Chapter I - Gynecology

Gynecology

Gynecology (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). Gynecology is 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 gynecologist. However, in the United States, law and many health insurance plans allow gynecologists to provide primary care, and some women select that option.

Some of the investigations used in gynecology 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 anesthetic.
• 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 gynecologist 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.
• Amenorrhea (absent periods)
• Dysmenorrhea (painful periods)
• Infertility
• Menorrhagia (heavy periods). This is a main indication for hysterectomy.
• Prolapse

Therapies

Occasionally gynecologists will use drugs, such as clomiphene (which stimulates ovulation), and, most famously, oral contraceptives (which are also used for dysmenorrhea). Surgery, however, is the mainstay of gynecological therapy. For historical reasons, gynecologists are not usually considered "surgeons" - this has always been the source of some controversy - though modern advancements in both fields have blurred many of the once rigid lines of distinction.

Some of the more common operations that gynecologists perform include:

• Termination of pregnancy
• Dilation and curettage (removal of the uterine contents, for various reasons, including miscarriage and menorrhagia; procedurally very similar to the above);
• Hysterectomy (removal of the uterus);
• Oophorectomy (removal of the ovaries);
• Tubal ligation;
• Exploratory laparoscopy or laparotomy (used to diagnose and treat sources of pelvic and abdominal pain, dysmenorrhea, vaginal bleeding, etc.)
• 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).