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Capelli et al. Art Int Surg 2023;3:80-9 https://dx.doi.org/10.20517/ais.2022.40 Page 82

Marital status
According to a survey distributed to members of the American Society of Plastic Surgeons, the results of
[33]
which were published in 2010 , female plastic surgeons are more often unmarried compared with their
male colleagues. In line with this study, Ridgway et al. produced a survey investigating the private life of
women plastic surgeons and found that a significant rate of them had deliberately postponed marriage, with
[34]
14.0% of survey respondents declaring that they were single mainly due to job constraints . Another survey
published by Ponzio et al. confirmed these results: compared to their male colleagues, female surgeons
were more often unmarried (12.4% vs. 2.6%; P < 0.001) or married later in life (30.2 +/- 4.7 vs. 28.3 +/- 3.9
years; P < 0.001) . The results of these studies should be carefully interpreted; the number of respondents
[11]
was limited, and the risk of selection and response bias was real. Nevertheless, such results underline the
struggle of women surgeons to find a balance between their personal and professional lives.

Pregnancy and childcare
A significant proportion of female trauma surgeons were divorced or unmarried, according to a survey
distributed in 2014 among members of the Eastern Association for the Surgery of Trauma. The same study
reported that 48.0% of women surgeons, vs. 13.0% of men, did not have children . These results are
[35]
consistent with those reported by Rogers et al., who distributed a survey among Irish residents and found
that approximately 22.5% of female surgical trainees, whose mean age was 30.8 +/- 3.8 years, had children,
compared to 40.0% of their male counterparts (P = 0.0215); no significant difference between sexes could be
[10]
identified among non-surgical trainees . Similarly, American female head and neck surgeons have been
reported to have a lower number of children compared to their male counterparts (mean, median 1.18, 1 vs.
2.29, 2) . Likewise, female facial plastic surgeons have been reported to be less likely to have children
[37]
[36]
(52.0%) compared to male peers (89.0%) and more likely to have fewer children (P < 0.0001).

While for some women surgeons, the choice not to have children is personal and heartfelt, many of them
choose to postpone pregnancy or even abandon the project of having children due to multiple and complex
reasons. As Dr. Mia Fahlen rightly said in a commentary on a study by Kawase et al. addressing work-life
[7]
balance and comparing the experiences of women surgeons from different countries and cultural
backgrounds, the surgical profession “serves as a magnifying glass for structures hidden or diluted in the rest
[6]
of the society” . The author underlined the most relevant issue of invisible work: women tend to include the
work they do at home in their total workload, while men very rarely do so. This is probably because women
are held responsible for household management, both by themselves and their partners. In a survey
distributed to all surgical trainees (residents, clinical fellows) and faculty in different surgical specialties of
the Indiana University School of Medicine, most women faculty declared that they were responsible for
childcare planning (P < 0.001), meal planning (P < 0.001), grocery shopping (P < 0.001) and vacation
planning (P = 0.003) in their households . Similar results were reported by Rogers et al., with
[38]
approximately 75% of male doctors delegating to their partner the majority of domestic tasks , and by
[10]
Ponzio et al., who found that female surgeons were more often considered responsible for parenting and
home duties (P < 0.001) compared to their male counterparts . A cross-sectional survey conducted among
[38]
[11]
US surgeons and published in 2020 also reported that women were more often in charge of meal
preparation (46.0% vs. 12%) and housekeeping (24.0% vs. 5.0%). Similar results were reported by Japanese
surgeons where, according to a survey distributed among members of the Japan Surgical Society in 2014,
both men and women surgeons considered women to bear primary responsibility for the family .
[39]

Another reason for women surgeons having fewer children is linked to the issues connected to pregnancy
during a surgical residency or the early years of a physician's career. According to the study by Rogers et al.,
adverse pregnancy events were more likely to occur among pregnant surgical trainees compared to the