Consent and Chaperones for Internal Examinations in Women's Health Physio

Vaginal and anorectal examination is a post-registration competence for physiotherapists, and the techniques are not accepted as within the scope of practice of physiotherapy support workers or assistants. There is no route to delegating this, whatever the appointment is called.

That line comes from the CSP and POGP guidance and it is the one clinic owners most need to know. The consent position around it is more nuanced than people assume, and the most useful guidance on chaperones sits behind a members-only wall, which is why so little accurate information exists on the open web.

Who can perform an internal examination?

A physiotherapist who is adequately educated, trained and competent in the technique.

The CSP and POGP guidance paper on pelvic floor examination, PD092, treats this as a post-registration competence. It is not conferred by your qualifying degree and it is not something you acquire by watching.

The route is flexible. A higher education module, a commercial course, or work-based learning are all acceptable, provided the training includes practical education overseen by an appropriately qualified practitioner. What is not acceptable is theory alone.

And it cannot be delegated. The guidance is explicit that these techniques are not currently accepted as being within the scope of practice of physiotherapy support workers or physiotherapy assistant roles.

For a clinic owner that is a staffing constraint with commercial consequences. A busy pelvic health service cannot be scaled by putting assessments through an assistant, however experienced. The appointment requires a competent physiotherapist, every time.

One note on sourcing: there is some suggestion that PD092 has been withdrawn from the CSP website, though a copy remains hosted by POGP. We could not confirm its current status. Check with the CSP for the version in force before relying on it as your governance basis.

No, and this surprises people who assume that an intimate examination must involve a signed form.

The CSP position is that written consent is not mandatory for intimate examinations. What is required is valid consent, which means the patient understood what was proposed, why, what it involves, and that they could decline.

What should be recorded is:

That the examination was explained and consent given
That a chaperone was offered
Who the chaperone was, if one was present
Any refusal of a chaperone

The offer and the response are the parts that get missed, and they are the parts that matter if the examination is later questioned.

Some practices use a written consent form anyway. That is a reasonable choice, and it can be useful as a prompt to cover everything. But a signed form is not a substitute for the conversation, and a form on file with no record of what was discussed is weaker evidence than a good contemporaneous note.

The chaperone problem in private practice

Here is the practical difficulty nobody addresses, because the guidance was written with services in mind rather than solo practitioners.

The CSP's own chaperoning guidance, PD104, is members-only. So there is no free, accurate, physiotherapy-specific chaperone guidance available to a practitioner who is not a member, and general NHS trust policies are written for a very different setting.

And a solo physiotherapist renting a treatment room has no colleague to act as one. An impartial chaperone is a trained person acting in that role. A patient's partner or relative is not an impartial chaperone, though a patient is of course entitled to have someone present for support.

That leaves realistic options that are worth thinking through in advance rather than improvising: arranging chaperone cover on days when internal examinations are scheduled, working from a clinic where a colleague is available, or being clear with patients at booking about what can and cannot be offered so they can decide.

What is not an option is treating the offer as unnecessary because it is inconvenient to fulfil.

What should be in the record?

Six things, contemporaneously.

What was proposed and why, in terms the patient could understand
What was explained, including that they could stop at any point
That consent was given
That a chaperone was offered, and the response
Who was present
The findings, in clinical terms

The confidentiality of that record deserves particular thought. Pelvic health notes are among the most sensitive a practice holds, and note visibility tiers exist for exactly this. Atlacare enforces three levels, with confidential notes restricted to the treating practitioner and the practice owner, applied everywhere including the patient portal. Our UK GDPR guide covers the wider obligations.

What about young people?

A separate question with its own rules.

Sixteen and seventeen year olds consent for themselves. Under-16s may consent if Gillick competent, assessed for the specific decision. Where someone with parental responsibility is consenting, note that the category is narrower than people assume, and our guide to consent for under-18 athletes sets out who actually holds it.

For an intimate examination on a young person, the chaperone question is not optional in practice even though the guidance frames it as an offer.

Getting it right without overcomplicating it

The whole thing reduces to five habits.

Be trained, properly, with practical supervision. Do not delegate it. Explain and check understanding. Offer a chaperone and record the answer. Write it down the same day.

None of that is burdensome. The failures in this area are almost never failures of intent. They are failures of record, discovered a year later when nobody can evidence a conversation that certainly happened.

This is general information about consent and competence, not clinical or legal advice. CSP and POGP guidance is updated and some of it is restricted to members; confirm the current documents through the CSP. Take advice from your professional body or indemnity provider on your own arrangements.

Sources: POGP-hosted CSP guidance on pelvic floor examination, PD092 · CSP, consent in physiotherapy practice · CSP, chaperoning and related issues