Gynaecology
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224366389
2008-07-08T15:16:07Z
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{{unreferenced|date=January 2007}}
[[Image:Gynaecology-1822.jpg|thumb|250px|The shamefulness associated with the examination of female [[genitalia]] has long inhibited the science of gynaecology. This 1822 drawing by [[Jacques-Pierre Maygnier]] shows a "compromise" procedure, in which the [[physician]] is kneeling before the woman but cannot see her genitalia. Modern gynaecology has shed these inhibitions.]]
'''Gynaecology''' or '''gynecology''' (see [[American and British English spelling differences|spelling differences]]) refers to the surgical specialty dealing with health of the female [[sex organ|reproductive system]] ([[uterus]], [[vagina]] and [[ovaries]]). Literally, outside medicine, it means "the science of women". Almost all modern gynaecologists are also [[obstetrics|obstetricians]]; see ''[[Obstetrics and gynaecology]]''.
==History==
According to the [[Suda]], the ancient Greek physician [[Soranus (Greek Physician)|Soranus]] practiced in Alexandria and subsequently Rome. He was the chief representative of the school of physicians known as "Methodists." His treatise ''Gynaikeia'' is extant (first published in 1838, later by V. Rose as ''Gynaecology'', in 1882, with a 6th-century Latin translation by Moschio, a physician of the same school).
In the United States, [[J. Marion Sims]] is considered the father of American gynaecology. Practitioners included Dr. [[Benjamin B. Weinstein]] ([[1913]]-[[1974]]) of [[Tulane University]] in [[New Orleans]], who specialized in [[fertility]] studies.
==Examination==
Gynaecology is typically considered a consultant specialty. 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 technique, or equipment unavailable to the GP, the patient is then referred to a gynaecologist. In the [[United States]], however, law and many [[health insurance]] plans allow/force 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 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 (medical)|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 exam for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists often have a female [[chaperone (clinical)|chaperone]] ([[nurse]] or medical student) for their examination. An abdominal and/or vaginal [[obstetric ultrasonography|ultrasound]] can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.
==Diseases==
The main conditions dealt with by a gynaecologist are:
# [[Cancer]] and pre-cancerous diseases of the reproductive organs including ovaries, [[fallopian tube]]s, uterus, vagina, and vulva
# [[Urinary incontinence|Incontinence]] of urine.
# [[Amenorrhea]] (absent [[Menstrual cycle|menstrual periods]])
# [[dysmenorrhea|Dysmenorrhoea]] (painful menstrual periods)
# [[Infertility]]
# [[Menorrhagia]] (heavy menstrual periods). This is a common indication for [[hysterectomy]].
# [[Prolapse]] of pelvic organs
# [[Scabies]]
There is some crossover in these areas. For example a woman with incontinence may be referred to a [[urology|urologist]].
==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]], [[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]] and/or [[gonad]]al 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 [http://www.facs.org American] and [[Royal College of Surgeons|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]] (removal of the uterine contents for various reasons, including partial miscarriage and dysfunctional uterine bleeding refractive to medical therapy)
# [[Hysterectomy]] (removal of the uterus)
# [[Oophorectomy]] (removal of the ovaries)
# [[Tubal ligation]]
# [[Hysteroscopy]]
# Diagnostic [[laparoscopy]] - used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide definitive diagnosis of [[endometriosis]].
# 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.
# Various surgical treatments for [[urinary incontinence]], including [[cystoscopy]] and sub-[[urethra]]l slings.
# Surgical treatment of pelvic organ [[prolapse]], including correction of [[cystocele]] and [[rectocele]].
# [[Appendectomy]] - often performed to remove site of painful [[endometriosis]] implantation and/or prophylactically (against future acute [[appendicitis]]) at the time of [[hysterectomy]] or [[Cesarean section]]. May also be performed as part of a [[Cancer staging|staging]] operation for [[ovarian cancer]].
# [[Cervix|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]].
==See also==
*[[Andrology]], the study of the male reproductive system.
*[[Cervical cancer]]
*[[Dalkon Shield]]
*[[HPV vaccine]]
*[[Hydatiform mole]]
*[[Infant]]
*[[Obstetrics]]
*[[Pediatrics]]
*[[Pelvic inflammatory disease]] (PID)
*[[Reproduction medicine]]
*[[Sexually transmitted disease]]
*[[Vulvovaginal health]]
==External links==
*[http://www.ingenious.org.uk/See/Medicineandhealth/Obstetricsgynaecologyandcontraception/ Ingenious]: archive of historical images related to obstetrics, gynaecology, and contraception.
*[http://www.obgynhealth.net/ Articles and News on Obstetrics and Gynecology]
*[http://www.womenshealth.gov U.S Federal Government Website for Women´s Health Information].
{{Medicine}}
{{sex}}
[[Category:Gynecology| ]]
[[Category:Subjects taught in medical school]]
[[ar:طب النساء والتوليد]]
[[bn:স্ত্রীরোগবিদ্যা]]
[[bg:Гинекология]]
[[ca:Ginecologia]]
[[cs:Gynekologie]]
[[da:Gynækologi]]
[[de:Gynäkologie]]
[[et:Günekoloogia]]
[[es:Ginecología]]
[[eo:Ginekologio]]
[[eu:Ginekologia]]
[[fr:Gynécologie]]
[[ga:Liacht bhan]]
[[hr:Ginekologija]]
[[io:Ginekologio]]
[[id:Ginekologi]]
[[ia:Gynecologia]]
[[it:Ginecologia]]
[[he:גינקולוגיה]]
[[la:Gynaecologia et Obstetricia]]
[[lt:Ginekologija]]
[[hu:Nőgyógyászat]]
[[nl:Gynaecologie]]
[[ne:महिलारोग शास्त्र]]
[[ja:婦人科学]]
[[no:Gynekologi]]
[[pl:Ginekologia]]
[[pt:Ginecologia]]
[[qu:Warmi unquy hampikamayuq]]
[[ru:Гинекология]]
[[sq:Gjinekologjia]]
[[sk:Gynekológia]]
[[sl:Ginekologija]]
[[sh:Ginekologija]]
[[fi:Gynekologia]]
[[sv:Gynekologi]]
[[th:นรีเวชวิทยา]]
[[tr:Jinekoloji]]
[[uk:Гінекологія]]
[[zh:婦科學]]