What counts as an intimate examination?
The GMC describes intimate examinations as examinations of the breasts, genitalia and rectum. It also says they can include any examination where you need to touch, or even be close to, the patient. NHS England's chaperoning guidance adopts the GMC's definition.
Whether an examination feels intimate depends on the patient. For some, listening to the chest, feeling a groin pulse, or a physiotherapy assessment of the hip or pelvis may feel intimate. Culture, religion, past trauma, gender identity and the setting all matter. Ask rather than assume.
- Breast examination.
- Vaginal and speculum examination, including cervical screening.
- Genital examination in any patient.
- Digital rectal examination.
- Pelvic floor assessment in pelvic health physiotherapy.
- Some examinations of the chest, groin, buttocks or inner thigh, depending on the patient.
What does the GMC say about chaperones?
The GMC's guidance on intimate examinations and chaperones is the most detailed of the UK regulators. In summary, doctors should:
- Explain why the examination is needed, what it involves and any alternatives, and give the patient a chance to ask questions.
- Get the patient's permission and record it.
- Offer a chaperone wherever possible, whether or not the doctor and patient are the same gender.
- Give the patient privacy to undress and dress, and keep them covered as much as possible.
- Explain what they are doing during the examination and stop if the patient asks.
- Record who was present, or that a chaperone was offered and declined.
The GMC's separate guidance on decision making and consent, and on maintaining personal and professional boundaries, also applies. Doctors must never use their professional position to pursue a sexual or improper emotional relationship with a patient.
Is there NMC chaperone guidance for nurses and midwives?
The NMC does not publish a separate chaperone guide in the way the GMC does. Nurses, midwives and nursing associates are bound by the Code, which requires them to respect dignity and privacy, get properly informed consent and document it, communicate clearly, keep to professional boundaries and act in line with local policy. In practice that means following the same principles and your employer's chaperone policy.
HCPC registrants, such as pelvic health physiotherapists and paramedics, have the same duties under the HCPC standards, plus guidance from professional bodies such as the Chartered Society of Physiotherapy. Pharmacists carrying out examinations follow GPhC standards and local policy.
NHS England's chaperoning principles
In late 2025 NHS England published Improving chaperoning practice in the NHS: key principles and guidance, so that local policies follow a common framework. Key points include:
- Every NHS organisation should have a chaperone policy that is easy for staff and the public to find, including in easy-read formats.
- The chaperone offer should be made clearly before the consultation, ideally at booking, and repeated before an intimate examination.
- Only trained and competent people should act as chaperones, with clinical staff preferred where possible.
- A family member or carer does not replace a chaperone.
- For intimate examinations of under-18s, a formal chaperone should be present; a parent or trusted adult may also attend.
- Records should show the clinical need, the offer, the patient's decision, who was present, and the reason if no chaperone was used.
How do you get valid consent for an intimate examination?
Consent is valid only if the patient has capacity, has enough information, and decides freely. For intimate examinations it should be specific and checked again as you go.
- Explain why: Say why you are recommending the examination, what you hope to find, any alternatives such as imaging, and what may happen if they decline.
- Explain what it involves: Describe in plain words which areas you will look at or touch, any instruments, how long it takes and whether it may be uncomfortable.
- Offer a chaperone: Offer one whatever your gender and theirs, and explain what a chaperone does.
- Check understanding and agreement: Ask if they have questions and whether they are happy to go ahead. A patient undressing is not consent.
- Make clear they can stop: Tell them they can stop you at any time, and agree a word or signal if helpful.
- Keep checking: Explain as you go, especially before touching, and stop at once if asked or if they seem distressed.
Special situations
| Situation | What applies |
|---|---|
| Adult lacks capacity | In England and Wales the Mental Capacity Act 2005 applies. Assess capacity for this decision, support them to decide, and if they still lack capacity act in their best interests, considering whether it can wait. A chaperone should usually be present, and any objection or distress taken very seriously. |
| Children and young people | Examine only when clinically necessary. Under-16s may consent if competent (Gillick competence); otherwise someone with parental responsibility consents. Explain in a way the child understands and follow safeguarding procedures. |
| Under anaesthesia or sedation | Do not examine intimately unless the patient gave specific consent beforehand, or it is immediately necessary as part of the planned procedure and covered by existing consent. Examinations for teaching need explicit consent for that purpose. |
| Need to extend the examination | Consent for one examination is not consent for another. Stop, explain and seek fresh consent. |
Who can be a chaperone, and can a relative do it?
A chaperone is an impartial observer. They reassure the patient, protect dignity, observe that the examination is done properly, can raise concerns about anyone's behaviour, and may help practically if trained. They should usually be a health professional or a trained member of staff who understands the examination and their role.
A relative or friend is not impartial, so would not normally act as the chaperone. You should still agree to a reasonable request for them to be present as well. An interpreter is there for communication, not as a chaperone, unless trained and the patient agrees.
| Practical point | Good practice |
|---|---|
| Position | Inside the curtain where they can see the examination and support the patient |
| Privacy | Let the patient undress and dress in private, and provide a gown or cover |
| Preferences | Ask about any preference for the gender of the chaperone or examiner and accommodate it where you can |
| Private conversation | Offer a chance to talk without the chaperone before or after, where appropriate |
What if the patient declines or no chaperone is available?
Patients can decline a chaperone, and you should respect that. Record that the offer was made and declined. If you do not feel comfortable proceeding without one, for example because of the patient's history or your own concerns, explain this and offer to rearrange.
If no chaperone is available and the examination is not urgent, offer to rearrange within a reasonable time. If delay would put the patient at risk, discuss the options with them, decide together, and record the decision and your reasons clearly. In one-to-one settings such as home visits, plan ahead where you can.
What should you write in the notes?
If a concern is raised months later, the record may be the only evidence of what was discussed. Record the reason for the examination, the explanation and consent, the chaperone offer and the patient's decision, the name and role of anyone present, the reason if no chaperone was used, the findings, and any concerns the patient raised.
PR done. NAD.
Rectal bleeding for six weeks. Explained need for digital rectal examination to look for a cause, and what it involves. Patient agreed. Chaperone offered and accepted: [full name], staff nurse, present throughout. Findings: [recorded]. Findings and plan explained. Patient had no concerns about the examination.
Running late, Leo examines a young woman's abdomen for pelvic pain, says "I just need to do an internal check" and carries out a vaginal examination. He does not explain why, does not offer a chaperone because he assumes it is unnecessary in a routine appointment, and records no discussion. The patient, who has a history of sexual assault, leaves distressed and complains she did not understand what was happening and felt unable to say no. In a strong reflection, Leo accepts that not objecting was not consent, recognises the harm and the effect on her future trust in care, does not blame the clinic or the patient, and sets out specific changes: a structured explanation and chaperone offer every time, trauma-informed care training, supervised examinations and an audit of his records.
What to do if a patient raises a concern
Most complaints about intimate examinations stem from poor explanation, not misconduct. If a patient raises a concern, stop, listen, acknowledge their distress and make sure they are supported. Tell a senior colleague promptly. Write a factual account and never alter earlier entries. Follow complaints, incident and safeguarding processes. Do not contact the patient about the complaint yourself.
Regulators look closely at the clinical reason, consent, the chaperone offer, the record and the patient's account. Allegations of sexual motivation are treated as particularly serious. If you are told a formal complaint or allegation has been made, or your regulator contacts you, get advice from your defence organisation, trade union or legal representative before giving a formal response.
Learning more about intimate examinations and chaperones
Our course Intimate Examinations and the Use of Chaperones covers consent, chaperone practice, communication, dignity, documentation and how to reflect after a concern. Record Keeping and Documentation: Remediation Course goes further on writing records that protect patients and you, and Medication Errors: Reflection and Remediation is available if your learning plan covers medicines. No course can decide the outcome of a complaint, investigation or hearing.
Frequently asked questions
Do I need a chaperone if I am the same gender as the patient?
You should still offer one. The GMC says doctors should offer a chaperone wherever possible before an intimate examination whether or not they are the same gender as the patient, and NHS England's principles take the same approach. Patients can decline. Record the offer and their decision.
Can a family member act as a chaperone?
Usually not. A chaperone should be impartial, and a relative or friend is not. NHS England's guidance says a family member or carer does not replace a chaperone. You should still agree to a reasonable request for a relative to be present as well as a trained chaperone, for example for reassurance.
Can a healthcare assistant or receptionist be a chaperone?
Possibly, if trained. NHS England's principles say only trained and competent people should chaperone, with clinical staff preferred where possible. In primary and community care, trained non-clinical staff may act as chaperones. Follow your organisation's policy on training and checks.
What should I do if the patient refuses a chaperone?
Respect their choice and record that a chaperone was offered and declined. If you are not comfortable going ahead without one, explain why and offer to rearrange, unless delay would harm the patient. If proceeding is clinically urgent, discuss the options together and document the decision and reasons.
Is a chest examination an intimate examination?
It can be. The GMC's definition includes breasts, genitalia and rectum, and also any examination where you need to touch or be close to the patient. Whether a chest or groin examination feels intimate depends on the patient's culture, history and preferences, so ask and offer a chaperone if in doubt.
Can students do intimate examinations on anaesthetised patients?
Only with the patient's explicit prior consent for that specific purpose. The GMC says intimate examinations under anaesthesia must not be carried out unless the patient gave specific consent beforehand or the examination is immediately necessary as part of the planned procedure and covered by existing consent.
What should be documented when a chaperone is used?
Record the reason for the examination, the explanation and consent, that a chaperone was offered and the patient's decision, the chaperone's name and role, anyone else present, the findings, and any concerns raised. If no chaperone was present, record why and what was agreed with the patient.
Related courses
Intimate Examinations and the Use of Chaperones
This course explains how to carry out intimate examinations safely, respectfully and lawfully, including valid consent, offering and using…
Medication Errors: Reflection and Remediation
This course explains why medication errors happen, what you must do when one occurs, and how to show a regulator or employer that you have understood…
Record Keeping and Documentation: Remediation Course
This course explains what good clinical documentation looks like, why record-keeping concerns arise, and why altering or falsifying a record is…
Sources and further reading
- Intimate examinations and chaperones. General Medical Council.
- Decision making and consent. General Medical Council.
- Maintaining personal and professional boundaries. General Medical Council.
- Improving chaperoning practice in the NHS: key principles and guidance. NHS England.
- The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Mental Capacity Act 2005 Code of Practice. GOV.UK.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
The Mental Capacity Act 2005 Five Principles and Valid Consent Explained
The Mental Capacity Act 2005 five principles explained with examples, plus the capacity test, best interests and what makes consent valid after Montgomery.
What Happens If You Breach Patient Confidentiality? A Guide for Healthcare Staff
What happens if you breach patient confidentiality: disciplinary action, regulator referral, possible prosecution, what to do straight away and how to reflect.
DNACPR and the ReSPECT Form Explained for Clinicians
DNACPR and ReSPECT explained for UK clinicians: what each means, who decides, the duty to consult, capacity, recording the decision and handling disagreement.