Article: Gynaecology

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The shamefulness 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.

Gynaecology (British) or gynecology (American) literally means 'the science of women', but in medicine this is the specialty of diseases of the female reproductive system (uterus, vagina and ovaries). Almost all modern gynaecologists are also obstetricians; see Obstetrics and gynaecology.

Examination

It is typically a consultant specialty. In most countries, women must see a general practitioner first. If their condition requires knowledge or equipment unavailable to the GP, they are referred to a gynaecologist. However, in the United States, law and many health insurance plans allow gynaecologists to provide primary care, and some women select that option.

As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is special in that it is quite intimate, and that it involves special equipment — the speculum. The speculum consists of two hinged blades of flat metal, which are used to open the vagina, to permit examination of the cervix uteri. Gynaecologists may also do a bimanual examination (one hand on the abdomen, two fingers in the vagina), to palpate the uterus and ovaries. They may occasionally do a rectal exam. Male gynaecologists often have a female chaperone (nurse or medical student) for their examination. An abdominal ultrasound is used normally to confirm the bimanual examination.

The Department of Plastic Surgery at the University of Virginia School of Medicine recommends that surgical devices, such as gloves, with dusting powders, including talc, should not be used during surgery because of acute and chronic problems that may occur if it finds its way into adominal cavity via the vagina. It also makes an analogy to condoms which have the very same dusting powders used on them.[1]

Investigations

Some of the investigations used in gynaecology are:

1. abdominal ultrasound, to give a low-power view of the pelvic organs.
2. vaginal ultrasound. A probe is passed into the vagina, which allows a detailed view of the uterus and its contents.
3. blood tests. Levels of hormones such as estradiol, luteinizing hormone, follicle stimulating hormone and progesterone are measured, as well as prolactin.
4. hysteroscopy -- a fine tube is passed into the uterus via the cervix under a general anaesthetic.
5. laparoscopy -- tubes are passed into the peritoneal cavity, which is then insufflated with carbon dioxide. This is commonly used to diagnose endometriosis.

MRI and CT scans are rarely used, apart from tumor staging in gynecological cancer. Pelvic X-ray is rare. It can be used to delineate the uterine cavity with an injected dye (hysterosalpingogram) and to measure the pelvic girdle.

Diseases

The main conditions dealt with by a gynaecologist are:

1. cancer of the cervix. The Papanicolaou (Pap) smear is a means of detecting this, by obtaining a sample of cervical epithelial cells and examining them under a microscope for malignant changes. All women are encouraged to have pap smears at regular intervals after commencing intercourse.
2. incontinence of urine.
3. amenorrhoea (absent periods)
4. dysmenorrhoea (painful periods)
5. infertility
6. menorrhagia (heavy periods). This is a main indication for hysterectomy.
7. prolapse

Obviously there is some crossover in these areas. Amenorrhoea in a young girl may be referred to a paediatrician, incontinence to a urologist.

Therapies

Occasionally gynaecologists will use drugs, such as clomiphene (which stimulates ovulation), and, most famously, oral contraceptives (which are also used for dysmenorrhoea).

Surgery, however, is the mainstay of gynaecological therapy. For historical reasons, gynaecologists are not usually considered "surgeons" - this has always been the source of some controversy - though modern advancements in both fields have blurred many of the once rigid lines of distinction. The rise of sub-speciatlies within gynaecology which are primarily surgical in nature (for example, urogynaecology and gynecological 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 and Royal Colleges of Surgerons, and many newer surgical textbooks include chapters on (at least basic) gynecological surgery.

Some of the more common operations that gynaecologists perform include:

1. termination of pregnancy
2. dilation and curettage (removal of the uterine contents, for various reasons, including miscarriage and menorrhagia; procedurally very similar to the above);
3. hysterectomy (removal of the uterus);
4. oophorectomy (removal of the ovaries);
5. tubal ligation;
6. Exploratory laparoscopy or laparotomy (used to diagnose and treat sources of pelvic and abdominal pain, dysmenorrhea, vaginal bleeding, etc.)
7. colposuspension ('tightening' of the ligaments around the vagina, a common therapy for incontinence and discomfort in older women);
8. Large Loop Excision of the Transition Zone (LLETZ), where the surface of the cervix, containing pre-cancerous cells identified on Pap smear are removed).

See also

• Andrology, the study of the male reproductive system
• Cervical cancer
• Dalkon Shield
• Hydatiform mole
• HPV vaccine
• Obstetrics
• Pelvic inflammatory disease
• Reproduction medicine
• Sexually transmitted disease