What is the role of a gynaecologist

• Introduction
• Women's Health Issues
• FAQs On Women's Health
• Femininity
• Gynecology/Gynecologist
• Reproductive Medicine
• Patient Information
• Internet Information
• Anatomy
• Physiology
• Hormones
• Sex Hormones
• Menstrual Cycle / Menstruation
• Pathology - Disease Processes
• Psycholgical Disorders
• Syndromes
• Consultations
• Symptoms and Signs
• Hormone Levels
• Pelvic Ultrasound
• Diagnosis
• Treatment Choice
• Abortion
• Amenorrhoea
• Birth Control
• Bladder Symptoms
• Cancer in Women
• Childbirth
• Children and Teenagers
• Diet / Weight Loss
• Dysmenorrhoea
• Endometriosis
• Fibroids
• HRT
• Hirsutism
• Hysterectomy
• Infections
• Infertility
• Medication Drugs
• Menopause
• Menorrhagia
• Miscarriage
• Painful Sex
• Pap Smear Test
• PCOS
• Pelvic Pain
• PMS
• Postpartum
• Pregnancy
• Self Esteem
• Sexual Problems
• Vaginal Discharge
• Vaginal Prolapse
• Vulval Symptoms

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Gynaecology is the clinical speciality caring for problems associated with the female genital tract (Figure 2.1). Obstetrics, the management of pregnancy and childbirth by doctors, and gynaecology was initially a branch of surgery becoming a speciality in its own right in the 1920's. A significant change in philosophy with regard to training for the aspiring obstetrician and arose in the 1970s. Until then, most gynaecologists underwent a general surgical training before specialising. A shift towards medical treatment and an ever increasing breadth to the subject have encouraged direct entry into obstetrics and gynaecology.

An Introduction To gynaecologists

Gynaecology is a hospital based specialty. In some countries, including the UK, women must first see a general practitioner (GP; also known as a family practitioner ) who refers them to the gynaecologist as required.

J. Marion Sims is considered to be the father of American gynaecologists. Sims was born in South Carolina. After studying medicine at the Medical College of Charleston, he moved to Philadelphia, Pennsylvania and graduated from Jefferson Medical College in 1835. In 1845, Marion Sims established a private hospital for women in Alabama. Before the relatively recent development of caesarean section, women with long and difficult labour sometimes developed a vesicovaginal fistulas (a hole develops between the bladder and the vagina, resulting in urinary incontinence. Those who suffered this calamity inevitably became social outcasts. Sims used three slave women to develop his new techniques to repair this condition.

James Marion Sims - The "father" of American gynaecologists

One of the first surgeons to specialise as a Gynacologist

In England, Aleck William Bourne was a prominent gynecologist and writer who is best known for his 1938 trial, a landmark case, for performing an illegal abortion on a 14-year-old girl rape victim. Termination of pregnancy (induced abortion) probably began well before written history. There is a fundamental clash between the rights of a woman who does not wish her pregnancy to continue and the sanctity of life coupled with the rights of the unborn child. Before 1967, it was illegal to terminate (abort) a pregnancy in the UK. The case of a fourteen-year old girl who was raped by officers of the Royal Horse Guards in 1938 illustrates the difficulty. The parents sought an abortion for their daughter. They argued that the baby would remind their daughter of her frightening experience. The girl was admitted to hospital under the care of Aleck Bourne. He agreed that termination of the pregnancy was in the girl’s best interest and undertook the procedure risking a twenty-year prison sentence. The judge at the Old Bailey accepted that, although the operation had not been performed to save life, it preserved the girls mental and physical health. The jury found in favour of the gynaecologist.

Gynaecological diagnosis, as with all other other braches of medicine, involves clinical history, physical examination and investigation. Gynaecological examination includes examination of the external genitalia and the vagina and cervix with a vaginal speculum. The gynaecologist will perform a bimanual examination - one hand on the abdomen and two fingers introduced vaginally to palpate the cervix, uterus and ovaries. A female chaperone, usually a nurse, accompanies the patient during the examination.

Gynaecological problems range in severity from a minor disruption of the menstrual cycle to life threatening malignancy. They may be of a physical origin such as an ovarian cyst leading to abdominal pain or distension. They may arise from hormonal changes leading to menstrual cycle disturbance or psychological (affecting the mind) symptoms such as anxiety, tension or depression. Female contraception, infertility and problems in early pregnancy, such as miscarriage are within the province of gynaecology. The range of investigations and treatments available to us is increasing rapidly.

Obstetrics, the management of pregnancy and childbirth by doctors, and gynaecology was initially a combined branch of surgery becoming a speciality in its own right in the 1920's.

The main conditions dealt with by a gynaecologist are:

• Period problems:-

• amenorrhoea (absent periods) or oligomenorrhoea (reduced periods)
• heavy periods (menorrhagia)

• Pelvic pain:-

• painful periods (dysmenorrhoea)
• pain with sexual intercourse (dyspareunia)

• Birth Control - Family Planning - Contraception
• Infertility:-

• investigation
• treatment

• Early pregnancy problems:-

• miscarriage
• ectopic pregnancy

• Infections:-

• pelvic inflammatory disease
• cystitis - urinary tract infection
• thrush
• chlamydia
• HIV / AIDS
• Genital Warts
• Genital Herpes

• Hirsutism
• PMS
• Postpartum
• Menopause andHRT
• Prolapse
• Urinary Incontinence
• Cancer:-

• Cervical
• Endometrial
• Ovarian
• Breast

Sub-Specialties

A significant change in philosophy with regard to training for the aspiring obstetrician and gynaecologist arose in the 1970s. Until then, most Gynaecologists underwent a general surgical training before specialising. A shift towards medical treatment and an ever increasing breadth to the subject have encouraged direct entry into obstetrics and gynaecology.

The arrival of refined technologies including ultrasound assessment of the pelvic organs (pelvic ultrasound), hormone tests, laser, embryology, and sophisticated hormonal treatment have changed the direction of the speciality from its surgical origins ever towards a more medical approach. Just as obstetrics and gynaecology became too large a discipline to remain within general surgery, so in turn there has been a need for sub-specialisation. Reproductive medicine focuses on medical, as opposed to surgical, treatment of gynaecological problems. Hormones are the major, but by no means the only, component of treatment.

Reproductive medicine includes the medical treatment of menstrual (period) problems (Chapters 6, 7, 8 and 24), infertility (Chapters 9-11), premenstrual tension (Chapter 25) and the menopause (Chapters 26-8). The other sub-specialities include feto-maternal medicine (high-risk obstetrics), oncology (malignancy - Chapter 32) and uro-gynaecology (bladder problems) amenable to gynaecological intervention (Chapters 29 and 30).

There have been many remarkably developments in gynaecology. One of the most important has been the application of ultrasound which was pioneered by Ian Donald.

Professor Ian Donald, the Obstetrician and gynaecologist who pioneered the application of ultrasound to obstetrics and gynaecology.

He was born in Scotland in 1910 and educated in Edinburgh and following the family move to South Africa he graduated BA from the Diocesan College in Cape Town. He then studied medicine and was awarded MB BS at London University in 1937. During 1942-1946 he served as a medical officer in the RAF. He was mentioned in dispatches and awarded the MBE for rescuing airmen from a burning aircraft.

In 1954, he accepted the Regius Chair of Midwifery at Glasgow University, where, to quote his own words he "arrived with the residue of a Leverhulme Research grant from the RCOG, a rudimentary knowledge of radar from my days in the RAF and a continuing childish interest in machines, electronic and otherwise". This was combined with a little knowledge of echo-sounding and contact with some of the few others in the world who were interested in its possible medical applications.

 

Gynaecologists perform a variety of operations including:

• Cervical dilation and curettage (D and C). A curette is a specialised spoon employed by a gynaecologist to scrape the lining of the uterus (endometrium) to obtain samples for microscopic analysis (histology).
• Hysteroscopy - A hysteroscope is and endoscopic instrument employed byGynaecologists to visualise the cavity of the uterus. MostGynaecologists will perform hysteroscopy in combination with a D and C.
• Evacuation and removal of retained products of conception (ERPC). If the uterus is incomplete after miscarriage, it can be emptied by a D and C type of operation - the uterus is generally emptied by using a suction curette.
• Endometrial ablation. At one time many women with a structurally normal uterus came to hystectomy to treat heavy periods that would not respond to medical treatment. Endometrial ablation is a relatively small operation in which the uterine lining is destroyed. Many of these procedures are undertaken as an outpatient.
• Colposcopy (microscopic visualisation of the surface of the cervix) and cervical excision procedures (including cryosurgery, LLETZ, LEEP) - removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.
• laparoscopy - Another endoscope used byGynaecologists to visualise the pelvic organs. Increasingly,Gynaecologists are undertaking surgical procedures through small abdominal wounds under laparoscopic visualisation. For many years, the main laparoscopic operation was sterilisation. More recently many operations previoulsy conducted through an abdominal incision of about 10 - 15 cms (laparotomy) are performed laparoscopically. This includes ablation of endometiosis and hysterectomy.
• Sterilisation.
• 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. The pelvic organs may be removed for ovarian, endometrial and cervical cancer.
• Hysterectomy (removal of the uterus).
• Oophorectomy (removal of the ovaries).
• Various surgical treatments for urinary incontinence, including cystoscopy (visualisation of the bladder lining) and sub-urethral slings (e.g. TVT).
• Surgical treatment of pelvic organ prolapse, including correction of cystocoele and rectocoele.
• Appendicectomy.

It has been estimated that every ten years mankind doubles scientific knowledge. In other words, we accumulate as much new understanding about the universe in ten years as had been learned by all previous generations. There can be little doubt that medicine in general, and obstetrics and gynaecology in particular, have more than kept pace. This would mean that since the author qualified from medical school thirty years ago there would have been an eight-fold increase. It follows that medical knowledge will increase sixteen-fold during the clinical careers ofGynaecologists currently qualifying.