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Gynaecology or gynecology (see spelling differences) is the area of
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
that involves the treatment of women's
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
s, especially those of the reproductive organs. It is often paired with the field of
obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a sur ...
, forming the combined area of
obstetrics and gynecology Obstetrics and Gynaecology (also spelled as Obstetrics and Gynecology; abbreviated as Obs and Gynae, O&G, OB-GYN and OB/GYN) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and ...
(OB-GYN). The term comes from Greek and means "the
science Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe. Science may be as old as the human species, and some of the earliest archeological evidence ...
of
women A woman is an adult female human. Prior to adulthood, a female human is referred to as a girl (a female child or Adolescence, adolescent). The plural ''women'' is sometimes used in certain phrases such as "women's rights" to denote female hum ...
". Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.


Etymology

The word "gynaecology" comes from the oblique stem (γυναικ-) of the Greek word γυνή (''gyne)'' semantically attached to "woman", and ''-logia'', with the semantic attachment "study". The word gynaecology in Kurdish means "jinekolojî", separated word as "jin-ekolojî", so the Kurdish "jin" called like "gyn" and means in Kurdish "woman".


History


Antiquity

The Kahun Gynaecological Papyrus, dated to about 1800 BC, deals with gynaecological diseases,
fertility Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Ferti ...
, pregnancy,
contraception Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
, etc. The text is divided into thirty-four sections, each section dealing with a specific problem and containing
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
and treatment; no
prognosis Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain sta ...
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.
Ayurveda Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. Ayurveda is heavily practiced in India and Nepal, where around 80% of the population rep ...
, an Indian traditional medical system, also provides details about concepts and techniques related to gynaecology. The Hippocratic Corpus contains several gynaecological treatises dating to the 5th and 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.'' The gynaecological treatise ''Gynaikeia'' by Soranus of Ephesus (1st/2nd century AD) is extant (together with a 6th-century
Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through ...
paraphrase by Muscio, a physician of the same school). He was the chief representative of the school of physicians known as the " methodists".


Modern gynaecology. J. Marion Sims

In the medical schools of the early nineteenth century, doctors did not study female reproductive anatomy, seen as repulsive, nor train in pregnancy and childbirth management. That women, because of their anatomy and the risks of the dangerous birthing process, had unique medical concerns and challenges, enough that a doctor might specialize in them, is an innovation widely credited to J. Marion Sims and to a lesser extent his trainee and partner Nathan Bozeman, physicians from
Montgomery, Alabama Montgomery is the capital city of the U.S. state of Alabama and the county seat of Montgomery County, Alabama, Montgomery County. Named for the Irish soldier Richard Montgomery, it stands beside the Alabama River, on the Gulf Coastal Plain, coas ...
. Sims is widely considered to be the father of modern gynaecology. While there have been isolated precedents for some of his innovations, he was the first to have published on the
Sims' position The Sims position, or left lateral Sims position, named after the gynaecologist J. Marion Sims, is usually used for rectal examination, treatments, enemas, and examining women for vaginal wall prolapse. The Sims Position is described as in t ...
, the Sims' speculum, the Sims sigmoid catheter, and on gynecological surgery, first on repair of
vesico-vaginal fistulas Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF). Presentation Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the bladder ('' vesica'') and the vagina that allows the continuous involu ...
, a socially devastating consequence of protracted childbirth, at the time without treatment of any sort. He founded the first women's hospital in the country, first in his backyard in Montgomery, limited to Black enslaved women, then the Woman's Hospital of New York. He was elected president of the
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's sta ...
, and was the first American physician of whom a statue was erected.. Sims developed his new specialty using the bodies of enslaved women, who could not refuse the extended glance of any white male that cared to observe any part of their anatomy. They could not "consent" in the sense modern medical research requires. No one did. Sims did not use
anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
, for which he would be severely criticized 160 years later. At the time anesthesia was itself a research area, and the first experiments (in dentistry) were being published. Using early anesthesia (in 1845, say) was much more dangerous and difficult than it would be a century later. In addition, it was widely believed that Blacks did not feel pain as much as whites, and white women proved unable to endure the pain. At the time, Sims was seen as a hero. Even his enemies, Bozeman chief among them, did not attack him for either experimenting on the enslaved, or for not using anesthesia. Abolitionists such as
William Lloyd Garrison William Lloyd Garrison (December , 1805 – May 24, 1879) was a prominent American Christian, abolitionist, journalist, suffragist, and social reformer. He is best known for his widely read antislavery newspaper '' The Liberator'', which he fo ...
were quick to put in print any mistreatment of the enslaved; Garrison's influential '' The Liberator'' has been completely indexed, but it never mentions Sims. Nor does the digitized portion of the Black press mention him. When he left Alabama in 1853, a local newspaper called him "an honor to our state". In the late 20th century, Sims has come to be villainized. Now criticized for his practices, Sims developed some of his techniques by operating on slaves, many of whom were not given anaesthesia. Sims performed surgeries on 12 enslaved women in his homemade backyard hospital for four years. While performing these surgeries he invited men physicians and students to watch invasive and painful procedures while the women were exposed. On one of the women, named Anarcha, he performed 30 surgeries without anesthesia. Due to having so many enslaved women, he would rotate from one to another, continuously trying to perfect the repair of their fistulas. Physicians and students lost interest in assisting Sims over the course of his backyard practice, and he recruited other enslaved women, who were healing from their own surgeries, to assist him. In 1855, Sims went on to found the Woman's Hospital in New York, 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
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
, however, law and many
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among m ...
plans allow gynaecologists to provide primary care 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, 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 cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
, 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 The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...
. 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 Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
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: *
Cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
and pre-cancerous diseases of the reproductive organs including ovaries,
fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In o ...
s, uterus, cervix, vagina, and vulva *
Incontinence Incontinence or Incontinent may refer to: *Fecal incontinence, the involuntary excretion of bowel contents * Urinary incontinence, the involuntary excretion of urine * Lack of moderation or self-control, especially related to sexual desire - see ...
of urine * Amenorrhoea (absent
menstrual periods The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs a ...
) * Dysmenorrhoea (painful menstrual periods) *
Infertility Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal st ...
* Menorrhagia (heavy menstrual periods); a common indication for
hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...
* Prolapse of pelvic organs *
Infections An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
of the vagina (
vaginitis Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy. The three ma ...
), cervix and uterus (including fungal,
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...
l, viral, and
protozoa Protozoa (singular: protozoan or protozoon; alternative plural: protozoans) are a group of single-celled eukaryotes, either free-living or parasitic, that feed on organic matter such as other microorganisms or organic tissues and debris. Histo ...
l) *
Pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be ...
* Urinary tract infections *
Polycystic ovary syndrome Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women of reproductive age. The syndrome is named after the characteristic cysts which may form on the ovaries, though it is important to note that this is a sign and no ...
*
Premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms that cause significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptom ...
* Post-menopausal osteoporosis *Other vaginal diseases There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a
urologist Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...
.


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
antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and preventio ...
, diuretics, antihypertensives, and antiemetics. Additionally, gynaecologists make frequent use of specialized
hormone A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required ...
-modulating therapies (such as Clomifene citrate and hormonal contraception) to treat disorders of the female genital tract that are responsive to pituitary or
gonad A gonad, sex gland, or reproductive gland is a mixed gland that produces the gametes and sex hormones of an organism. Female reproductive cells are egg cells, and male reproductive cells are sperm. The male gonad, the testicle, produces sp ...
al signals.
Surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
, 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 The American College of Surgeons is an educational association of surgeons created in 1913.American College of Surgeons Online "What is the American College of Surgeons?"/ref> See also *American College of Physicians The American College o ...
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: #
Dilation and curettage Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping ( curettage). It is a gynecologi ...
(removal of the uterine contents for various reasons, including completing a partial miscarriage and diagnostic sampling for dysfunctional uterine bleeding refractive to medical therapy) #
Hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...
(removal of the uterus) # Oophorectomy (removal of the ovaries) # Tubal ligation (a type of permanent sterilization) # Hysteroscopy (inspection of the uterine cavity) # Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain. Laparoscopy is the only way to accurately diagnose pelvic/abdominal
endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, fa ...
. # Exploratory
laparotomy A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. Origins and history The first successful laparotomy was performed without ane ...
 – may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs. # Various surgical treatments for urinary incontinence, including cystoscopy and sub-
urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra ...
l slings. # Surgical treatment of pelvic organ prolapse, including correction of
cystocele A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complicat ...
and rectocele. # Appendectomy – often performed to remove site of painful
endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, fa ...
implantation or prophylactically (against future acute
appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...
) at the time of
hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...
or
Caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or m ...
. May also be performed as part of a staging operation for
ovarian cancer Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...
. # 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

In the UK the
Royal College of Obstetricians and Gynaecologists The Royal College of Obstetricians and Gynaecologists (RCOG) is a professional association based in London, United Kingdom. Its members, including people with and without medical degrees, work in the field of obstetrics and gynaecology, that ...
, 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
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
. Urogynaecology is a subspecialty of gynaecology and urology dealing with urinary or fecal incontinence and pelvic organ prolapse.


Gender of physicians

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. In some gynaecological sub-specialties, where an over-representation of males persists, income discrepancies appear to show male practitioners earning higher averages. 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. 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. This, when coupled with more women choosing female physicians has decreased the employment opportunities for men choosing to become gynaecologists. In the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
, it has been reported that 4 in 5 students choosing a residency in gynaecology are now female. In several places in
Sweden Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic countries, Nordic c ...
, 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
Turkey Turkey ( tr, Türkiye ), officially the Republic of Türkiye ( tr, Türkiye Cumhuriyeti, links=no ), is a transcontinental country located mainly on the Anatolian Peninsula in Western Asia, with a small portion on the Balkan Peninsula ...
, 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 the 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 Columbia is a census-designated place in Howard County, Maryland. It is one of the principal communities of the Baltimore–Washington metropolitan area. It is a planned community consisting of 10 self-contained villages. Columbia began wit ...
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".


See also

* Obstetrics and gynaecology * Howard Atwood Kelly *
Childbirth and obstetrics in antiquity Childbirth and obstetrics in Classical Antiquity (here meaning the ancient Greco-Roman world) were studied by the physicians of ancient Greece and Rome. Their ideas and practices during this time endured in Western medicine for centuries and many ...
*
Genital schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody st ...
*
Hydatidiform mole A molar pregnancy also known as a hydatidiform mole, is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus. A molar pregnancy is a type of gestational trophoblastic disease that used to be known as a ''hy ...
*
Gynography Gynography (Spanish: ''ginógrafo''ginógrafo
wordmagicsoft.com
) is defined as "
List of bacterial vaginosis microbiota * Pediatric gynaecology


References


Sources


The Female Reproductive System
Britannica


External links


Ingenious
archive of historical images related to obstetrics, gynaecology, and contraception.
U.S. Federal Government Website for Women's Health Information

Gynaecology Clinic
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