Do I Really Have To Take Off My Underwear?

Clean Underwear on a line

Most People Hate Coming To The Operating Room

Aside from the prospect of having strangers with knives do things to you while you’re sleeping, there are many other psychological and physical insults along the way.

Losing your undies is a big one. For many people, it’s worse than getting an IV.

Patient Gown

You Will Feel Naked

That ill-fitting patient gown does not count as clothes because its main purpose is to make it easier for us to work. On you.

You are the work.

The gown is awful enough, so why do you have to suffer the added indignity of going commando?

Especially if we are operating on an area of the body (tonsils, knee, elbow, etc.) far removed from your nether-region … It is a little puzzling. But rest assured,

We Are Not Healthcare Predators …

Predator Healthcare Practitioner

Who somehow found jobs in the operating room. We are normal people who simply don’t notice nudity anymore.

The truth is, getting used to seeing naked people only takes about 3 naked people. You are over it by noon on your first day in the operating room. This “naked immunity” happens quickly because your nakedness is so unimportant, so incidental, so mundane compared to the tender and awesome responsibility of the work.

Of the work of caring for you.

Now that you know we’re not freaks and that your naked-anxiety is not just matched, but significantly surpassed by our naked-indifference – do you still want to know why the “no undies rule?” Because it’s not pretty.

It’s Mostly “Eeeewwwww, Really?”

The short answer is, you’re at risk of soiling yourself and wearing underwear complicates the cleanup.

Poop Emoji


It’s Because Anesthesia Blunts Your Governor

Think of wakefulness as a volume knob named “The Governor.” The Governor is what makes wearing that pathetic patient gown without your undies so painful. It knows: I look covered, but I am exposed. I am vulnerable. I am at risk. I am breaking many social norms.

As you descend into a deep sleep the Governor is turned off. And when it’s time to wake up, the Governor is turned on. During this off/on journey, you pass through what’s called stage 2 or excitement phase. And the Governor is out to lunch during stage 2/excitement.


Your primitive brain, your deep inside I’m-here-to-keep-your-heart-beating-and-your-lungs-breathing-and-make-decisions-way-above-my-paygrade-if-the-Governor-is-out-to-lunch-brain is not turned off. And this primitive brain is just smart enough to know: Things are amiss! The Governor is out of commission and the organism is exposed, cold, maybe in pain, and leaderless. AHHHHHH! To your primitive brain,

If Ever There Was A Fight Or Flight Situation – This. Is. It.

For some people, the combination of no Governor and a high threat situation means they poop and/or pee themselves when they pass through the aforementioned stage 2/excitement phase.

But there’s more:

You get two chances to lose control. Once on the way down to deep sleep and another on the way back up to full wakefulness. Now, ask your Governor these questions:

Do I really want to know if I soil myself?

Do I really want to go home commando?

If the answer is “yes” to both: Do you want your soiled underwear bagged up and returned?

And if the answer is still “yes,” consider this: Removing soiled clothes from a patient who is not awake enough to cooperate is challenging. Your primitive brain perceives the attempts to clean you as a threat to your nether-region. Which your primitive brain now bids you protect.

By putting your hands in the mess and batting our hands away.

Truth. I’ve seen it. I’ve definitely medicated it. (This is one of those times the entire OR Crews forgets the many elegant anesthetics you’ve administered and is now silently but collectively cursing you.)

There Are A Few More Miscellaneous Reasons…

  • Multiple layers of soiled linens increase the risk of contaminating fresh dressing/wounds.
  • In an emergency, underwear complicates the insertion of big IVs or an arterial line into a groin vessel.
  • Surgical prep fluids, drainage, or blood can ruin underwear. (Don’t wear your good stuff to the OR.)
  • The metal in some underwear can act as an arc when we use cautery and it poses a fire/burn risk to you.

Clean Underwear on a line

The Bottom Line Is:

(No pun intended.) We understand your modesty concerns. But we don’t really want to look you in the eye and explain you might be a pooper. You are already having a bad day.

This is why the “In an emergency, your undies are in the way” explanation is so popular. We find that way easier to say.

So there you have it: The real reason we want your undies off is to protect you from embarrassment and us from a messy cleanup.


None of the photos in this essay are my own. They are Shutterstock purchases.


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