Purpose <p>The presence of chaperones during intimate physical examinations is a matter of ongoing debate. While most guidelines recommend the use of chaperones in all cases, there are no clinical trials specifically investigating intimate exams performed on women by male physicians. We aimed to evaluate female patients’ perceptions regarding the presence or absence of chaperones during proctological examinations conducted by male physicians.</p> Methods <p>In this randomised clinical trial, patients were assigned, unaware that they were participating in a study, to either Group 1 (without a chaperone during their proctological exam) or Group 2 (with a chaperone). After the appointment, they completed a questionnaire regarding the examination they had just undergone. The study was conducted at two hospitals in Southern Brazil.</p> Results <p>Ninety-five patients were included in each group. The mean (SD) comfort score was 8.3 (2.9) with a chaperone and 8.8 (2.5) without a chaperone (<i>P</i> = 0.25). When asked if they would want the exam performed the same way in the future, 72.6% in Group 1 answered ‘yes’, compared to 58.9% in Group 2 (<i>P</i> = 0.046). In Group 2, 48.4% of patients did not feel more protected by the chaperone, while none of the patients in Group 1 felt less protected without one.</p> Conclusions <p>Forgoing chaperones during proctological examinations of women, when the physician is male, is well accepted by most patients. Preferences regarding chaperones are complex, demanding a selective approach. The use of chaperones should remain a recommendation, not a requirement, to accommodate individual needs while maintaining the doctor-patient relationship.</p> Trial registration <p>ClinicalTrials.gov number, NCT03615586.</p>