Gynaecology (or gynecology in American English) is the area of medicine concerned with conditions affecting the female reproductive system. It is sometimes combined with the field of obstetrics, which focuses on pregnancy and childbirth, thereby forming the combined area of obstetrics and gynaecology (OB-GYN).
Gynaecology encompasses preventative care, sexual health and diagnosing and treating health issues arising from the female reproduction system, such as the uterus, vagina, cervix, fallopian tubes, ovaries, and breasts; subspecialties include family planning; minimally invasive surgery; paediatric and adolescent gynaecology; and pelvic medicine and reconstructive surgery.
Gynaecological care is discussed in the Kahun Gynaecological Papyrus and the Hippocratic Corpus, showing the ancient origins of the subject. J. Marion Sims contributed to the advancement of the specialism developing instruments such as the Sims speculum, Pantaleoni completed the first hysteroscopy in 1869 and Papanikolaou first wrote about the pap smear in 1928.
Transgender, intersex and nonbinary individuals can require gynaecological care. Health disparities exist within gynaecology, which can impact women in low and middle income countries, minority groups in some countries and the LGBTQ+ community.
Etymology The word gynaecology comes from the oblique stem () of the Greek word () meaning , and meaning . Literally translated, it means . Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.
History Antiquity The Kahun Gynaecological Papyrus, dated to about 1800 BC, deals with gynaecological diseases, fertility, pregnancy and contraception. The text is divided into thirty-four parts, each dealing with a specific problem and containing diagnosis and treatment; no prognosis is suggested. Treatments are non-surgical, consisting of applying medicines to the affected body part or delivering medicines orally. During this time, the womb was sometimes seen as the source of problems manifesting in other body parts.
Ayurveda, an Indian traditional medical system, also provides details about concepts and techniques related to gynaecology, addressing fertility, childbirth complications, and menstrual disorders amongst other things.
The Hippocratic Corpus contains several gynaecological treatises dating to the 5th and 4th centuries BC. Aristotle is another source for medical texts from the 4th century BC. The gynaecological treatise Gynaikeia by Soranus of Ephesus (1st/2nd century AD) is extant (together with a 6th-century Latin paraphrase by Muscio, a physician of the same school). He was the chief representative of the school of physicians known as the "methodists".
Middle ages and renaissance period During the Middle Ages, midwives dominated women's health concerns through experienced-based knowledge, traditional remedies, and herbal medicines. Midwifery was often regarded as unscientific and was challenged with the rise of gynaecology as an official medical field. The Renaissance period, 16th century, brought about a resurgence of classical scientific advancements, including the rise of medical advancements in the field of gynaecology and obstetrics. Figures like Ambroise Pare were imperative in improving obstetrics techniques during this period. Peter Chamberlen developed the forceps, an important surgical tool that transformed childbirth and lessened maternal mortality.
18th, 19th and 20th centuries
As medical institutions continued to expand in the 18th-19th centuries, the authority of midwives was challenged by men who dominated medical professions. The formalization of midwifery training by male doctors and advancements in medical knowledge of women's health and anatomy occurred during this period. Figures such as William Smellie, William Hunter, Paul Zweifel, Franz Karl Naegele, and Carl Crede contributed to the understanding of childbirth and women's health in Europe.
In the early 18th and 19th centuries, in the United States, the field of gyneacology, as with most medical specialities, had ties to black women and therefore slavery. Brothers Henry and Robert Campbell were editors of the first medical journal in the deep south. Henry worked as gynaecologist including on enslaved women, whilst publishing medical case narratives of operations in the journal the brothers edited. Others, such as Dr. Mary Putnam Jacobi, challenged the exclusion of women from medical education and shifted gynaecology to a scientific practice.Morantz-Sanchez, R. (1985). Sympathy and Science: Women Physicians in American Medicine. Oxford University Press.
J. Marion Sims is regarded as the father of modern gynaecology. Some of his published medical contributions included the development of the Sims' position (1845), the Sims' speculum (1845), the Sims' sigmoid catheter, and gynaecological surgery. He was the first to develop surgical techniques for the repair of vesico-vaginal fistulas (1849), a consequence of protracted childbirth which at the time was without treatment. He founded the first women's hospital in the country in Alabama 1855 and subsequently the Woman's Hospital of New York in 1857. He was elected president of the American Medical Association in 1876. Sims conducted experimental operations on black enslaved women, without anaesthesia. Historically, white women were also subjected to experimental medical procedures.
In terms of common procedures within gynaecology, the first hysteroscopy was completed in 1869 by Pantaleoni, to treat an endometrial polyp, using a cystoscope.
Obstetrics and gynaecology were recognized as specialties in the mid-19th century, in the United Kingdom. Specialist societies came into being but it became clear that to become disciplines in their own right, a separate college was required. William Fletcher Shaw (Professor of Midwifery at Manchester University) and William Blair-Bell (Professor of Obstetrics at Liverpool University) worked to establish The British College of Obstetricians and Gynaecologists in 1929, this later became the Royal College of Obstetricians and Gynaecologists.
Georgios Papanikaou, from Greece, is credited with discovering the pap smear test, he identified differences in the cytology of normal and malignant cervical cells by viewing swabs smeared on microscopic slides. His first publication of the finding in 1928 was not widely received. He later collaborated with Dr Herbert Traut at an American hospital and they published a book, Diagnosis of Uterine Cancer by the Vaginal Smear and this medical advancement became more widely known about.
By the 20th century, the American College of Obstetricians and Gynecologists (1951) was founded. There were advances in antiseptic techniques, anaesthesia, and diagnostic tools, which transformed gynaecological care.Briggs, L. (2002). Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. University of California Press.
Minority groups in the United States experienced forced sterilizations and eugenic policies. Between 1909 and 1979, an estimated 20,000 forced sterilizations occurred in California, primarily in mental institutions and prisons. Healthcare later became more focused on the importance of informed consent.
In Canada during the 1940's, practitioners focused on obstetrics and gynaecology began identifying the need for a separate organization to deal with this specialism and the idea to form the Society of Obstetricians and Gynaecologists of Canada (SOGC) was conceived. The Royal College of Physicians and Surgeons formally recognized obstetrics & gynaecology in 1957.
Ian Donald, a gynaecologist from the United Kingdom was an early pioneer of the use of sonography within gyneacology and obstetrics. He gained knowledge of radar technology in the air force and working with an engineer called Tom Brown and an engineering company, they developed a compact 2D ultrasound machine. In 1958, he published a paper in the Lancet.
Newer techniques for hysterectomies have evolved over time, with the first laparoscopic hysterectomy completed by Harry Reich in Pennsylvania, in January 1988.
Birth control trials
Margaret Sanger worked to make contraception legal and available. In 1951 she met Gregory Pincus and in a project that was financially sponsored by Katharine McCormick, they developed the contraceptive pill. In 1954, due to anti-birth control laws, the first trials in Massachusetts were positioned as being fertility trials. Gregory Pincus and John Rock conducted these trials. Oral progesterone was tested on fertility patients, with consent, however the oral contraceptive was also tested on 28 psychiatric patients at Worcester State Hospital, without the patients consent. They discovered that women stopped ovulating and that this occurred only whilst taking this. To get FDA approval, a larger clinical trial was needed.
Larger clinical trials took place in Puerto Rico, a territory of the United States. Puerto Rico had no anti-birth control laws and already had services offering birth control. Trials began in Rio Piedras in 1956, and women were offered the pill, called Envoid in 1960, on the basis it prevented pregnancy, without knowing it did not have FDA approval. Three women died in the trial and criticisms include that side effects were not taken seriously. Dr. Edris Rice-Wray, a professor at the Puerto Rico Medical School raised concerns about the negative side effects of the pill.
Diagnosis In some countries or within some healthcare systems, women must first see a general practitioner or family practitioner before seeing a gynaecologist. If the condition cannot be diagnosed or treated and requires a specialist the patient is referred to a gynaecologist. In other countries, patients can see a gynaecologist without a referral.
Gynecologists give reproductive and sexual health services that include pelvic exams, Pap tests, cancer screenings, treatment for hormone imbalance, and testing and treatment for vaginal infections. They diagnose and treat reproductive system disorders such as endometriosis, infertility, ovarian cysts, and pelvic pain. They may also care for people with ovarian, cervical, and other reproductive cancers.
As with 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 can also require instruments such as the speculum which is used to retract the tissues of the vagina to allow examination of the cervix, the lower part of the uterus located within the upper portion of the vagina. Gynaecologists may do a bimanual examination (one hand on the abdomen and one or two fingers in the vagina) to palpate the cervix, uterus, ovaries and pelvis.
An abdominal or vaginal ultrasound can be used for diagnostic purposes. This can help to detect growths, such as polyps, endometrial hyperplasia, carcinoma, endometriosis, pelvic inflammatory disease, polycystic ovary syndrome and many other gynaecology conditions. This is a very common diagnostic technique.
Hormone tests can be useful when investigating gynaecology based conditions or symptoms. These may check the hormone levels of oestradiol, progesterone, follicle stimulating hormone and luteinizing hormones, for example. Levels considered not normal, could indicate the presence of conditions and could impact reproductive function.
Conditions and diseases
Examples of conditions dealt with by a gynaecologist are: Cancer and pre-cancerous diseases of the reproductive organs including ovaries, uterus, cervix, vagina, and vulva Incontinence of urine Amenorrhoea (absence of menstrual periods) Abnormal uterine growths such as fibroids and polyps Endometriosis Dysmenorrhoea (painful menstrual periods) Infertility Menorrhagia (heavy menstrual periods); a common indication for hysterectomy when other treatments have failed