In The Sims: Medieval, the player may create both male and female Sims for any profession. Departing from the medieval setting, men and women are treated equally, with gender only effecting a few minor aspects of gameplay. Many outfits and hairstyles are gender specific. Marriages between the same-sex can occur as their is no restriction against it.
- Only women can become pregnant.
- Only men can have facial hair.
- Mothers will start out as friends with their children, while fathers only start out as acquaintances.
- When using a chamberpot, men will stand up in front of it, while women will stand over it and squat.
- Many titles will change to reflect the sim's gender.
- When naked, more of a woman's body is censored.
- Only women can feed babies (by breast feeding)
Hero Sims can have both a son or a daughter. But can be influenced by eating Turnip Soup for a girl and Apple's for a boy. Only certain way for an unmarried Monarch to get a boy or girl is to take the mission Heir to the Throne, and choose the gender of the first child.
Unlike adults, children look and sound the same regardless of gender. Despite this, there are many outfits and hair that can only be worn by one gender.