This study assesses the influence of the interest and skill in adolescent health care on a pediatrician's use of a chaperone during the pelvic examination. A national sample of 558 pediatricians selected at random and 384 members of the American Academy of Pediatrics' Section on Adolescent Health (SAH) completed questionnaires assessing their perceived skills in and practice of adolescent medicine. Some 90.4% of the non-SAH males and 31.0% non-SAH females always used a chaperone compared to 69.4% of SAH males and 12.5% of SAH females (p less than or equal to 0.05). The actual frequency of chaperone use was less among SAH members than non-SAH pediatricians (p less than or equal to 0.013) and less among females in both groups (p less than or equal to 0.0001). Among male physicians, the variables found to have the strongest association with a less frequent use of chaperones included the frequency that oral contraceptives were prescribed, perceived skill in providing contraceptive counseling, percent of adolescents in the pediatrician's practice, and the frequency with which confidential services were provided. These correlations were stronger among SAH members than non-SAH pediatricians. Among female SAH members, not using a chaperone was associated with a higher perceived skill in managing sexually transmitted diseases, the frequency with which they performed pelvic examinations, and the percent of adolescents in their practice. Among non-SAH female physicians, the perceived skill to perform a pelvic examination and provide contraceptive counseling were associated with increased chaperone use. These data suggest that many factors other than gender and medicolegal influences are associated with the physician's decision concerning the use of a chaperone.