Gynaecology
Medical area for women's reproductive health From Wikipedia, the free encyclopedia
Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the female reproductive organs. It is often paired with the field of obstetrics, which focuses on pregnancy and childbirth, thereby forming the combined area of obstetrics and gynaecology (OB-GYN).[1]
| |
| System | Female reproductive system |
|---|---|
| Subdivisions |
|
| Significant diseases | Gynaecological cancers, infertility, dysmenorrhea |
| Significant tests | Laparoscopy |
| Specialist | Gynaecologist |
The term comes from Greek and means 'the science of women'.[2][3] Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.[4]
Etymology
The word gynaecology comes from the oblique stem (γυναικ-) of the Greek word γυνή (gyne) meaning 'woman', and -logia meaning 'study'.[5]
History
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Antiquity
The Kahun Gynaecological Papyrus, dated to about 1800 BC, deals with gynecological 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, consisting of applying medicines to the affected body part or delivering medicines orally. During this time, the womb was at times seen as the source of complaints manifesting themselves in other body parts.[6]
Ayurveda, an Indian traditional medical system, also provides details about concepts and techniques related to gynaecology, addressing fertility, childbirth complications, and menstrual disorders among other things.[7][8] These writings provide a post and prenatal care, integrating lifestyle practices, meditations and yoga, and a dietary regime for overall well-being.
The Hippocratic Corpus contains several gynaecological treatises dating to the 5th and 4th centuries BC. Aristotle is another 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.[9] 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."
During the Middle Ages, midwives dominated women's health concerns through experienced-based knowledge, traditional remedies, and herbal medicines. Midwifery was often regarded unscientific and was challenged with the rise of gynecology as an official medical field. The Renaissance period, 16th century, brought about a resurgence of classical scientific advancements, including the ride of medical advancements in the field of gynecology and obstetrics. Figures like Ambroise Pare were imperative in improving obstetrics techniques during this period. Peter Chamberlen developed the forceps, an important surgical tool that transformed childbirth and lessened maternal mortality.[10]
As medical institutions continued to expand in the 18th and 19th centuries, the authority of midwives was further challenged by men involving themselves in women's health practices and research.[11] The formalization of midwifery training by male doctors and advancements in medical knowledge of women's health and anatomy was seen during this period. Figures such as William Smellie, William Hunter, Paul Zweifel, Franz Karl Naegele, and Carl Crede contributed to understandings of childbirth and women's health in Europe.[10] In the early 18th and 19th century United States, the field of gynecology held close ties to slavery and the Black women's reproduction. Figures such as Henry Ford Campbell and Robert Campbell worked as gynelogical surgeons on enslaved women, publishing their work in accredited medical journals that while advanced gynecological knowledge, simultaneously laid the foundation for medical racism, medical ethics atrocities, and discrimination that fueled rationale for slavery.[11] Furthermore, known as the "father of gyneoclogy" in America, J.Marion Sims also contributed to nonconsensual medical examinations on enslaved women in the name of advancing gynecological knowledge.[11]
United States Modern Gynecology: J. Marion Sims
J. Marion Sims is widely regarded as the father of modern gynecology.[12] Isolated precedents exist for some of his innovations; however, he was the first to have published medical contributions such as development of the Sims' position (1845), the Sims' speculum (1845), the Sims’ sigmoid catheter, and gynecological surgery. He was the first to develop surgical techniques for the repair of vesico-vaginal fistulas (1849), a consequence of protracted childbirth which at the time was without treatment. He founded the first women's hospital in the country in Alabama 1855 and subsequently the Woman's Hospital of New York in 1857. He was elected president of the American Medical Association in 1876. Sims died in 1883 and was the first American physician of whom a statue was erected in 1894.[13]
Sims’ legacy is widely controversial as he developed this new specialty experimenting on Black enslaved women, as recounted in his autobiography. [14][15] In this era, anesthesia was unprecedented and a focus in research. Its use was novice and considered dangerous. Sims developed various of his techniques and instruments by operating on slaves, many of whom were not given anesthesia. [16][17] On one of the women, named Anarcha, he performed 30 surgeries without anesthesia.[18] In addition, during the antebellum era, medical racism funded and founded science that supported the belief that Black people had higher pain tolerance, and white women proved unable to endure the pain. [15] The lack of voluntary, informed consent and experimentation on Black enslaved women’s bodies during the antebellum era went ethically unquestioned in the medical community, and contributed to medical racism that founded beliefs on pain tolerance, race, and gender.[15]
Throughout his success, he was invited by European Royalty to treat their female relatives of gynecological problems. His medical knowledge had been produced globally without acknowledgement of the methods delaying these techniques.[15] When he left Alabama in 1853, a local newspaper called him "an honor to our state." [19] Currently, Sims’ experimentation on Black enslaved women is widely discoursed and criticized in the Journal of Medical Ethics and academic scholars.[20][21]
Examination
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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 other countries, laws may allow patients to see gynaecologists without a referral. Some gynaecologists provide primary care in addition to aspects of their own specialty.[22] 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, examination and investigations. 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 a 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:
- Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, cervix, vagina, and vulva
- Incontinence of urine[23]
- Amenorrhoea (absent menstrual periods)
- Endometriosis
- Dysmenorrhoea (painful menstrual periods)
- Infertility[24]
- Menorrhagia (heavy menstrual periods); a common[citation needed] indication for hysterectomy
- Prolapse of pelvic organs
- Infections of the vagina (vaginitis), cervix and uterus (including fungal, bacterial, viral, and protozoal)
- Pelvic inflammatory disease[25]
- Urinary tract infections
- Polycystic ovary syndrome
- Premenstrual dysphoric disorder
- Post-menopausal osteoporosis
- Other vaginal diseases
There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a urologist.
Therapies
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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:[26]
- 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)
- Hysterectomy (removal of the uterus)
- Oophorectomy (removal of the ovaries)
- Tubal ligation (a type of permanent sterilization)
- Hysteroscopy (inspection of the uterine cavity)
- Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain. Laparoscopy is the only way to accurately diagnose pelvic/abdominal endometriosis.[27]
- 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.
- Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
- Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
- 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.
- 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
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| Occupation | |
|---|---|
| Names |
|
Occupation type | Specialty |
Activity sectors | Medicine, Surgery |
| Description | |
Education required |
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Fields of employment | Hospitals, Clinics |
 | This section needs additional citations for verification. (July 2023) |
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.[28]
In the United States, obstetrics and gynecology requires residency training for four years. This encompasses comprehensive clinical and surgical education. OBGYN residents participate in a yearly in-training exam that is administered by the Council on Resident Education in Obstetrics and Gynecology (CREOG). Research suggests that combining curriculum and focused mentorship can improve residents' performance on the exam and overall educational outcomes.[29]
Gynaecologic oncology is a subspecialty of gynaecology, dealing with gynaecology-related cancer.
Urogynaecology is a subspecialty of gynaecology and urology dealing with urinary or fecal incontinence and pelvic organ prolapse.
Gender of physicians
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Improved access to education and the professions in recent decades has seen women gynaecologists outnumber men in the once male-dominated medical field of gynaecology.[30] In some gynaecological sub-specialties, where an over-representation of males persists, income discrepancies appear to show male practitioners earning higher averages.[31]
Speculations on the decreased numbers of male gynaecologist practitioners report a perceived lack of respect from within the medical profession, limited future employment opportunities and questions to the motivations and character of men who choose the medical field concerned with female sexual organs.[32][33][34][35][36]
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.[37] This, when coupled with more women choosing female physicians[38] has decreased the employment opportunities for men choosing to become gynaecologists.[39]
In the United States, it has been reported that four in five students choosing a residency in gynaecology are now female.[40] 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.[41][42] In Turkey, due to patient preference to be seen by another female, there are now few male gynaecologists working in the field.[43]
There have been a number of legal challenges in the US against healthcare providers who have started hiring based on the gender of physicians. 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.[44] 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.[45] In 2000, David Garfinkel, a New Jersey-based OB-GYN, sued his former employer[46] after being fired due to, as he claimed, "because I was male, I wasn't drawing as many patients as they'd expected".[44]
See also
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