Gynecology

I

Introduction

Gynecology, study of women’s diseases, with special emphasis on the female reproductive organs. Areas of special concentration for gynecologists include disorders of the uterus, or womb, the organ where an unborn fetus develops; ovaries, the organs that produce ova, or eggs, which are the female sex cells; fallopian tubes, the channels connecting the uterus and ovaries; cervix, the organ that connects the vagina and uterus; vagina, the canal between the cervix and vulva, or external female organs; and breasts. For a more detailed discussion of the female reproductive organs, see Reproductive System or Human Sexuality.

Gynecologists are physicians who have completed advanced training in female reproductive disorders, typically a four-year program that encompasses the field of obstetrics (the medical specialty concerned with pregnancy and childbirth) as well as gynecology. Gynecologists perform routine checkups that include such tests as Pap smears and breast exams to help detect disorders of the female reproductive system. They perform a variety of surgical procedures on the female reproductive system. In addition, gynecologists often serve as the primary care physician for many of their patients. If they are licensed in obstetrics, they may also deliver babies.

II

The Gynecological Exam

The gynecological exam is designed as a preventive measure to screen for cervical cancer and breast cancer, as well as to detect abnormalities such as cysts in the ovaries. The exam also ensures that a woman who is sexually active uses appropriate contraception (birth control) if she does not wish to become pregnant, or it permits her to discuss family planning and fertility (see Infertility) issues if she does want to have a child. The gynecologist also provides measures to prevent transmission or contraction of sexually transmitted infections.

A typical gynecological exam begins with a medical history—an interview conducted by the gynecologist or another healthcare professional to learn the patient’s medical background. The patient then undergoes routine exams, which include checking her weight and blood pressure as well as taking a urine sample to check for bladder infections, kidney disease, and pregnancy, if the patient is of childbearing age. The doctor then performs an external exam that usually includes a breast exam and may include general assessment of the heart, lungs, thyroid gland, and any other areas that the woman’s medical history indicated may need special attention. Following the external exam, the doctor performs a Pap smear, removing cell samples from the cervix and vaginal secretions. These specimens are sent to a laboratory to be studied under a microscope for signs of unusual growth that may be an indication of cancer. In addition to the Pap smear, the doctor palpates the uterus and ovaries by putting two fingers in the vagina or one finger in the vagina and one in the rectum and then placing the other hand on the patient’s lower abdomen and pressing the uterus and ovaries between two hands. This hands-on exam enables the physician to feel abnormal changes in the size or position of these organs. Such changes may indicate a problem.

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If a woman is planning a pregnancy—or is at risk for one—the doctor may recommend testing for immunity to such infections as German measles, which can result in birth defects if contracted during pregnancy. If the patient’s family history includes hereditary disorders, such as Tay-Sachs disease (a brain disorder), the physician might also suggest screening for inherited diseases.

Often the doctor will have an assistant in the room during the exam. In part, the assistant helps with supplies needed for the exam; but in large measure the assistant’s presence protects the patient, the doctor, and the clinic from any question of impropriety during the exam. Some states have laws requiring that a chaperone be present during pelvic exams. Any woman who feels uncomfortable with the exam or the setting should request that a chaperone, friend, or family member be present.

Many gynecologists recommend that a woman begin having regular gynecological exams by her mid- to late-teens, preferably before she becomes sexually active. In addition, a girl should be examined at the time of puberty (the onset of sexual maturity) if problems occur that suggest a gynecological disorder, such as failure to develop breast tissue or pubic hair by her early teens, lack of normal menstrual cycles (see Menstruation), or menstrual periods marked by heavy bleeding, severe cramping, or other pelvic pain. Women should have yearly gynecological exams after becoming sexually active.

III

Conditions and Diseases

Gynecologists commonly treat a wide variety of disorders of the female reproductive system, including cancers, noncancerous conditions such as endometriosis, and infectious diseases, including sexually transmitted infections.

A

Gynecological Cancers

Gynecologists frequently detect cancers of the breast, skin, cervix, ovaries, and uterus, either during the physical exam or from results of tests such as Pap smears and pelvic ultrasounds. Each type of cancer is then evaluated to determine if a tumor has spread to other areas or remains confined to a specific location. Gynecologists may refer women with suspicious skin lesions or breast lumps to surgeons. Alternatively, they may perform diagnostic procedures such as biopsies (removing tissue samples to study under a microscope) and, if a problem is identified, refer to cancer specialists for follow-up treatment such as specialized cancer surgery, chemotherapy, or radiation therapy.

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