Chaperone Use by Residents During Pelvic, Breast,
Testicular, and Rectal Exams
Deborah B. Ehrenthal, MD, Neil J. Farber, MD, Virginia U. Collier, MD, Brian M. Aboff, MD
We designed a questionnaire survey to study internal medi-
cine residents’ plans to use a chaperone during the pelvic,
breast, rectal, and testicular examinations. We found chaper-
one use by male and female residents differed markedly, and
neither group planned to use chaperones universally. When
examining female patients, male residents overall were very
likely to use a chaperone during a pelvic exam, but less likely
for the breast exam and rectal exam. For the female resident,
there was a significantly lower likelihood of using chaperones
during the pelvic, breast, or rectal exams. There was a much
lower rate of chaperone use during the sensitive portions of
the male physical examination compared with the female ex-
amination, with somewhat higher use by female residents.
We concluded that male and female residents differ signifi-
cantly in their patterns of chaperone use. It would be valu-
able to develop guidelines for chaperone use to help residents
understand the issues involved in the choices, and to protect
the residents from the possible medico-legal consequences of
patient-physician relationship; chaperone; resi-
dents; medical education.
J GEN INTERN MED 2000;15:573–576.
mong practicing physicians, there is diversity in
their use of a chaperone during sensitive portions of
the physical examination. For many male physicians, it is
customary to have a chaperone present during a pelvic
examination of female patients. Among women physi-
cians, the tradition differs, and chaperones are used less
frequently. Reasons typically cited to justify the use of a
chaperone include medico-legal protection for the physi-
cian, the need for an assistant, and custom.
The training students and residents receive about
chaperone use also varies. One physical diagnosis textbook
commonly used by medical students advises that during
the gynecologic exam, “male examiners are customarily
attended by female assistants. Female examiners may or
may not prefer to work alone but should be similarly at-
tended if the patient is emotionally disturbed.” Another
states that the pelvic exam “requires . . . atten-
dance of a female assistant who also serves as a chaper-
one.” Use of a chaperone during the breast exam, rectal
exam, or testicular exam is not discussed.
In 1996, the American Academy of Pediatrics
lished guidelines for chaperone use in children and ado-
lescents, but guidelines for use of chaperones by physi-
cians caring for adults have not been established. A
recent study found no consensus among state medical
boards regarding their use.
In their paper about profes-
sional boundaries in the physician-patient relationship,
Gabbard and Nadelson
recommend the use of chaper-
ones with patients with a known history of sexual abuse,
who have extreme anxiety or a psychiatric disorder, who
are litigiously minded, who are undergoing a pelvic exam-
ination, and who, for any reason, raise concerns in the
Several studies of physician use of chaperones have
been done in both the adult and adolescent popula-
However, these studies have not addressed the
use of chaperones by resident doctors in training. We
therefore surveyed residents in order to determine when
they plan to use chaperones when examining patients in
their outpatient office practices. We also examined char-
acteristics of the residents and patients that might be
found in a typical office setting to see how these would in-
fluence chaperone use.
A questionnaire survey was developed and pretested
for face validity. It was distributed to all categorical resi-
dents in the internal medicine, internal medicine/emer-
gency medicine, and internal medicine/pediatrics pro-
grams at the Christiana Care Health System. Anonymity
was assured since no questions had identifying features.
The survey consisted of 13 vignettes describing typical
doctor-patient encounters with male and female patients
in the resident outpatient medicine office (see Appendix).
Using a 5-point Likert scale, the residents were asked
how likely they were to use a chaperone during a breast
exam, a pelvic exam, a rectal exam, or a testicular exam
(very unlikely, somewhat unlikely, neither likely nor un-
Received from the Department of Medicine, Christiana Care
Health System, Wilmington, Del (DBE, NJF, VUC, BMA).
Presented in part as a poster at the 18th Mid-Atlantic Re-
gional Meeting of the Society of General Internal Medicine, New
York, NY, February 1998.
Address correspondence and reprint requests to Dr. Ehrenthal:
Suite 5043, Wilmington Hospital, 501 West 14th St., Wilmington,