Medical modesty with “BAMD” trousers; a modified theatre outfit for female patients undergoing short surgical perineal procedures

Background

Surgical operations can be worrying for patients. Anxiety leads to increased blood pressure, heart rate, need for sedation, prolonged operating times, and negative perceptions and experiences by patient and peers [1]. Many factors contribute to perioperative anxiety [2], including unfamiliar environments and clothing. Reducing patient’s anxiety and individualized care means better experiences and faster recovery [3]. Patients’ comfort and dignity should be maintained when they are changing into their theatre outfits. The public nature of hospitals usually puts privacy at risk [4]. Studies have found that hospital gowns diminish privacy as they are ill-fitting and expose the back [5]. While patients’ perceptions of bodily exposure can vary [5], gynaecologic procedures by their very nature lead to exposure of sensitive bodily parts. The use of curtains or screens in hospitals is an attempt to prevent unnecessary exposure but is usually inadequate [6]. Researchers opine that complete health care includes sensitivity to patients’ spiritual needs [5]. The ritual of making patients theatre remove their underwear in the theatre is embarrassing and may serve no useful purpose [7]. Fear of infection may be overrated as reports have noted no increase in infection rates when the patients remained fully dressed in theatre [7].

Local problem

Northern Nigeria generally has poorer health indices than the south. Skilled care may help improve health but barriers may prevent patients accessing care. In a small community, people know each other and may feel shy interacting with staff especially for gynaecological cases; hence, medical modesty is important. Some of our female patients and relatives (especially Muslims) sometimes complain about lack of privacy.

Intervention

This very simple innovation may appear insignificant but may have a great impact in making the female patients undergoing minor vaginal operations (such as manual vacuum aspiration, dilatation and curettage, hydrotubation, hysteroscopy, etc.) feel more comfortable and relaxed and increase hospital attendance. Patients were given a pair of trousers, a shirt and cap to change into before entering the theatre. The modified trousers (“BAMD” after authors’ initials) had a large semi-oval cutout as shown in Fig. 1, which was not obvious when standing up but exposed the perineum adequately in the lithotomy position. Routine cleaning and draping is still done.

Fig. 1

The modified trousers (“BAMD” after authors’ initials). (A) The shaded portion is cut off from theater trousers. (B) Operating field (PERINEUM)

Observation

We tried this on a few patients, and the patients seemed less anxious, and they, along with their relatives, were more at ease and more satisfied. There were no obvious adverse effects, and it is unlikely to increase infection rates but this outcome was not specifically tested for. Initially, the cut edges of the trousers got wet while cleaning the perineum so we expanded the cut a bit further.

Conclusions

The “BAMD” trouser is a simple modification of theatre wear which may help reduce patient anxiety, ensure privacy and dignity and improve service uptake and satisfaction especially for conservative Muslim female patients undergoing short surgical perineal procedures. It is unlikely to improve infection rates, but further work is required to confirm this, as well as more patient feedback.