Gynaecology
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Gynaecology (British) or gynecology (North American) literally means 'the science of women', but in medicine this is the specialty of diseases of the female reproductive system (uterus, vagina and ovaries). Almost all modern gynaecologists are also obstetricians; see Obstetrics and gynaecology.
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Examination
Gynaecology is a typically a consultant specialty. In most countries, women must see a general practitioner first. If their condition requires knowledge or equipment unavailable to the GP, they are referred to a gynaecologist. However, in the United States, law and many health insurance plans allow gynaecologists to provide primary care, and some women select that option.
As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is special in that it is quite intimate, and that it involves special equipment -- the speculum. The speculum consists of two hinged blades of flat metal, which are used to open the vagina, to permit examination of the cervix uteri. Gynaecologists may also do a bimanual examination (one hand on the abdomen, two fingers in the vagina), to palpate the uterus and ovaries. They may occasionally do a rectal exam. Male gynaecologists often have a female chaperone (nurse or medical student) for their examination. Virgins are not usually examined vaginally. An abdominal ultrasound is used normally to confirm the bimanual examination.
Investigations
Some of the investigations used in gynaecology are:
- abdominal ultrasound, to give a low-power view of the pelvic organs.
- vaginal ultrasound. A probe is passed into the vagina, which allows a detailed view of the uterus and its contents.
- blood tests. Levels of hormones such as estradiol, luteinizing hormone, follicle stimulating hormone and progesterone are measured, as well as prolactin.
- hysteroscopy -- a fine tube is passed into the uterus via the cervix under a general anaesthetic.
- laparoscopy -- tubes are passed into the peritoneal cavity, which is then insufflated with carbon dioxide. This is commonly used to diagnose endometriosis.
MRI and CT scans are rarely used, apart from tumor staging in gynecological cancer. Pelvic X-ray is rare. It can be used to delineate the uterine cavity with an injected dye (hysterosalpingogram) and to measure the pelvic girdle.
Diseases
The main conditions dealt with by a gynaecologist are:
- cancer of the cervix. The Papanicolaou (Pap) smear is a means of detecting this, by obtaining a sample of cervical epithelial cells and examining them under a microscope for malignant changes. All women are encouraged to have pap smears at regular intervals after commencing intercourse.
- incontinence of urine.
- amenorrhoea (absent periods)
- dysmenorrhoea (painful periods)
- infertility
- menorrhagia (heavy periods). This is a main indication for hysterectomy.
- prolapse
Obviously there is some crossover in these areas. Amenorrhoea in a young girl may be referred to a paediatrician, incontinence to a urologist.
Therapies
Occasionally gynaecologists will use drugs, such as clomiphene (which stimulates ovulation), and, most famously, oral contraceptives (which are also used for dysmenorrhoea).
However, surgery is the main area of therapy. For historical reasons, gynaecologists are not actually surgeons (this is the source of some tension).
Operations that gynaecologists do include:
- termination of pregnancy
- hysterectomy (removal of the uterus);
- colposuspension ('tightening' of the ligaments around the vagina, a common therapy for incontinence and discomfort in older women);
- Large Loop Excision of the Transition Zone (LLETZ), where the surface of the cervix, containing pre-cancerous cells identified on Pap smear are removed).