gynecologist

Gynaecology or gynecology (see spelling differences) 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 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, two fingers in the vagina), to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do a rectovaginal exam for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists often have a female chaperone (nurse or medical student) 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.

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. Adominal ultrasound, to give a low-power view of the pelvic organs.
2. Vaginal ultrasound. An ultrasound probe is passed into the vagina, which allows a more detailed view of the cervix, ovaries and uterus and its contents (such as a fetus, polyp, fibroid, endometrium or collection of fluid).
3. Blood tests. Levels of hormones such as estradiol, luteinizing hormone, follicle stimulating hormone and progesterone are measured, as well as prolactin. Thyroid function may be analyzed. Routine blood tests for STDs such as HIV, syphilis, and hepatitis are also done by the gynecologist.
4. Vaginal swabs -- samples collected for Gonorrhea and Chlamydia testing are performed this way. A wet prep may be performed in order to diagnose candidiasis or bacterial vaginosis.
5. Pap smear -- Short for Papanicolau smear, this test checks the cervix for abnormal changes in the cells called dysplasia caused by the Human Papilloma Virus and may eventually lead to cervical cancer if left untreated. This term is often confused with the pelvic exam itself though a woman receiving a pelvic exam would usually only have a pap smear done if it was at her annual well-woman visit or another indicated interval.
6. Colposcopy -- This procedure is the recommended followup for most abnormal results obtained from a Pap smear. This in-office procedure uses a binocular microscope to look at the vulva, vagina, and cervix with a coating of acetic acid which makes abnormal (pre-cancerous) cells show up white. A biopsy may be taken for further testing and in the case of an abnormal Pap smear. An endocervical currettage (ECC) is usually performed at the same time as the colposcopy.
7. Hysteroscopy -- a small telescope is passed into the uterus using either direct visualization or aided by video. The telescope may be flexible or rigid. If the procedure is done in the office, the patient may have the discomfort alleviated via local anesthesia administered to the cervix and uterus. If the hysteroscopy is performed as part of a series or of a larger procedure, regional or general anaesthia would likely be administered and the patient would be in an operating room.
8. Laparoscopy -- A small telescope and instruments are passed into the peritoneal cavity, which is then insufflated with carbon dioxide. This is commonly used to diagnose endometriosis, though increasingly, procedures traditionally done through an abdominal incision are being accomplished entirely laparoscopically--including hysterectomy.
9. MRI and CT scans are rarely used. They can be helpful in tumor staging in gynecological cancer and diagnosis of uterine malformation.
10. Pelvic X-ray is rare. It can be used to delineate the uterine cavity with an injected dye (hysterosalpingogram, a frequent test ordered by fertility specialists) and to measure the pelvic girdle for assessment of a woman's liklihood of successful vaginal delivery.

Diseases

The main conditions dealt with by a gynaecologist are:

1. cancer of the reproductive organs including ovaries, tubes, uterus, vagina, and vulva
2. incontinence of urine.
3. amenorrhoea (absent periods)
4. dysmenorrhoea (painful periods)
5. infertility
6. menorrhagia (heavy periods). This is a common indication for hysterectomy.
7. prolapse of pelvic organs

Obviously, there is some crossover in these areas. For example, a woman with incontinence may be referred 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 Surgeons, 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

External links

• Ingenious: archive of historical images related to obstetrics, gynaecology, and contraception.