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Gynaecology

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For the book by Mary Daly, see Gyn/Ecology.

Gynaecology
A dilating vaginal speculum, a tool for examining the vagina, in a model of the female reproductive system
SystemFemale reproductive system
Subdivisions
  • Oncology
  • Maternal medicine
  • Maternal-fetal medicine
Significant diseasesGynaecological cancers, infertility, dysmenorrhea
Significant testsLaparoscopy
SpecialistGynaecologist

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]

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

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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

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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

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Main article: J. Marion Sims
See also: Mothers of Gynecology Movement

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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The historic taboo associated with the examination of female genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygrier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology no longer uses such a position.

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

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Main article: Female genital disease

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 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.

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:[26]

  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. Laparoscopy is the only way to accurately diagnose pelvic/abdominal endometriosis.[27]
  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 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

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Gynaecologist
Occupation
Names
  • Physician
  • Surgeon
Occupation type
Specialty
Activity sectors
Medicine, Surgery
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.[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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References

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  1. ^ "Obstetrics and gynecology". www.cancer.gov. 2 February 2011. Retrieved 28 February 2025.
  2. ^ Porter, Roy (July 1991). "Ornella Moscucci, The science of women: gynaecology and gender in England, 1800–1929, Cambridge History of Medicine, Cambridge University Press, 1990, 8vo, pp. x, 278, illus., £35.00, $49.50". Medical History. 35 (3): 372. doi:10.1017/S0025727300054004.
  3. ^ McGill, Markus (29 August 2017). "Gynecologists: When to see one, what to expect, common procedures". Medical News Today. Archived from the original on 21 May 2022. Retrieved 23 April 2022.
  4. ^ Sadri-Ardekani, Hooman; Atala, Anthony (2019). "Regenerative Medicine for the Male Reproductive System". Principles of Regenerative Medicine. pp. 1251–1261. doi:10.1016/B978-0-12-809880-6.00071-0. ISBN 978-0-12-809880-6.
  5. ^ "gynecology". Academic Dictionaries and Encyclopedias. Archived from the original on 25 September 2022. Retrieved 26 April 2022.
  6. ^ Dixon, Laurinda S. (1995). Perilous Chastity: Women and Illness in Pre-Enlightenment Art and Medicine. Cornell University Press. p. 15f. ISBN 978-0-8014-3026-8.
  7. ^ S. V. Govindan (November 2002). Fundamental Maxims of Ayurveda: Prepared for the Common People. Abhinav Publications. pp. 142–143. ISBN 978-81-7017-417-2. Archived from the original on 9 July 2020. Retrieved 23 June 2020.
  8. ^ Islam, Md. Nazrul (2017). Chinese and Indian Medicine Today. p. 134. doi:10.1007/978-981-10-3962-1. ISBN 978-981-10-3961-4.
  9. ^ Dean-Jones, Lesley (2003). "The Cultural Construct of the Female Body in Classical Greek Science". Sex and Difference in Ancient Greece and Rome. pp. 183–201. doi:10.1515/9781474468541-014. ISBN 978-1-4744-6854-1.
  10. ^ a b Oyelese, Yinka; Grünebaum, Amos; Chervenak, Frank (1 November 2024). "Respect for history: an important dimension of contemporary obstetrics and gynecology". Journal of Perinatal Medicine. 52 (9): 914–926. doi:10.1515/jpm-2024-0348. ISSN 1619-3997.
  11. ^ a b c Owens, Deirdre Cooper (2017). Medical Bondage Race, Gender, and the Origins of American Gynecology. Athens: University of Georgia Press (published 15 November 2017). pp. 15–18. ISBN 9780820353036.
  12. ^ Semple, Henry Churchill (1923). J. Marion Sims, the Father of Modern Gynecology. Archived from the original on 11 June 2020. Retrieved 11 October 2013.
  13. ^ "James Marion Sims (1813-1883) | Embryo Project Encyclopedia". embryo.asu.edu. Retrieved 24 March 2025.
  14. ^ "The story of my life". Library of Congress, Washington, D.C. 20540 USA. Retrieved 24 March 2025.
  15. ^ a b c d Cooper Owens, Deirdre Benia (2018). Medical bondage: race, gender, and the origins of American gynecology (Paperback edition ed.). Athens: The University of Georgia Press. ISBN 978-0-8203-5475-0. {{cite book}}: |edition= has extra text (help)
  16. ^ Russ, Joanna; Daly, Mary (1979). "Gyn/Ecology: The Metaethics of Radical Feminism". Frontiers: A Journal of Women Studies. 4 (1): 68. doi:10.2307/3346672. ISSN 0160-9009.
  17. ^ Adekunle, Julius O.; Williams, Hettie V., eds. (2010). Color Struck. Hamilton. ISBN 978-0-7618-5092-2.
  18. ^ Wall, L. Lewis (2 November 2006). "Did J. Marion Sims Deliberately Addict His First Fistula Patients to Opium?". Journal of the History of Medicine and Allied Sciences. 62 (3): 336–356. doi:10.1093/jhmas/jrl045. ISSN 1468-4373.
  19. ^ "Medical Journals". Sumter County Whig. Livingston, Alabama. 22 March 1854. p. 2. Archived from the original on 18 June 2022. Retrieved 18 June 2022 – via newspapers.com.
  20. ^ Wall, L L (26 May 2006). "The medical ethics of Dr J Marion Sims: a fresh look at the historical record". Journal of Medical Ethics. 32 (6): 346–350. doi:10.1136/jme.2005.012559. ISSN 0306-6800.
  21. ^ Ojanuga, D (1993-03). "The medical ethics of the 'father of gynaecology', Dr J Marion Sims". Journal of Medical Ethics. 19 (1): 28–31. doi:10.1136/jme.19.1.28. ISSN 0306-6800. {{cite journal}}: Check date values in: |date= (help)
  22. ^ Beyer, M; Gerlach, Fm; Flies, U; Grol, R; Król, Z; Munck, A; Olesen, F; O’Riordan, M; Seuntjens, L; Szecsenyi, J (August 2003). "The development of quality circles/peer review groups as a method of quality improvement in Europe". Family Practice. 20 (4): 443–451. doi:10.1093/fampra/cmg420. ISSN 1460-2229.
  23. ^ Ackley B (2010). Nursing diagnosis handbook : an evidence-based guide to planning care (9th ed.). Maryland Heights, Mo: Mosby. ISBN 978-0-323-07150-5.[page needed]
  24. ^ "Infertility". The Lecturio Medical Concept Library. Archived from the original on 27 August 2021. Retrieved 27 August 2021.
  25. ^ "What Is Pelvic Inflammatory Disease?". WebMD. Archived from the original on 24 March 2022. Retrieved 24 April 2022.
  26. ^ "Obstetrics and Gynecology Specialty Description". American Medical Association. Archived from the original on 28 October 2020. Retrieved 24 October 2020.
  27. ^ Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML (February 2016). "Imaging modalities for the non-invasive diagnosis of endometriosis". The Cochrane Database of Systematic Reviews. 2016 (2): CD009591. doi:10.1002/14651858.cd009591.pub2. PMC 7100540. PMID 26919512.
  28. ^ "RCOG strategy". RCOG. Retrieved 28 February 2025.
  29. ^ Lundeberg, Kathleen R; Madison, Shannon; Lo, Nancy; Maxwell, Rose; Massengill, Jason (1 November 2024). "Resident Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Academic Curriculum". Cureus. doi:10.7759/cureus.72861. ISSN 2168-8184. PMC 11610421. PMID 39624527.
  30. ^ Groves, Nancy (February 2008). "From Past to Present: The Changing Demographics of Women in Medicine". Ophthalmology Times. American Academy of Ophthalmology.
  31. ^ "Women dominate ob/gyn field but make less money than male counterparts". ScienceDaily (Press release). University of Colorado Anschutz Medical Campus. 1 April 2019.
  32. ^ More, Dr Ashwin (4 December 2013). "Why Are Men Gynaecologists?". Akhandajyoti Multispeciality Hospital, Nashik. Retrieved 24 June 2014.
  33. ^ "Are Male Gynecologists Creepy?". The Daily Beast. 9 December 2013. Archived from the original on 27 June 2014. Retrieved 24 June 2014.
  34. ^ Gerber, Susan E.; Lo Sasso, Anthony T. (November 2006). "The evolving gender gap in general obstetrics and gynecology". American Journal of Obstetrics and Gynecology. 195 (5): 1427–1430. doi:10.1016/j.ajog.2006.07.043. PMID 17074550.
  35. ^ Kornfield, Meryl (9 September 2020). "New York OB/GYN Robert Hadden indicted on federal charges of sexual assault". The Washington Post.
  36. ^ "Gynecologist Loses License After Having Sex With Patients Who Asked About G-Spots Dr. Kurt Froelich assaulted patients in his office and the hospital". 10 February 2015. Archived from the original on 12 November 2020. Retrieved 22 October 2020.
  37. ^ Hall Judith A, Roter Debra L (2 December 2002). "Do patients talk differently to male and female physicians?: A meta-analytic review". Patient Education and Counseling. 48 (3): 217–224. doi:10.1016/S0738-3991(02)00174-X. PMID 12477606.
  38. ^ Schnatz, Peter F.; Murphy, Jessica L.; O’Sullivan, David M.; Sorosky, Joel I. (November 2007). "Patient choice: comparing criteria for selecting an obstetrician-gynecologist based on image, gender, and professional attributes". American Journal of Obstetrics and Gynecology. 197 (5): 548.e1–548.e7. doi:10.1016/j.ajog.2007.07.025. PMID 17980206.
  39. ^ "Career Trends for OB/GYN Physician Jobs". Archived from the original on 17 December 2014. Retrieved 24 June 2014.
  40. ^ "Enhancing the Representation of Women as Senior Leaders in Obstetrics and Gynaecology" (PDF). Archived from the original (PDF) on 17 December 2014. Retrieved 24 June 2014.
  41. ^ "Discrimination against male gynaecologists? Swedish clinics ban women from choosing female doctors". 29 January 2007. Archived from the original on 23 June 2018. Retrieved 24 June 2014.
  42. ^ Trysell, Katrin (11 April 2018). "Byta doktor ingen rättighet" [Switching Doctor Not a Right]. Läkartidningen (in Swedish). Archived from the original on 26 April 2018. Retrieved 25 April 2018.
  43. ^ "Male Gynaecologist in Turkey: Dying profession?". 22 May 2014. Archived from the original on 4 March 2016. Retrieved 25 June 2014.
  44. ^ a b Lewin, Tamar (7 February 2001). "Women's Health Is No Longer a Man's World". The New York Times. Archived from the original on 4 July 2018. Retrieved 14 July 2014.
  45. ^ Sun, Baltimore (2 February 2014). "Nurse questions all-female OB-GYN practice". Archived from the original on 4 April 2014. Retrieved 14 July 2014.
  46. ^ "DAVID A. GARFINKEL, M.D. v. MORRISTOWN OBSTETRICS and GYNECOLOGY ASSOCIATES, P.A., et al". Justia Law. Retrieved 9 August 2023.

Sources

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[edit]
Look up gynecology or gynaecology in Wiktionary, the free dictionary.
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