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Gynaecology

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Gynaecology
A dilating vaginal speculum, a tool for examining the vagina, in a model of the female reproductive system
SystemFemale reproductive system
SubdivisionsOncology, Maternal medicine, Maternal-foetal medicine
Significant diseasesGynaecological cancers, Menstrual bleeding, Infertility
Significant testsLaparoscopy
SpecialistGynaecologist

Gynaecology or gynecology[1] is the medical practice dealing with the health of the female reproductive and sexual systems (uterus, vagina, ovaries and breasts). Literally, outside medicine, it means "the science of women". Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.

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

Etymology

The word "gynaecology" comes from the Greek γυνή gyne "woman" and -logia, meaning "study."

History

The Kahun Gynaecological Papyrus is the oldest known medical text of any kind. Dated to about 1800 B.C., it deals with women's complaints—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.[2]

The Hippocratic Corpus contains several gynaecological treatises dating to the 5th/4th centuries BC. 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.[3] Now criticized for the short comings.[4] He developed some of his techniques by operating on slaves, many of whom were not given anesthesia.[5]

Examination

The historic taboo associated with the examination of female genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygnier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology has shed these inhibitions.

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 and/or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.

Diseases

The main conditions dealt with by a gynaecologist are:

  1. Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, cervix, vagina, and vulva
  2. Incontinence of urine
  3. Amenorrhoea (absent menstrual periods)
  4. Dysmenorrhoea (painful menstrual periods)
  5. Infertility
  6. Menorrhagia (heavy menstrual periods); a common indication for hysterectomy
  7. Prolapse of pelvic organs
  8. Infections of the vagina (vaginitis), cervix and uterus (including fungal, bacterial, viral, and protozoal)

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 and/or gonadal signals.

For lists of gynaecological drugs (by the ATC classification system), see ATC code G01 and ATC code G02.

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:

  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 and/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.

Code of ethics and sexual abuse cases

Possibly due to women becoming more educated about how examinations are undertaken (and when they are appropriate), reports of malpractice and sexual assault by male gynaecologists on their patients have increased in recent years.[6]

To help ensure patient trust in 2007 The American Congress of Obstetricians and Gynecologists, the largest member organization of OB/GYNs, developed a Code of Professional Ethics.[7]

In their code of conduct they state "Sexual contact or a romantic relationship between a physician and a current patient is always unethical, and sexual contact or a romantic relationship between a physician and a former patient also may be unethical." and also make it obligatory for physicians aware of instances of sexual misconduct to report it.

However, despite the new code of ethics there have still been a number of high profile cases of abuse, including against children[8][9][10][11][12][13] which has helped persuade a larger number of women than ever before to specify a preference that they're treated only by a female and not male gynaecologist.[14]

See also

References

  1. ^ See American and British English spelling differences. Gynecology is the American spelling, but it is also common in international contexts, e.g. International Federation of Gynecology and Obstetrics and International Society of Ultrasound in Obstetrics and Gynecology.
  2. ^ Laurinda S. Dixon. Perilous Chastity: Women and Illness in Pre-Enlightenment Art and Medicine, Cornell University Press 1995, pp.15f.
  3. ^ Semple, Henry Churchill (1923). J. Marion Sims, the Father of Modern Gynecology. Retrieved 11 October 2013.
  4. ^ Daly, Mary (1990). Gyn/ecology: The Metaethics of Radical Feminism. Beacon Press. pp. 225–. ISBN 9780807014134. Retrieved 11 October 2013.
  5. ^ Adekunle, Julius O.; Williams, Hettie V. (2010-02-24). Color Struck: Essays on Race and Ethnicity in Global Perspective. University Press of America. pp. 397–. ISBN 9780761850922. Retrieved 11 October 2013.
  6. ^ "Sexual misconduct by physicians on the increase". Biz Journals. Retrieved 6 February 2014.
  7. ^ "Committee on Ethics Sexual Misconduct". Retrieved 6 February 2014.
  8. ^ "Sexual Abuse Puts Spotlight on Pediatric Gynecology". Retrieved 13 February 2014.
  9. ^ "Gynecologist changes story on how he conducted exams / Never intentionally caused dozens of orgasms, he says". Retrieved 13 February 2014.
  10. ^ "Gynecologist Convicted of Sexual Abuse". Retrieved 13 February 2014.
  11. ^ "Betrayal: the sex-hungry doctors who prey on patients". Retrieved 12 February 2014.
  12. ^ "Nikita Levy, Gynecologist, Filmed And Photographed Underage Patients Before Killing Himself: Police". Retrieved 12 February 2014.
  13. ^ "Gynaecologist told patient 'this is how we do it in India' when he groped her breasts during three years of treatments". Retrieved 12 February 2014.
  14. ^ "Do Women Prefer Care From Female or Male Obstetrician-Gynecologists? A Study of Patient Gender Preference" (PDF). Retrieved 12 February 2014.
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