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Sarah Silverman's Instagram About Her Mammogram Speaks Volumes About Patient-Doctor Relationships

I have yet to meet a single person who looks forward to an annual gynecologist exam. Medical appointments in general aren't usually the highlight of someone's week, but gyno exams specifically can be extra uncomfortable. Being touched intimately by a stranger in a non-sexual setting is a pretty vulnerable experience, even when you know that that stranger is a medical professional. When it comes to vaginal and breast exams especially, it can be difficult to know for sure whether your doctor is following medical procedure, or is actually being inappropriate. Sarah Silverman's Instagram post about her mammogram tells the story of an unnamed doctor whom she believes crossed a serious line with her during an exam.

"He opened my gown and put gel on my breasts and smeared it around with his bare hands," Silverman wrote in the caption to the post. According to the comedian, the doctor then began to have a conversation with her while her breasts were fully uncovered, which she then told him made her feel uncomfortable. Then, Silverman wrote, "he smears the gel on with his hands and NO GLOVES on and when he glides the ultrasound wand thing over my breasts he drags his fingers on them and it f*cking bothers me." She continued,

Again, AS I TOLD HIM LAST YEAR, I said “Hey! Do you need to be touching me with your fingers?” He said “No.” And he pulled them off of me. Then he added “I do that for balance.” I said “Well I believe in you and I think you can do with without your fingers on me.” Look, I truly don’t think he was getting off on it, BUT it is his job to be aware that this is vulnerable for a woman. Wear f*cking GLOVES - this isn’t a date. For him to be so arrogant that he didn’t even internalize the problem when I said something to him about it last year is obnoxious and probably a subconscious power thing if we’re getting deep.

"All this to say speak up," Silverman concluded in her post. "Trust that thing in your gut that tells you this sh*t ain’t right."

The thing is, it seems like Silverman's gut feeling was onto something. Richard Reitherman, MD, PhD, medical director of breast imaging at MemorialCare Breast Center at Orange Coast Medical Center in Fountain Valley, California, told Women's Health that, during the type of ultrasound exam that Silverman described on Instagram, the gel that the doctor uses to help them see what's happening inside of the breast is "applied directly from the container to the breast." In other words, the wand-like object that works with the gel to actually see inside of the breast (which, FYI, is called a transducer), "is generally the only thing that touches the woman's breast" during the exam, said Dr. Reitherman. Additionally, he told the outlet, "The technologist or radiologist only uncovers the breast being ultrasounded at that moment. The other is covered. You never have both breasts uncovered."

As Silverman said in her post, it's unclear whether her doctor intended to act inappropriately, or he was simply being careless in his work. Either way, Silverman's story reinforces the notion that it is always in your best interest to know what to expect going into a medical exam, so you can feel empowered to speak up when you feel confused and/or uncomfortable.

In terms of what to expect during a routine breast exam with your gynecologist, Planned Parenthood explains how and where you will likely be touched over the course of the exam: "Your doctor or nurse will look at both of your breasts to see the shape, size, and texture of your skin. They’ll feel your breasts with the tips of their fingers to check if there are any lumps or if something else doesn’t feel normal," the organization states. "They’ll start with one breast and then do the other, including both nipples, and also check your armpits."

Although it may seem strange, apparently not all doctors wear gloves when conducting a breast exam, Teresa Newsome, a former Family Planning Assistant, Clinic Manager, and Certified Responsible Sexuality Educator for Planned Parenthood, wrote in an article for Bustle. But, as Dr. Erica Hinz, an OB/GYN based at NYU Langone Medical Center, told The Atlanta Journal-Constitution, “It’s important that at any point, if a patient feels uncomfortable for whatever reason, that they speak up.” She continued, “Sometimes a doctor may not know that the way they’re saying things or approaching things is making their patient uncomfortable.”

Another detail that can help protect you from any kind of inappropriate behavior during a sensitive exam is the presence of a chaperone. According to the American Medical Association's Code of Medical Ethics, the doctor's office should always have a chaperone available to be with you in the room during an intimate exam, regardless of your gender identity. So know that, if you're feeling uncomfortable at any point, you have a right to have someone else there to make you feel more secure.

What's most frustrating about all of this is that doctors are supposed to be trustworthy individuals, and the feeling that you, as a patient in their care, have to be vigilant about their conduct in the exam room, is an exhausting and stressful one, to say the least. The reality is, though, that you have to look out for yourself. “It doesn’t matter how many degrees, how much prestige, (or) what kind of reputation [doctors] have,” David Clohessy, executive director of the survivors group SNAP, told The Atlanta Journal-Constitution. “All of those positive attributes, they do not guarantee our safety. Only vigilance guarantees our safety.”