Women in Orthopaedics
Many women still disproportionately suffer from unconscious and conscious bias within orthopaedics. Much work is going into addressing these issues head-on but there is more to be done.
This article will cover:
Please see our separate articles on sexual harassment and family planning.
1. What are the challenges?
This Times article featuring several orthopaedic surgeons including Joanna Maggs and Roahana Mehdian-Staffell gives a honest insight into some of the current struggles facing
female surgeons: https://www.thetimes.com/article/sexism-assault-female-surgeons-nhs-times-health-commission-lnqbm2kjp
Listen to these podcasts:
The Glass Slipper and Other Challenges for Women in Medicine
https://youarenotafrog.com/episodes/158/
Dr Jane Dacre on How to Be a Professional Woman
https://youarenotafrog.com/episodes/41/
Read this brilliant thread by Roshana Mehdian, T+O SpR doing a huge amount to increase awareness around remaining inequity for female surgeons:
https://x.com/RoshanaMN/status/1639339090502877190?s=20
2. Breast Radiation Protection and cancer risk
The BOA have published guidance on radiation exposure in theatre and associated risks to orthopaedic surgeons, particularly the female breast tissue:
https://www.boa.ac.uk/standards-guidance/radiation-exposure-in-theatre.html
Each trust should provide you with a lead protection gown which fits snugly and covers your breast tissue. Currently commercially available adequate PPE to cover the axillary tail does not exist and
the BOA are in talks with industry to develop this ASAP. In the meantime there are less optimal (but better than generic male tabard) gowns available. If you are concerned about your amount of breast tissue coverage using the generic gowns provided, please approach your local radiation protection lead with your concerns and request that a female specific gown is purchased for you.
An example that provides improved (but importantly still not total) coverage is the Protecx Princess gown:
https://www.protecx.co.uk/shop/princess-vest-custom/
3. Menstruation & Menopause
Periods, Mittlesmirtz, and menstrual cycles can be troublesome both during long on-calls and long operating lists.
Read this excellent RCS article:This has been covered in an excellent RCS article:
https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsbull.2023.103
Top tips include:
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Don’t feel afraid to ask to pause to visit the bathroom - anyone would do this if you needed a wee!
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Don’t feel afraid to ask to stop if you are in pain - anyone would do this if they had a splitting headache distracting them!
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Many have chosen to use a Mirena coil to help with lessening heaviness of flow - some have experiences periods stopping altogether!
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Others have discussed the possible benefits of using TXA with their GP.
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Always have additional tampons/pads in your bag/locker for any emergencies!
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DO NOT feel awkward about saying that you have to step out of a case as you have abdominal cramps and need to go to the changing room to get some medication. This is normal.
Menopause can affect a woman's working life. Sometimes menopausal symptoms or working conditions can impact your ability to concentrate or carry out your role to the best
of your ability. A survey of 1,000 adults found many women find managing their menopause symptoms in the workplace very challenging, especially as many women find it difficult to talk about
menopause at work.
Ginny Bowbrick, a vascular surgeon, has produced a great article summarising the challenges and some solutions: https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsbull.2023.99
NHS Inform has produced a great page on what employees and employers can do to support women experiencing troublesome symptoms of menopause:
https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause-and-the-workplace
This brilliant webinar explains how to support staff going through the menopause: https://horizonsnhs.com/caring4nhspeople-8th-december-2021-menopause-how-to-support-staff-wellbeing-in-the-workplace/
4. Theatre ergonomics
This 2022 article identified ergonomic challenges highlighting the fact that women tend to experience more musculoskeletal pain than men, potentially because the size and design of
theatre tools are designed for male and tall individuals.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9225169/
The BOA is driving a call for industry to develop inclusive-sized tools and equipment for individuals of different sizes:
https://www.boa.ac.uk/about-us/diversity-and-inclusion/inclusive-orthopaedics-initiative.html
Table height
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Table heights are often set up for “average height male”
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Don’t struggle with operating table height:
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If you are lead surgeon have the table height set to wear YOU feel comfortable
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If assisting, ask for a sturdy foot stool early on if needed.
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Try decreasing the table height to aid putting more of your weight over the reamer when reaming the acetabulum if you are struggling to push the reamers with enough force
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Long hair & theatre caps
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The unconscious bias provides “theatre caps” for short hair and “nursing caps” for long hair…
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For those with long hair, washable ponytail scrub caps or bouffant-style scrub caps are available or you can make your own if you’re feeling creative
Feeling faint
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Many of us will have fainted in theatre at some point.
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Women are physiologically four times more likely to faint than men and if you are standing very still for long periods of time whilst assisting feeling light headed iscertainly common.
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Most female trainees will tell you that their body has gradually got used to long periods of standing up over time and that they no longer have so much of a problem with it.
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However, there are other things you can do to combat it.
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Eat regular small meals and stay hydrated
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If you feel yourself getting slightly light headed do some heal raises or move around a bit at the table to get the blood pumping back up from your legs.
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If you really feel faint step back away from the table and sit down, you will desterilise yourself but clearly that is highly preferable to fainting onto the patient’s open wound and jeopardising the sterility of the operation.
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Some people find DVT stockings or maternity compression stockings helpful.
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5. Women in Surgery (WinS)
Women in Surgery (WinS) is a national organisation working to promote surgery as a career for women and to enable women who have chosen a career in surgery to realise their professional goals.
https://www.rcseng.ac.uk/careers-in-surgery/trainees/foundation-and-core-trainees/women-in-surgery/
WinS hosts a number of networking events you can attend, and can also provide sponsorship if you would like to organise this kind of event yourself.
The RCS Emerging Leaders programme supports women and non-binary people in their leadership journeys. The programme has been specifically designed for those who are looking to advance their leadership career, develop their skills, grow their network, and influence and change the environment for the better as they move into formal leadership roles. Applications run annually via the RCS website: https://diversity.rcseng.ac.uk/develop-and-learn/emerging-leaders/
Medical Women’s Federation:
Offers advice and support to female doctors including mentoring and coaching schemes, support around issues with maternity leave, less the full time training, non-training grade doctors.
https://www.medicalwomensfederation.org.uk/
6. Edits / updates / improvements?
These support / welfare articles require constant updating to reflect the changing world of the modern Orthopaedic trainee.
If you have any edits / updates / improvements for this article please email them to:
wins@bota.org.uk
Thank you for your support.
Florence Shekleton, BOTA Women in Surgery Rep 2025