Informed consent has evolved over time from a paternalistic model to one rooted in evidence-based medicine and shared decision-making. Several key landmark court cases in the twentieth century framed the medicolegal discussion around informed consent. They reaffirmed patient autonomy and a patient model of disclosure. There has since been a gradual shift to a shared model. Urogynecology and reconstructive pelvic surgery highlight the importance of shared decision-making as there are usually many treatment options available to patients, and patient preferences are of utmost importance in determining the best option. The physician–patient relationship is at the center of understanding patient preferences and of making sure patients are informed. These principles are highlighted specifically when looking at overactive bladder, mesh-based prolapse repair, and in gender-affirming surgery.