The unclothed patient

But to many people, everything about those instructions induces anxiety and even anger. They fear the vulnerability that comes with it. They can't relax when they're ceding control over what's happening to them, and it's irrelevant that physicians and nurses have seen thousands of bare bottoms or private parts.

"I don't have some magical switch that I can turn off in my head that makes me feel completely at ease with another man having intimate access to (my wife's) body, just because that man went to medical school," complained a contributor to a modesty blog.

The reasons for modesty can be cultural, religious or intensely personal. To a woman committed to purity or to a man who fears how his body will react to a woman's touch, accommodations are so important that they will shop around for providers or in extreme cases, forgo care.

Requested accommodations can range from same-gender caregivers to wearing special shorts during a colonoscopy and can engender understanding, hostility or something in between, say testimonials on the website of Medical Patient Modesty (www.patientmodesty.org), a fledgling nonprofit based in North Carolina that offers emotional support and practical resources.

A willingness to make accommodations depends to a large extent on providers' commitment to patients' emotional health as well as their medical care, say those in the modesty movement, but also on the size and location of a medical facility. Small towns and rural areas tend to have fewer specialists, complicating requests, for example, for same-gender treatment. 

Katherine Johnson, 32, of Loveland, Colo., was searching about a year ago for the right team to back up the midwife who was to deliver her baby. She needed assurances that, should an emergency arise, she would have a female obstetrician and nurse on standby. She also wanted to avoid an epidural or any other anesthesia.

"I'd had problems with sexual abuse," she said, and was not comfortable with a man in that physical proximity. "And I had to be awake, to know that I could run away."

Even though she offered to have her psychologist, whom she has been seeing since she was 15, present the reasons behind her demands, several facilities told her that guaranteeing an all-female team was impossible, particularly because she was on Medicaid.

"They made me feel that I was not worthy to have a baby," Johnson said. She stumbled upon Medical Patient Modesty and wrote a middle-of-the-night appeal that founder Misty Roberts answered almost immediately.

"She validated my feelings, that I wasn't some freak," Johnson said. And Roberts pointed her to an all-female obstetrics practice about an hour from her home. 

To Roberts, modesty concerns need to be taken seriously, however they arise.

"It is heartbreaking that many women who do not want male gynecologists under any circumstances are forced to give up their wishes," Roberts said. "I've also been concerned about how many hospitals do not have enough male nurses available for male patients who do not want female nurses to do intimate procedures."

She calls ridiculous the common policy of making patients disrobe completely, even if the procedure is on a hand or knee, and laments the loss of control that sedation produces.

Her organization, she said, is trying to school people on how to achieve maximum modesty.

"It is impossible to change the whole medical industry. It is more realistic to educate patients about how to take steps to stand up for their wishes to reduce unnecessary exposure and unnecessary intimate exams," Roberts said.