Diseases

Examples of conditions dealt with by a gynaecologist are:

• Cancerand pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, cervix, vagina, and vulva
• Incontinenceof urine
• Amenorrhoea(absent menstrual periods)
• Dysmenorrhoea(painful menstrual periods)
• Infertility
• Menorrhagia (heavy menstrual periods); a common indication for hysterectomy
• Prolapseof pelvic organs
• Infectionsof the vagina (vaginitis), cervix and uterus (including fungal, bacterial, viral, and protozoal)
• Pelvic inflammatory disease
• Urinary tract infections
• Polycystic ovary syndrome
• Premenstrual dysphoric disorder
• Post-menopausal osteoporosis
• Other vaginal diseases

There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a 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 or gonadal signals.

For lists of gynaecological drugs (by the ATC classification system), see ATC code G01 and ATC code G02.

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 American College of Surgeons and 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:

1. Dilation and curettage(removal of the uterine contents for various reasons, including completing a partial miscarriage and diagnostic sampling for dysfunctional uterine bleeding refractive to medical therapy)
2. Hysterectomy(removal of the uterus)
3. Oophorectomy(removal of the ovaries)
4. Tubal ligation(a type of permanent sterilization)
5. Hysteroscopy(inspection of the uterine cavity)
6. Diagnostic laparoscopy– used to diagnose and treat sources of pelvic and abdominal pain. Laparoscopy is the only way to accurately diagnose pelvic/abdominal endometriosis.^[20]
7. 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.
8. Various surgical treatments for urinary incontinence, including cystoscopyand sub-urethral
9. Surgical treatment of pelvic organ prolapse, including correction of cystoceleand rectocele.
10. Appendectomy– often performed to remove site of painful endometriosis implantation or prophylactically (against future acute appendicitis) at the time of hysterectomy or Caesarean section. May also be performed as part of a staging operation for ovarian cancer.
11. Cervical Excision Procedures (including cryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.

In the UK the Royal College of Obstetricians and Gynaecologists, based in London, encourages the study and advancement of both the science and practice of obstetrics and gynaecology. This is done through postgraduate medical education and training development, and the publication of clinical guidelines and reports on aspects of the specialty and service provision. The RCOG International Office works with other international organisations to help lower maternal morbidity and mortality in under-resourced countries.

Gynaecologic oncology is a subspecialty of gynaecology, dealing with gynaecology-related cancer.

Urogynaecology is a subspecialty of gynaecology and urology dealing with urinary or fecal incontinence and pelvic organ prolapse.