Gynaecology

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Gynecology
Dilating vaginal speculum inflating vagina and light illuminating.jpg
A dilating vaginal speculum, a tool for examining the vagina, in a model of the female reproductive system
System Female reproductive system
SubdivisionsOncology, Maternal medicine, Maternal-fetal medicine
Significant diseases Gynaecological cancers, infertility, dysmenorrhea
Significant tests Laparoscopy
SpecialistGynaecologist

Gynaecology or gynecology (see spelling differences) is the medical practice dealing with the health of the female reproductive system (vagina, uterus, and ovaries). Outside medicine, the term means "the science of women". Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.

Contents

Almost all modern gynaecologists are also obstetricians (see obstetrics and gynaecology ). In many areas, the specialities of gynaecology and obstetrics overlap.

Etymology

The word "gynaecology" comes from the oblique stem (γυναικ-) of Greek γυνή (gyne), "woman", and -logia, "study".

History

The Kahun Gynaecological Papyrus, dated to about 1800 BC, deals with women's health —gynaecological diseases, fertility, pregnancy, contraception, etc. The text is divided into thirty-four sections, each section dealing with a specific problem and containing diagnosis and treatment; no prognosis is suggested. Treatments are non surgical, comprising applying medicines to the affected body part or swallowing them. The womb is at times seen as the source of complaints manifesting themselves in other body parts. [1]

Texts of Ayurveda, an Indian traditional medical system, also provides details about concepts and techniques related to Gynaecology. [2] [3]

The Hippocratic Corpus contains several gynaecological treatises dating to the 5th/4th centuries BC. Aristotle is another strong source for medical texts from the 4th century BC with his descriptions of biology primarily found in History of Animals, Parts of Animals, Generation of Animals. [4] The gynaecological treatise Gynaikeia by Soranus of Ephesus (1st/2nd century AD) is extant (together with a 6th-century Latin paraphrase by Muscio, a physician of the same school). He was the chief representative of the school of physicians known as the "Methodists".

J. Marion Sims is widely considered the father of modern gynaecology. [5] Now criticized for his practices, Sims developed some of his techniques by operating on slaves, many of whom were not given anaesthesia. [6] [7] Sims performed surgeries on 12 enslaved women in his homemade backyard hospital for four years. While performing these surgeries he invited men physicians and students to watch invasive and painful procedures while the women were exposed. On one of the women, named Anarcha, he performed 30 surgeries without anesthesia. [8] Due to having so many enslaved women, he would rotate from one to another, continuously trying to perfect the repair of their fistulas. Physicians and students lost interest in assisting Sims over the course of his backyard practice, and he recruited other enslaved women, who were healing from their own surgeries, to assist him. In 1855 Sims went on to found the Woman's Hospital in New York, the first hospital specifically for female disorders. [9]

Examination

The historic taboo associated with the examination of female genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygrier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology no longer uses such a position. Gynaecology-1822.jpg
The historic taboo associated with the examination of female genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygrier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology no longer uses such a position.

In some countries, women must first see a general practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynaecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynaecologist. In the United States, however, law and many health insurance plans allow gynaecologists to provide primary care in addition to aspects of their own specialty. With this option available, some women opt to see a gynaecological surgeon for non-gynaecological problems without another physician's referral.

As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is quite intimate, more so than a routine physical exam. It also requires unique instrumentation such as the speculum. The speculum consists of two hinged blades of concave metal or plastic which are used to retract the tissues of the vagina and permit examination of the cervix, the lower part of the uterus located within the upper portion of the vagina. Gynaecologists typically do a bimanual examination (one hand on the abdomen and one or two fingers in the vagina) to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do a rectovaginal examination for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists may have a female chaperone for their examination. An abdominal or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.

Diseases

Examples of conditions dealt with by a gynaecologist are:

There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a urologist.

Therapies

As with all surgical specialties, gynaecologists may employ medical or surgical therapies (or many times, both), depending on the exact nature of the problem that they are treating. Pre- and post-operative medical management will often employ many standard drug therapies, such as antibiotics, diuretics, antihypertensives, and antiemetics. Additionally, gynaecologists make frequent use of specialized hormone-modulating therapies (such as Clomifene citrate and hormonal contraception) to treat disorders of the female genital tract that are responsive to pituitary or gonadal signals.

Surgery, however, is the mainstay of gynaecological therapy. For historical and political reasons, gynaecologists were previously not considered "surgeons", although this point has always been the source of some controversy. Modern advancements in both general surgery and gynaecology, however, have blurred many of the once rigid lines of distinction. The rise of sub-specialties within gynaecology which are primarily surgical in nature (for example urogynaecology and gynaecological oncology) have strengthened the reputations of gynaecologists as surgical practitioners, and many surgeons and surgical societies have come to view gynaecologists as comrades of sorts. As proof of this changing attitude, gynaecologists are now eligible for fellowship in both the American College of Surgeons and Royal Colleges of Surgeons, and many newer surgical textbooks include chapters on (at least basic) gynaecological surgery.

Some of the more common operations that gynaecologists perform include: [10]

  1. Dilation and curettage (removal of the uterine contents for various reasons, including completing a partial miscarriage and diagnostic sampling for dysfunctional uterine bleeding refractive to medical therapy)
  2. Hysterectomy (removal of the uterus)
  3. Oophorectomy (removal of the ovaries)
  4. Tubal ligation (a type of permanent sterilization)
  5. Hysteroscopy (inspection of the uterine cavity)
  6. Diagnostic laparoscopy  – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide a definitive diagnosis of endometriosis.
  7. Exploratory laparotomy  – may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs.
  8. Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
  9. Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
  10. Appendectomy  – often performed to remove site of painful endometriosis implantation or prophylactically (against future acute appendicitis) at the time of hysterectomy or Caesarean section. May also be performed as part of a staging operation for ovarian cancer.
  11. Cervical Excision Procedures (including cryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.

Specialist training

Gynaecologist
Occupation
NamesDoctor, Medical Specialist
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, Clinics

In the UK the Royal College of Obstetricians and Gynaecologists, based in London, encourages the study and advancement of both the science and practice of obstetrics and gynaecology. This is done through postgraduate medical education and training development, and the publication of clinical guidelines and reports on aspects of the specialty and service provision. The RCOG International Office works with other international organisations to help lower maternal morbidity and mortality in under-resourced countries.

Gynaecologic oncology is a subspecialty of gynaecology, dealing with gynaecology-related cancer.

Gender of physicians

Improved access to education and the professions in recent decades has seen women gynecologists outnumber men in the once male-dominated medical field of gynecology. [11] In some gynecological sub-specialties, where an over-representation of males persists, income discrepancies appear to show male practicioners earning higher averages. [12]

Speculations on the decreased numbers of male gynecologist practitioners report a perceived lack of respect from within the medical profession, limited future employment opportunities and even questions to the motivations and character of men who choose the medical field concerned with female sexual organs. [13] [14] [15] Some high profile cases of prosecutions of male gynecologists for sex assault of patients may act as a deterrent for some considering whether to enter the field. [16] [17]


Surveys of women's views on the issue of male doctors conducting intimate examinations show a large and consistent majority found it uncomfortable, were more likely to be embarrassed and less likely to talk openly or in detail about personal information, or discuss their sexual history with a man. The findings raised questions about the ability of male gynaecologists to offer quality care to patients. [18] This, when coupled with more women choosing female physicians [19] has decreased the employment opportunities for men choosing to become gynaecologists. [20]

In the United States, it has been reported that 4 in 5 students choosing a residency in gynaecology are now female. [21] In several places in Sweden, to comply with discrimination laws, patients may not choose a doctor—regardless of specialty—based on factors such as ethnicity or gender and declining to see a doctor solely because of preference regarding e.g. the practitioner's skin color or gender may legally be viewed as refusing care. [22] [23] In Turkey, due to patient preference to be seen by another female, there are now few male gynaecologists working in the field. [24]

There have been a number of legal challenges in the US against healthcare providers who have started hiring based on the gender of physicians. Dr Mircea Veleanu argued, in part, that his former employers discriminated against him by accommodating the wishes of female patients who had requested female doctors for intimate exams. [25] A male nurse complained about an advert for an all-female obstetrics and gynaecology practice in Columbia, Maryland claiming this was a form of sexual discrimination. [26] Dr David Garfinkel, a New Jersey-based ob-gyn sued his former employer after being fired due to, as he claimed, "because I was male, I wasn't drawing as many patients as they'd expected". [25]

So far, all legal challenges by male gynaecologists to remove patient choice have failed due to there being protection in law for 'bona fide occupational qualification' which in previous cases involving wash-room attendants and male nurses have recognized justification for gender-based requirements for certain jobs.

See also

Related Research Articles

Vagina part of the female genital tract

In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vulva to the cervix. The outer vaginal opening is normally partly covered by a membrane called the hymen. At the deep end, the cervix bulges into the vagina. The vagina allows for sexual intercourse and birth. It also channels menstrual flow (menses), which occurs in humans and closely related primates as part of the monthly menstrual cycle.

Obstetrics and gynaecology or obstetrics and gynecology is the medical specialty that encompasses the two subspecialties of obstetrics and gynecology. It is commonly abbreviated as OB-GYN or OB/GYN in US English, and as obs and gynae or O&G in British English.

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynaecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

Hysterectomy

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.

Pessary

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage, and pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception. Pessaries come in different shapes and sizes, so it is important that individuals be fitted for them by health care professionals to avoid any complications.However, there are a few instances and circumstances that allow individuals to purchase pessaries from a store without a prescription or without seeking help from a health care professional. Some side effects may occur if pessaries are not sized properly or regularly maintained, but with the appropriate care, pessaries are generally safe and well tolerated.

Vaginoplasty

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

Uterine malformation

A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.

The International Federation of Gynecology and Obstetrics, usually just FIGO ("fee'go") as the acronym of its French name Fédération Internationale de Gynécologie et d'Obstétrique, is a worldwide non-governmental organisation representing obstetricians and gynaecologists in over one hundred territories. It was founded on 26 July 1954 in Geneva, Switzerland, to "promote the well-being of women and to raise the standard of practice in obstetrics and gynaecology". Membership is currently composed of 132 professional societies of obstetricians and gynaecologists worldwide.

Vaginectomy

Vaginectomy is a surgery to remove all or part of the vagina. It is usually used as a treatment for vaginal cancer. Some transgender men and nonbinary people who were assigned female at birth have chosen to have a vaginectomy as part of their transition, because they do not want to have a vagina. Trans people can choose to have surgical changes made to their clitoris to make it more penis-like (metoidioplasty), or have a full-size penis constructed (phalloplasty) in addition to the vaginectomy. They can also choose not to do so, in order to create a relatively smooth, featureless genital area.

A Fellowship is the period of medical training, in the United States and Canada, that a physician, dentist, or veterinarian may undertake after completing a specialty training program (residency). During this time, the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the specialist field in which they were trained, such as Internal Medicine or Pediatrics. After completing a fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as Cardiology or Oncology.

Pelvic examination

A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma. It can also be used assess a patient's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the external genitalia 2) the internal exam with palpation to examine the uterus, ovaries, and fallopian tubes, and 3) the internal exam using the speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer.

Hematometra Human disease

Hematometra is a medical condition involving collection or retention of blood in the uterus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum.

Reproductive endocrinology and infertility (REI) is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infertility. While most REI specialists primarily focus on the treatment of infertility, reproductive endocrinologists are trained to also test and treat hormonal dysfunctions in females and males outside infertility. Reproductive endocrinologists have specialty training (residency) in obstetrics and gynecology (ob-gyn) before they undergo sub-specialty training (fellowship) in REI.

Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

The following outline is provided as an overview of and topical guide to obstetrics:

Postcoital bleeding is bleeding from the vagina in women after sexual intercourse and may or may not be associated with pain. The bleeding can be from the uterus, cervix, vagina and other tissue or organs located near the vagina. Postcoital bleeding can be one of the first indications of cervical cancer. There are other reasons why a woman may bleed after intercourse. Some women will bleed after intercourse for the first time but others will not. The hymen may bleed if it is stretched since it is thin tissue. Other activities may have an effect on the vagina such as sports and tampon use. Postcoital bleeding may stop without treatment. In some instances, postcoital bleeding may resemble menstrual irregularities. Postcoital bleeding may occur throughout pregnancy. The presence of cervical polyps may result in postcoital bleeding during pregnancy because the tissue of the polyps is more easily damaged. Postcoital bleeding can be due to trauma after consensual and non-consensual sexual intercourse.

Cervical agenesis is a congenital disorder of the female genital system that manifests itself in the absence of a cervix, the connecting structure between the uterus and vagina. Milder forms of the condition, in which the cervix is present but deformed and nonfunctional, are known as cervical atresia or cervical dysgenesis.

An obstetric hospitalist is an obstetrician and gynaecologist physician who is either employed by a hospital or a physician practice and whose duties include providing care for laboring patients and managing obstetric emergencies. Some obstetrics hospitalists also have responsibilities including resident and medical student teaching; providing backup support for family practitioners and nurse midwives, assisting private physicians with surgery, assuming care for ob-gyn patients unassigned to a physician and providing vacation coverage for the private practicing physician.

Jen Gunter Canadian-American gynecologist, columnist, and author

Jennifer Gunter is a Canadian-American gynecologist, a New York Times columnist covering women’s health, an author, and a specialist in chronic pain medicine and vulvovaginal disorders.

Victor Bonney

William Francis Victor Bonney FRCP FRCS was a prominent British gynaecological surgeon. He was described by Geoffrey Chamberlain as "a primary influence on world gynaecology in the years between the wars".

References

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  2. S. V. Govindan (November 2002). Fundamental Maxims of Ayurveda: Prepared for the Common People. Abhinav Publications. pp. 142–143. ISBN   978-81-7017-417-2.
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  16. "New York OB/GYN Robert Hadden indicted on federal charges ." 2020-09-09. Retrieved 2020-10-22.
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