Achieving gender equity in critical care and perioperative medicine is a complex and ongoing challenge, shaped by multiple systemic and cultural factors. Despite progress in institutional policies and cultural shifts, significant barriers remain. Implicit biases—often unconscious—are pervasive and affect decision-making processes, leading to disparities in recruitment, promotion, and professional recognition for women in these fields. Explicit gender biases further exacerbate the situation, creating additional obstacles to women’s advancement. The “leaky pipeline” phenomenon highlights the underrepresentation of women in leadership roles, driven by societal perceptions that such positions are better suited to men and the scarcity of female role models and mentors. The demanding nature of critical care and surgery, combined with inflexible working hours and lack of family-friendly policies, makes it particularly challenging for women, especially those with caregiving responsibilities, to balance professional and personal life, often resulting in burnout or career attrition. Additionally, the impostor phenomenon—where women doubt their abilities despite qualifications—further discourages them from seeking leadership positions, reinforcing gender disparities. This chapter explores these barriers and highlights international initiatives aimed at promoting gender equity in critical care and perioperative medicine, emphasizing the need for collaborative global efforts to address these persistent challenges.