to cover them. This man most likely had no idea this happened; that his genitals were exposed as the gown was removed.

Medical professionals often challenge patients who are concerned about their modesty during surgery and try to minimize patient concerns by withholding information about what really happens during surgery. Check out some examples of ways patients under anesthesia have been violated at this link: surgery patient violations in the news.

How to Respond to Arguments By Medical Professionals:

1.) Degrees of nudity occur in most major surgeries but the exposure does not last long (with prompt covering) and during surgery the patient is fully covered.

Here’s an example for the doctor who argued that a patient being exposed for a minimal amount of time is okay: Let’s say you are showering for work thinking no one is home. You get out of the shower to find out you forgot a towel and walk out naked to get one and your female neighbor who has come to see your wife is sitting there. You then make a hasty retreat to the bathroom. Does the brevity of your exposure make it not embarrassing or uncomfortable? There are so many justifications such as it is brief, we are professionals, we are used to it, or it is no different than an arm to us.

2.) A patient’s modesty does not matter while they are under anesthesia during surgery because that patient won’t know what happened.

Our Rebuttal: Many people feel that their body is sacred, even when they are asleep. If this warped surgery modesty mindset were true, why then is it legally not okay for a male next-door neighbor to view his female neighbor’s nude body while she is asleep without her consent?

Also, this argument that modesty doesn’t matter when a person is under anesthesia would mean that all crimes committed while someone is attacked while unconscious—such as with date rape drugs—would also not matter because the victim was unaware of what actually happened. These arguments are—if carried out to their indicated conclusions—ridiculous.

3.) We need access to your groin for any surgeries in case there is an emergency. The groin - which can be dirty with bacteria—needs to be scrubbed with antiseptic before the area is covered.

Our rebuttal: Underwear or shorts can be removed easily and quickly if there is any surgery emergency. Patients can scrub their groin area with antiseptic before surgery. In most surgeries the groin will never need to be accessed. Patient should be able to do as much as possible to prepare for surgery so they do not have to worry about their modesty.

Here are some articles about how patients can prepare for surgery at home:

Pre-Surgery Showers

Preparing the Skin at Home Before Surgery

Many patients are rushed into signing consent forms without adequately reading them. Also, most surgery consent forms do not give details about many surgery factors. For example, there is no known consent form for a urinary catheterization for surgery. Patients must write on surgery consent forms that no urinary catheter may be inserted. All patients should get consent forms at least one day before the surgery. It is difficult for patients to object to anything if they are given consent forms at the last minute.

Please read an example of how a man was rushed into signing a document when he was about to be sedated.

Dennis says:
February 8, 2014 at 1:49 am

Here is the problem with teaching hospitals. You’re right when you say most patients have little experience with teaching hospitals. Unfortunately, that’s the way physicians and these hospitals want it to be. I went into the hospital where my physician practiced for repair of an anal fistula. I had no idea of the processes or procedures and, when told to sign a document while lying naked under a hospital gown, I just signed it. You guessed it. It was a consent form that included allowing observers (undefined) to be present during my surgery. I was wheeled into an operating room with eleven people in it. Before I could question who these people were I was injected with versed and an epidural. I later asked for my medical records, including those from the operating room, and found out all the disgusting details. Without my INFORMED consent five nursing students got to observe a colonoscopy on me I was then put in the jackknife position, my buttocks were taped open and one of the student nurses got to do the prep of my buttocks and genitals. I was completely exposed during this entire procedure for all to see. I would never have known, thanks to the versed, had I not been awake long enough to feel the dread before I went out. That prompted me to investigate.

The dirty little secret of the medical profession in general is that their idea of informed consent is to hold back the consent form until you’re a half hour away from surgery. Mr. Patient, please sign this 16 clause form which overrides any oral conversations you may have had with physicians and nurses. In this form you give up all rights to privacy, modesty and dignity while undergoing your surgery and while in the PACU.

Don’t believe me? There is not one hospital or surgery center in Southern California that provides the consent form on their website. All the other forms needed to be filled out by the patient before surgery can be accessed from the web sites. But not the consent form. This is a morally repugnant practice and destroys any hope for patient/ provider trust. I know I will never trust the medical profession again to do what’s right. This is the same profession that thinks it’s okay to do pelvic exams on unconscious women without their permission and to do rectal/prostate exams on unconscious men going in for prostate surgery. This only ended as a result of legislation expressly forbidding it. The paternalistic attitudes of the medical profession persist to this day.

(Source: http://briansecemskymd.com/declining-care-from-physicians-in-training-the-residents-dilemma/)

Patients who are sedated or under general anesthesia are entirely vulnerable because they cannot willingly speak up for themselves which is why we advocate for a personal advocate not employed by the hospital to be present during surgery to advocate for the patient’s wishes.

Less use of general anesthesia and more regional and local anesthesia will be significant for patient modesty issues because medical professionals will not have as much occasion to expose patients who are awake and alert.

Please read Modesty Concerns for Procedures and Surgeries to get an idea of what steps to take for ensuring that patient's wishes are honored. Take time to research what body parts might be exposed for surgery and how maximum modesty can be achieved.

We recommend that all surgery patients consider opting for local or regional anesthesia instead of general anesthesia for most surgeries thus ensuring less patient vulnerability and modesty violations. Medical professionals will have less chance to expose patients unnecessarily or ignore patient's wishes if the patient is awake and alert. Also, there are generally less complications and a quicker recovery time with regional anesthesia. Surgery patients who plan on utilizing general anesthesia should contemplate having a personal advocate not employed by the hospital present for that surgery to ensure that requests are not ignored. Insist that they do not give you an IV until you have been prepped for surgery so you can observe all of the things they do to you before surgery such as cleansing your abdomen.

** Watch Surgery and Your Modesty video.

Check out some articles about being awake & nerve blocks for surgeries:

1.) Going Under the Knife, With Eyes and Ears Wide Open – Notice the picture of a woman watching her doctors operate on her wrist. She was able to drive herself home after the wrist surgery because she was not under general anesthesia. Another man in this article had knee replacement surgery with nerve blocks and was able to read a magazine while he was being operated on. This shows that regional anesthesia has fewer complications than general anesthesia and is less expensive. Recovery time is swifter and side effects are fewer which can reduce the need for postoperative opioids.

2.) Watching My Surgeon Cut Into My Knee - A female patient shared her story about undergoing knee surgery with a regional block.

3.) Sedation Before Nerve Block Increases Risks, Not Pain Relief - Dr. Cohen, a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine says that while many physicians may use sedation in a sincere effort to make the procedure less traumatic for patients, there is also a perverse financial incentive to use it. “Unfortunately, medicine in many places has become a business. The fact is, you get paid more money to do the procedure with sedation,” he says. “The costs of anesthesia can be more than the fee for the procedure itself. And patients are getting harmed.” It is interesting that there is a financial incentive for sedation.

4.) Is nerve block anesthesia better for surgery?

Surgery is a multi-billion dollar industry. Many surgeons and hospitals are driven by monetary gain. Patients should fight to have modesty wishes—before, during and after surgery— accommodated. Surgery is a big moneymaker for hospitals. These facilities will give in to patient modesty demands if patients stick together and demand these choices. Canceling surgery is another option if patient's wishes for modesty are not being honored. Walk out and cancel the surgery if wishes will not be honored. Find another hospital and/or doctor willing to accommodate those wishes. Also, research surgery alternatives and make sure that that specific surgery is absolutely necessary before moving forward with it and make it clear that you do not consent to Versed, a terrible sedative drug that causes amnesia.

5.) The Case for Continuous Nerve Blocks - Dr. Nadia Hernandez, an anesthiologist shared that her anesthesia group performs 10 times as many blocks at the Texas Medical Center's trauma center than they did when she became director of regional anesthesia five years ago. She shared that Regional anesthesia is significiantly less expensive and as safe. "The use of continuous nerve blocks to manage post-op pain provides many benefits. Patients require fewer opioids, which lowers their risk of opioid misuse and eliminates prolonged PACU stays caused by opioid-related side effects such as nausea, vomiting, urinary retention and sedation." Notice how Dr. Hernandez said that opoids can cause urinary retention (this is one of the reasons an urinary catheter could be needed). The article mentioned that light sedation could be used for patient comfort. This is concerning because light sedation could mean Versed, a horrible sedative that would cause amnesia for patients that would leave them powerless to speak up.

Unnecessary Underwear Removal For Surgeries

Sedation, Versed, and Your Procedure

Modesty Concerns for Procedures and Surgeries

Why You Should Have a Personal Advocate For Surgery?

What Should You Know Before You Have Surgery

Going Under the Knife, With Eyes and Ears Wide Open

Watching My Surgeon Cut Into My Knee

Sedation Before Nerve Block Increases Risks, Not Pain Relief

Is nerve block anesthesia better for surgery?

The Hidden Dangers of Going Under