Modesty, Gender-Concordant Care & Chaperones

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Physician or nurse: The examination, its purpose and alternatives.
• Chaperone: Presence during intimate examinations, if the person wants one.
• Social worker or advocate: Support after past harm, if the person wants it.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Saudi Arabia, Kenya, Argentina, India, United Kingdom, Australia, Multi-country, Malaysia, South Korea, Canada. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

• Global · Guidance · 2021

  The WHO 2021 cervical pre-cancer guideline states that HPV DNA testing by self-sampling has the potential to reduce cultural, socioeconomic and gender barriers to screening.

  Limits: Guidance, not outcomes

  What others could learn: A screening program can list self-sampling as a standard option beside clinician sampling and ask early which the person would accept. WHO frames it as a way to reduce cultural and gender barriers, so offering it fits a conversation about comfort and access.

  Conditions, limits and source

  Conditions that matter:

  A validated HPV DNA test that allows self-collection, clear instructions, a laboratory and a way to return results, and a pathway to triage and treatment after a positive result. The guideline notes that a test giving HPV16/18 genotype information avoids an extra test, which matters for self-sampling.

  Cannot be inferred:

  Does not show that self-sampling removes modesty-related barriers for any group. Does not address clinician gender, chaperones, gowns or covering. Does not report uptake by religion, gender identity or abuse history. Not a statement about any one country's program.

  Limits:

  A rationale remark inside a guideline, not a measured effect on modesty-related barriers. The formal Recommendation 4 is conditional, based on low-certainty evidence, and covers both the general population and women living with HIV. The self-sampling uptake review the guideline cites was primarily from high-income countries. The guideline does not discuss chaperones, gowns or clinician gender.

  Source: World Health Organization, WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention (Chapter 4, remarks on the recommendations: printed p. 30 (PDF p. 47), repeated for the screen, triage and treat approach at printed p. 36 (PDF p. 53). Recommendation 4 (provider-taken or self-collected samples) at printed p. 25 (PDF p. 42).). Where: Global. Population: Women eligible for cervical cancer screening. Published 2021-07-06; retrieved 2026-10-11.

• Saudi Arabia · Measured outcome · 2021

  In a 2017 survey of 227 women attending obstetrics and gynecology clinics at one university hospital in Jeddah, the authors report that preference for female providers was strongest for pelvic examination.

  What others could learn: Even where most patients in a clinic prefer a female clinician for a pelvic examination, a minority do not, and the study reports that experience, qualifications and reputation mattered more to these women than clinician gender. Asking each patient what would make the examination acceptable, then offering a female clinician where one exists, avoids assuming from age or income.

  Conditions, limits and source

  Conditions that matter:

  Honoring a request needs enough female physicians, a booking step that records the request, and a plan when none is available. The study did not examine staffing or booking.

  Cannot be inferred:

  Not representative of Saudi Arabia, the Gulf or any faith group. Does not show that preference changes screening uptake or outcomes. Says nothing about whether requests were met. Not evidence for what any religion requires.

  Limits:

  One hospital, consecutive patients who had attended at least three times; 93% married and 73% Saudi nationals. Stated preferences, not observed choices or screening uptake. In the tables, preference for a male physician for pelvic examination was higher among women over 35 (16.0%) than women 35 or younger (4.8%), and among higher-income women (20.4% vs 5.2%), so preferences varied within this one clinic population.

  Source: King Abdulaziz University and colleagues (Dove Medical Press, International Journal of Women's Health), How Relevant is Obstetrician and Gynecologist Gender to Women in Saudi Arabia? (Discussion, first paragraph; Table 3 (preference by income) and Table 4 (preference by age)). Where: Saudi Arabia (Jeddah). Population: Adult women who had attended an obstetrics and gynecology clinic at least three times. Published 2021-10-11; retrieved 2026-10-11.

• Kenya · Reported experience · 2019

  In interviews with women in Migori County, Kenya, who had used community-based HPV self-sampling, most reported that it eliminated the embarrassment and fear they associated with a pelvic examination by a clinician.

  What others could learn: Privacy has more than one layer. Participants described avoiding exposure to a male clinician, and one also described avoiding clinicians she might meet later in the village. A service could ask what part of an examination is the concern (who is present, who the clinician is, how visible the setting is) and offer a private self-collected option.

  Conditions, limits and source

  Conditions that matter:

  A private area, posters with self-collection diagrams, community health volunteers explaining the procedure, and results returned in about two weeks by text, phone call or home visit. Some participants said they wanted a clinician available for treatment after a positive result.

  Cannot be inferred:

  Not representative of Kenya or of women who declined screening. Does not compare self-sampling uptake with clinician examination uptake. Does not show that clinician gender alone drives embarrassment. Study period and services may have changed.

  Limits:

  Community health volunteers identified participants willing to share experiences, and interviews took place after self-sampling, so the sample is people who chose to be screened. The same results section records embarrassment if male providers offered a pelvic exam, and one participant worried about later meeting clinicians from her village. These are participant statements, not measured preferences. The source does not report how many women raised each point.

  Source: Kenya Medical Research Institute, Duke Global Health Institute, University of California San Francisco and colleagues (BMC Women's Health), Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (Results, 'Feeling of privacy and comfort conducting the HPV self-sampling'). Where: Kenya (Migori County). Population: Women aged 25 to 65 who completed HPV self-sampling in a cervical cancer screening trial. Published 2019-06-13; retrieved 2026-10-11.

• Argentina · Measured outcome · 2016

  In a 2012 mixed-methods study in Jujuy, Argentina, about 22% of 2,616 women who accepted HPV self-collection during home visits cited embarrassment-related reasons, well behind gaining time (57.5%).

  What others could learn: Do not assume modesty is the main reason a person wants self-collection. Practical barriers (time, appointments, other duties) led here, and embarrassment was a minority reason that interviewees tied to male gynecologists. A conversation can ask about both, and respect those who prefer a clinician.

  Conditions, limits and source

  Conditions that matter:

  Free HPV testing as primary screening in public centers, trained community health workers making respectful offers with information, and home collection. Acceptance depended on trust in those workers, per the authors.

  Cannot be inferred:

  Not representative of Argentina. 2012 data from a demonstration setting, not the current national program. Does not show that embarrassment is low where self-collection happens in a clinic. Reasons were self-reported by women who had just been offered the option.

  Limits:

  Reasons were multiple-response, and trained community health workers administered the questionnaire during the home visit. The leading reasons were gaining time, other responsibilities and avoiding appointments; the authors say these prevailed over shame or embarrassment. They add that embarrassment weighed more in studies where self-collection took place in health facilities. Among non-accepters, trust in the physician and fear of hurting oneself were the leading reasons. The paper reports no significant link between acceptance and the health worker's gender (87.9% of women were visited by female workers).

  Source: CEDES/CONICET, Instituto Nacional del Cáncer (Argentina) and colleagues (BMC Public Health), HPV testing: a mixed-method approach to understand why women prefer self-collection in a middle-income country (Results, discussion of reasons for choosing self-collection; Table 3). Where: Argentina (Jujuy province). Population: Women offered HPV self-collection by community health workers (age bands from 30 to 65+): 2,616 accepters and 433 non-accepters. Published 2016-08-19; retrieved 2026-10-11.

• India · Measured outcome · 2021

  In a pilot at mobile screening clinics in rural Mysore District, India, 84.8% of respondents preferred a provider of the same gender for pelvic examination and about three-in-five (59.3%) preferred to self-sample for HPV testing.

  What others could learn: Two preferences can differ: most women wanted a same-gender provider for the pelvic exam, yet only about three in five preferred self-sampling. A team can ask about provider gender and about method separately, and offer both a same-gender clinician where possible and a self-collected option.

  Conditions, limits and source

  Conditions that matter:

  Verbal and pictorial instructions, a private place to collect, staff trained to ask about experience without judgment, a laboratory for HPV DNA testing, and follow-up for positive results.

  Cannot be inferred:

  Not representative of India or of rural women generally. Stated preferences after both procedures, not uptake. Does not show how many clinics had a female clinician or whether requests were met. Says nothing about any religion or community.

  Limits:

  Authors note a small pilot sample, likely self-selection, and possible information bias from interviewer-administered questions. Every woman self-sampled first and then had a clinician exam, so the order was fixed. The abstract dates the study May to August 2017 while the methods say 2018. The paper does not state whether same-gender clinicians were available at the clinics.

  Source: Public Health Research Institute of India, University of Arizona and colleagues (Asian Pacific Journal of Cancer Prevention), Acceptability and Concordance of Self- Versus Clinician- Sampling for HPV Testing among Rural South Indian Women (Results, paragraph after Table 2; Table 3). Where: India (Mysore District, Karnataka). Population: Rural women over 30 attending a mobile cervical cancer screening program (120 enrolled). Published 2021-03; retrieved 2026-10-11.

• United Kingdom · Measured outcome · 2021

  In a 2019 UK online survey of 137 transgender men and non-binary people assigned female at birth, the gender of the clinician performing cervical screening was important to 35 of 134 respondents (26%).

  What others could learn: Clinician gender mattered to about a quarter, and a majority (86 of 134) said they would prefer a trans-specific clinic. More than half (71 of 134) wanted the option to self-swab. Participants also named dysphoria, leaflets written only for women, and a male gender marker that stopped invitations and results. A team could ask what would make the examination acceptable, offer self-swabbing where available, use neutral language, and check that records do not block recall.

  Conditions, limits and source

  Conditions that matter:

  Trans-specific or trans-confident clinicians, staff who accept the person's gender, call and recall systems that do not exclude people registered as male, and self-swab HPV testing offered as an option.

  Cannot be inferred:

  Not representative of all transgender or non-binary people or of the UK. Does not show that clinician gender affects uptake. Does not describe how clinics should assign clinicians.

  Limits:

  Recruited by email from two London-linked NHS services; 145 responses to 1,304 invitations, with 7% from Black, Asian or minority ethnic backgrounds. The paper does not say which clinician gender mattered, and marks the figure 'data not shown'. Self-report; no intervention was tested.

  Source: Queen Mary University of London, Jo's Cervical Cancer Trust, Chelsea and Westminster Hospitals NHS Foundation Trust and colleagues (British Journal of General Practice), Attitudes of transgender men and non-binary people to cervical screening: a cross-sectional mixed-methods study in the UK (Results, 'Preferences for future screening'). Where: United Kingdom (NHS gender identity clinic and sexual health service patients). Population: Transgender men and non-binary people assigned female at birth, aged 18 or older, UK residents. Published 2021-05-18; retrieved 2026-10-11.

• Australia · Reported experience · 2012

  In 2011 focus groups, general practitioners in Melbourne agreed a chaperone could be arranged for a scheduled Pap smear but said offering one may be more useful for unanticipated intimate examinations.

  What others could learn: A chaperone offer can be built into booking for scheduled intimate examinations and made at the point of decision when an exam arises unplanned. Participants said some patients do not know the option exists or feel uncomfortable asking. Recording the offer and any decline, and saying plainly when no suitable chaperone is available, are items a practice could work out in advance.

  Conditions, limits and source

  Conditions that matter:

  Practice nurse hours, costs and logistics of a second person, home visits and after-hours work where no chaperone may be present, and small communities where patients may not want reception staff to act as chaperone.

  Cannot be inferred:

  Does not show what patients want, whether chaperones change screening uptake, or what current Australian regulator guidance says (regulator sites could not be reached). Cannot be generalized to specialists or hospitals.

  Limits:

  Clinician views only; patients were not interviewed. A pilot of two urban focus groups, not representative of Australian GPs, run before later guidance. The authors note best practice may be to routinely offer a chaperone and record declined offers, but that this may not be feasible in all general practice settings. Remarks about particular patient backgrounds are GP views.

  Source: Monash University Department of General Practice (International Journal of Family Medicine), The Attitudes and Practices of General Practitioners about the Use of Chaperones in Melbourne, Australia (Findings, section 3.4 'Timing of Discussion and the Use of a Chaperone'). Where: Australia (Melbourne). Population: Seventeen general practitioners from an after-hours deputising service and a university general practice department. Published 2012-08-17; retrieved 2026-10-11.

• Multi-country · Reported experience · 2026

  A 2026 systematic review of 30 studies in OECD countries reports that trauma-informed approaches emphasizing trust, communication, choice and control were linked to improved cervical screening engagement and more positive experiences among women affected by sexual violence and abuse.

  Limits: Abstract only

  What others could learn: For people with a history of sexual violence or abuse, the review links choice and control during an intimate examination to better engagement. A care conversation could ask what would help the person feel in control before any examination starts. The abstract does not say which options were studied.

  Conditions, limits and source

  Conditions that matter:

  Time for a conversation before the examination, clinicians trained in trauma-informed communication, and options that let the person decide what happens. The abstract does not say which options were studied.

  Cannot be inferred:

  Does not show which specific practices (chaperone, gown, same-gender clinician, self-sampling) help. Does not apply to settings outside OECD countries. Not evidence that every survivor avoids or needs modifications to screening.

  Limits:

  Abstract only; the full text was not retrieved. The abstract says evidence that screening uptake is lower in this group remains mixed. The included studies' designs, countries and approaches are not described in the abstract. Linked to better engagement is an association across studies, not a trial result.

  Source: Bangor University School of Health Sciences and colleagues (BMJ Sexual & Reproductive Health), Cervical screening care for women living with the impact of sexual violence and abuse: a systematic review (PubMed abstract, Results). Where: Multi-country (OECD countries, not listed in the abstract). Population: Women living with the impact of sexual violence and abuse. Published 2026-07-13; retrieved 2026-10-11.

• Malaysia · Measured outcome · 2016

  In a 2013 to 2015 survey of 839 women at five urban clinics in Selangor, 68.2% preferred self-sampling to a Pap smear after trying it; the authors suggest self-sampling avoids embarrassment and inconvenience.

  What others could learn: When an exam is intimate, a patient-collected option offered with brief instruction may suit some patients, and many changed their view after trying it. A service could offer both options, ask which she prefers after explaining each, and set up the follow-up path for a positive result (95.2% said they would attend follow-up).

  Conditions, limits and source

  Conditions that matter:

  Brief instruction on using the brush, a laboratory route for HPV testing of self-collected samples, a follow-up pathway for positive results, and questionnaires in Malay and Mandarin. At the time of the study Malaysia offered free opportunistic Pap smears and had no population-based screening programme.

  Cannot be inferred:

  Not representative of Malaysia or of women who do not attend clinics. Does not show that embarrassment caused the preference, that self-sampling raises screening uptake, or how accurate it is. Does not show what any ethnic or religious group wants, or current Malaysian screening policy.

  Limits:

  Convenience sample of clinic attendees who agreed to self-sample; the authors note it excludes women who do not attend facilities and that those who declined may differ. Embarrassment was one of six acceptability items; the explanation in the quoted sentence is the authors' reading, not a tested mechanism. After the procedure, 68.2% preferred self-sampling, 13.5% preferred a Pap test and 14.1% had no preference. The abstract's percentages by ethnicity (72.6% Chinese versus 85.1% Malay) and by prior Pap experience (88.5% versus 80.9%) do not reconcile with the overall 68.2% or with the body text (75% preferred self-sampling among women never screened), so they are not used here. The abstract has a misprinted odds ratio for prior Pap experience (0.06 with an interval of 0.35 to 0.87). Test accuracy was not assessed.

  Source: University of Malaya and collaborators (BMJ Open), Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women (Discussion, paragraph on preference for self-sampling versus Pap smear; Results, 'Self-sampling versus conventional Pap test'). Where: Malaysia (Selangor). Population: 839 women aged 18 to 60 who agreed to self-sample (47.9% Malay, 30.8% Indian, 18.8% Chinese, 2.5% other); median age 38. Published 2016-08-04; retrieved 2026-10-11.

• United Kingdom · Measured outcome · 2025

  In a 2024 survey of 386 urology outpatients at one English NHS trust, patients identified genital, rectal and catheter care as most sensitive, yet only 23.6% to 34.5% preferred a chaperone for them.

  Limits: Abstract only

  What others could learn: Patients can find an exam very sensitive and still not want a chaperone, so a default may not match preference. The same abstract reports 74.1% knew the term, 67.4% knew the role and 52.1% knew when one may be offered, so a short explanation followed by asking may be worth building into the visit.

  Conditions, limits and source

  Conditions that matter:

  A chaperone available on request, clinic time for a brief explanation, a way to record the offer and the answer, and attention to clinician gender where patients express a preference.

  Cannot be inferred:

  Not representative of the United Kingdom or of all urology patients. Does not show how chaperones change experience, or what any regulator requires (regulator sites were not reachable). Does not describe women's gynecologic care or any cultural or religious preference.

  Limits:

  Abstract only; full text not read and open-access status not checked. One trust. The abstract does not give question wording, response rate or a breakdown by patient or clinician gender; it says attitudes were influenced by patient age, patient gender and clinician gender without stating the direction. Preferences are self-reported, not observed. The authors note most prior work asked clinicians, not patients.

  Source: Departments of Urology, Greater Manchester (Postgraduate Medical Journal), Chaperones in urology clinic: an updated survey of patient perspectives and preferences in the outpatient setting in the United Kingdom (PubMed abstract, Results). Where: United Kingdom (England, Bolton NHS Foundation Trust). Population: 386 consecutive adult patients attending urology outpatient clinics. Published 2025-11-18; retrieved 2026-10-11.

• South Korea · Measured outcome · 2019

  In 732 women at one Korean cancer center who tried a clinician Pap test, self-sampling and urine sampling, embarrassment was reported by 53.4% for the Pap test, 7.7% for self-sampling and 7.1% for urine sampling.

  What others could learn: Where a pelvic exam by a clinician carries embarrassment for many women, an option to collect the sample privately can lower it, and 52.0% of these women said they would like self-sampling at their next screening. A team could offer the choice, explain accuracy and follow-up, and note the person's choice, while leaving the clinician-collected test available for those who want it.

  Conditions, limits and source

  Conditions that matter:

  Self-sampling kits with brief instructions, a private place to use them, an HPV test and a result pathway. The study does not describe how follow-up would work outside the research setting.

  Cannot be inferred:

  Not representative of Korea or of women who skip screening. Does not show why women felt embarrassed, whether clinician gender mattered, or how a clinician-collected test would be rated if done first or last. Gives no national rule or cultural claim, and does not describe uptake or accuracy.

  Limits:

  Women were recruited at a screening clinic and likely favored screening, as the authors note. Every woman completed the modalities in the same order (Pap test first), and no randomization was used. Overall satisfaction was high for all three (87.2% Pap test, 93.4% self-sampling, 94.4% urine sampling) and trust was highest for the Pap test (93.4%). Reasons for embarrassment were not asked; the authors' cultural interpretation in the discussion was not tested. Clinician gender was not studied, and only brush-type dry devices were used. Women were asked about embarrassment through single questions per modality; no instrument is reproduced.

  Source: National Cancer Center (Goyang) and Korean universities (Journal of Gynecologic Oncology), Evaluation of satisfaction with three different cervical cancer screening modalities: clinician-collected Pap test vs. HPV test by self-sampling vs. HPV test by urine sampling (PMC full text, Results, "Satisfaction and psychological distress"). Where: South Korea (Goyang, one national cancer center). Population: 732 women aged 20 to 69 recruited in the waiting room of a screening clinic, excluding hysterectomy, cervical cancer history or menstruation. Published 2019-09; retrieved 2026-10-11.

• Canada · Reported experience · 2022

  In 40 telephone interviews with patients and family members, clinicians and system stakeholders, mostly in Canada, participants across groups described the standard hospital gown as humiliating, invading privacy and culturally insensitive.

  What others could learn: Coverage and privacy can be a design question as well as a conversation: all stakeholder groups suggested a front- or side-opening robe-like gown with fabric overlap, and discussed offering options on size, sleeve length and skin coverage. A team could ask patients what coverage they want for an examination and offer alternatives, with the cost and laundering tradeoffs that system stakeholders raised.

  Conditions, limits and source

  Conditions that matter:

  Supply and laundering processes that can hold more than one gown type, a procurement decision, and staff who offer coverage options. System stakeholders reported that more gown types raise costs and complicate laundering.

  Cannot be inferred:

  Not representative of Canada or of other countries, and not a count of how many patients feel exposed. Does not show that a redesigned gown improves outcomes, because no redesign was tested. Does not describe any religious or cultural requirement. The paper names Muslim women as one example of people who might feel insufficiently covered; this is an illustration, not data on any group.

  Limits:

  Only 8 of 40 interviewees were patients or family members, and the statement is pooled across all stakeholder groups. The authors state most participants were in Canada and results may not generalize. Telephone interviews, self-report and recall bias, and some transcripts replaced by field notes after audio faults. The study concerns gown design, not examinations, chaperones or clinician gender.

  Source: Queen's University and partner institutions, Canada (CMAJ Open), Comprehensive design considerations for a new hospital gown: a patient-oriented qualitative study (PMC full text, Results, "Gown comfort and patient dignity"). Where: Canada (most participants; others elsewhere in North America). Population: 40 interviewees: 8 patients and family members, 12 clinicians and 20 system stakeholders (designers, manufacturers, textile experts). Published 2022-12-20; retrieved 2026-10-11.

• The sourced examples include guidance, measured outcome, reported experience. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.