Gynaecology is the clinical speciality caring for problems associated with the female genital tract. 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 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.
Gynaecological problems are extremely common. The following are just a few of the more frequent gynaecological questions that women often ask themselves and their professional advisors.
- Is my body working normally?
- When should I seek professional advice?
- Will I require tests and if so what will these involve for me?
- Do I require treatment?
- What will be my treatment options?
- How can I tell which will be the best treatment for me?
- How will I benefit from a particular treatment?
- Could a proposed treatment cause problems (side effects) for me?
- Could I change my treatment if I am not happy with it?
- What is the best way for me to avoid an unplanned pregnancy?
- Will we be able to have children when we wish?
- What will happen to me at the menopause?
There are seldom simple answers to these questions. Every woman is an individual, with her own particular set of circumstances. Every clinical problem requires evaluation and the potential benefits and risks of investigations and treatments demand careful consideration and explanation. If you have a recurring pain that does not require even a paracetamol tablet it is unlikely that you would require an operation to determine the cause or remove the source of the pain – the risks of surgery are likely to be greater than the potential benefits.
It is apparent to all doctors that patients are seeking ever more detailed explanations for their symptoms and information to assist them with treatment options. There is a particular interest in women’s health. Many will have found a book or article in a magazine. Although few patients would wish to reach into the very depths of current research, some go as far as a computer search on the internet. These sites can provide a useful source of information although caution is required (Q4.28). At the end of most chapters of this book, a few selected Web sites have been included, which may set you on the road to some fascinating surfing. Details of support groups have also been provided.
In gynaecology, and particularly in reproductive medicine, there are quite complex issues to be addressed. It is relatively simple for a patient to understand that a ‘joint is wearing out’ or that a ‘heart-valve is leaking’ but hormones are an enigma to the majority. The interplay of the various hormones that are involved in the menstrual cycle, fertility, general health and the psyche are not yet fully understood even by specialists.