Authors: Mallory Johnson, Meghan Etsey, Dr. Divya Krishnan on behalf of the Gender Equity Task Force
Although women make up nearly 70% of specialists in Obstetrics and Gynecology, compared with about 46% across all medical specialties, their presence in gynecological surgical subspecialties, like oncology and minimally invasive surgery, remains strikingly low (Hertling et al., 2023). Creating equitable, supportive work environments is essential, not only for the success of female surgeons, but also for strengthening the profession and improving patient care (Hong et al., 2022). Yet, structural, cultural, and institutional barriers continue to limit women’s advancement in gynecologic surgery, highlighting the urgent need for systemic changes to expand opportunities, promote equity, and cultivate the next generation of surgical leaders (Hertling et al., 2023).
The male-dominated culture in gynecologic surgery has deep historical roots. Dr. James Marion Sims, often called the “Father of Modern Gynecology,” introduced surgical techniques and tools, such as the repair of vesicovaginal fistulas and the Sims speculum, that remain foundational today (Shende et al., 2024). However, these advancements came at the expense of enslaved Black women, who were repeatedly operated on without consent or anesthesia. From the Middle Ages through Colonial America, women provided most medical care within households and communities but were systematically denied professional recognition and training (Joseph et al., 2021). This long-standing exclusion helped shape a surgical culture where women’s expertise was undervalued and their participation restricted.
Even today, representation diminishes sharply at higher levels of gynecologic surgery. Women make up 81% of OB/GYN residents but only 54% of faculty and 20% of department chairs, and they are less likely than men to pursue surgical subspecialty fellowships (Hofler et al., 2015). Persistent stereotypes about what a “surgeon” looks like and the scarcity of senior female mentors reinforce these barriers (Offiah et al., 2024). Moreover, negative residency and work environment factors, including high prevalence of sexual harassment or gender harassment (approximately 69% among OBGYN trainees) and discrimination (67% for women), degrade job satisfaction and well-being (Menhaji et al., 2022). Women are often expected to adopt traditionally masculine traits while navigating their identity as “female surgeons,” and they are less likely than men to receive active sponsorship, which directly influences career advancement (Hill et al., 2015; Offiah et al., 2024). When they do adopt these traits, they frequently encounter the ‘double bind’: assertive behavior may cause them to be ignored, interrupted, or judged as abrasive rather than competent (Ciancetta, 2018). The shortage of senior female role models perpetuates these barriers, limiting both leadership development and the pipeline of future surgical leaders.
Barriers extend beyond leadership to training and day-to-day practice. Women in gynecologic surgical specialties face inequities in operative autonomy, case assignments, evaluations, and access to leadership tracks, which can undermine confidence and skill development (Lim et al., 2021). Family planning concerns, particularly around fertility and pregnancy, disproportionately affect women due to the long, demanding training schedules of surgical fellowships (Offiah et al., 2024; Lim et al., 2021). Inadequate maternity leave, inflexible schedules, and discouragement from personal choices like breastfeeding add to the challenges. Microaggressions, such as being mistaken for nonmedical staff or having competence questioned, may seem minor but accumulate over time, creating exclusion and disadvantage (Onyiego et al., 2023).
The underrepresentation of women in leadership has consequences for the profession, patients, and future trainees. Lack of female leaders reduces diversity in research priorities and innovation, while also limiting some patients’ preference for female surgeons in gynecologic care. Mentorship and sponsorship are critical for helping women access career-advancing opportunities. Institutional reforms—such as family-friendly policies, equitable scheduling, and unbiased evaluation systems—can dismantle structural barriers. Cultural change, including normalizing women as leaders, fostering allyship, and holding programs accountable for equity, is equally essential. Increasing visibility of female trailblazers through storytelling and recognition initiatives can inspire the next generation.
Gynecology embodies a striking paradox: a field devoted to women’s health still falls short in elevating women as surgical leaders. Bridging this gap requires bold systemic change, strong mentorship, and a cultural transformation that values equity at every level. Women belong in gynecology not only as patients but as pioneers, innovators, and leaders, shaping the future of surgical care and redefining what leadership in medicine can look like.
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About the Authors
Mallory Johnson, MS4
Mallory Johnson is a fourth-year medical student from St. George’s University. She holds a Bachelor of Science in Forensic Science and a Bachelor of Science in Chemistry from Tiffin University. She worked as an Analytical Chemist at P&G and KAO before medical school. She is passionate about giving back to vulnerable communities and providing equal access and opportunity to medical care. She is a member of the Domestic Violence and Music in Medicine Committees within the American Medical Women’s Association. When she’s not doing schoolwork, you can find her playing her cello, reading cozy mysteries, and playing with her poodles, Gertie and Maple.
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Divya Krishnan, MD
Dr. Divya Krishnan obtained a medical degree with honours at the University of Medicine and Health Sciences, St. Kitts. She is passionate about preventative medicine and community medicine. She believes that we can only begin to move towards good health for all patients, with health equity and consistent community education led by healthcare workers. When not working in the medical world, she spends her spare time learning outdoors (hiking, rock climbing, gardening), learning indoors through reading books, and studying to brainstorm creative ideas for how to improve her practice as a whole- for her patients and for her co-workers.