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

Almost all modern gynaecologists are also (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 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 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.Laurinda S. Dixon. Perilous Chastity: Women and Illness in Pre-Enlightenment Art and Medicine, Cornell University Press 1995, pp.15f.

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. Lesley Dean-Jones, "The Cultural Construct of the Female Body" In Women’s History and Ancient History, ed. Susan B. Pomeroy (Chapel Hill: The University of North Carolina Press, 1991), 113. The gynaecological treatise Gynaikeia by Soranus of Ephesus (1st/2nd century AD) is extant (together with a 6th-century paraphrase by , a physician of the same school). He was the chief representative of the school of physicians known as the "".

J. Marion Sims is widely considered the father of modern gynaecology.

(1990). 9780807014134, Beacon Press. .
He developed some of his techniques by operating on slaves, many of whom were not given anaesthesia.
(2010). 9780761850922, University Press of America. .
Sims performed surgeries on 12 enslaved women in his homemade backyard hospital for four years. While performing the surgeries he invited men physicians and students to come watch the invasive and painful surgeries while the women were exposed. On one of the women, named , he performed 13 surgeries and without anesthesia. Due to having so many enslaved women he would rotate from one to another continuous trying to perfect the repairment of fistulas. In the four years he performed these surgeries the physicians and students lost interest in assisting him. Due to this he got the other enslaved women, who were healing from their surgeries, to assist him in the operations, which required them to help in the performance of these painful surgeries on the other women. In 1855 Sims went on to found the Woman's Hospital in New York, this was the first hospital specifically for female disorders.


Examination

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 , however, law and many plans allow gynaecologists to provide 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 , 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 . 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 .


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 , , antihypertensives, and . Additionally, gynaecologists make frequent use of specialized -modulating therapies (such as citrate and hormonal contraception) to treat disorders of the female genital tract that are responsive to or 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:

  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. (removal of the uterus)
  3. (removal of the ovaries)
  4. (a type of permanent sterilization)
  5. (inspection of the uterine cavity)
  6. Diagnostic  – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide a definitive diagnosis of .
  7. Exploratory  – 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 and sub- slings.
  9. Surgical treatment of pelvic organ , including correction of and .
  10.  – often performed to remove site of painful implantation or prophylactically (against future acute ) at the time of or Caesarean section. May also be performed as part of a operation for .
  11. Cervical Excision Procedures (including ) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on .


Specialist training
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 .


Gender of physicians
Despite the patients being predominantly female, like all specialist areas of health, historically gynaecology has been dominated by male doctors. However, in recent times as many of the barriers to access the education and training required to successfully practice gynaecology were removed, women have started to outnumber men in the field. There are a number of reasons for this, ranging from women being motivated to become gynaecologists after having bad experiences with male doctors to men choosing to specialize in different fields.

Possible reasons reported for the decrease in male gynaecologists range from there being a perception of a lack of respect from other doctors towards them, distrust about their motivations for wanting to work exclusively with female sexual organs and questions about their overall character, as well as a concern about being associated with other male gynaecologists who have been arrested for sex offences and limited future employment opportunities.

Surveys have also shown a large and consistent majority of women are uncomfortable being forced to have intimate exams done by a male doctor. They are also less likely to be embarrassed, so as a result talk more openly and in greater details, when discussing their sexual history with another woman rather than a man, leading to questions about the ability of male gynaecologists to offer quality care to patients. This, when coupled with more women choosing female physicians has decreased the employment opportunities for men choosing to become gynaecologists.

In the , it has been reported that 4 in 5 students choosing a residency in gynaecology are now female. In , 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. In , due to patient preference to be seen by another female, there are now few male gynaecologists working in the field.

There have been a number of legal challenges in the US against healthcare providers who have started hiring based on 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. 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. 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".

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 a justification for gender-based requirements for certain jobs.


See also
  • Howard Atwood Kelly
  • Childbirth and obstetrics in antiquity
  • Genital schistosomiasis
  • Hydatidiform mole
  • List of bacterial vaginosis microbiota
  • Pediatric gynecology


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