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Gynecology

Ecto Derma Polyclinic - Dental - Medical - Laser  Educational and Research Center

1085. Budapest, József krt.37.  Hungary  Tel.: +36 1 3178175 ; +36 1 2350024
Fax.: +36 1 2350025  Email:  titkarsag@ectoderma.hu recepcios@ectoderma.hu

postheadericon Gynecology

image003The historic taboo associated with the examination of female genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygnier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology has shed these inhibitions.

Almost all modern gynaecologists are also obstetricians. In many areas, the specialties of gynaecology and obstetrics overlap. Gynaecology has been considered to end at 28 weeks gestation, but practically there is no clear cut-off. Since 1st October 1992, this cut-off may be considered to occur at 24 weeks gestation in the United States, since the law and definition of abortion changed to bring it closer to the gestation at which a foetus becomes viable.

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Examination

Gynaecology is typically considered a consultant specialty

As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is quite intimate, more so than a routine physical exam. It also requires unique instrumentation such as the speculum. The speculum consists of two hinged blades of concave metal or plastic which are used to retract the tissues of the vagina and permit examination of the cervix, the lower part of the uterus located within the upper portion of the vagina. Gynaecologists typically do a bimanual examination (one hand on the abdomen and one or two fingers in the vagina) to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do a rectovaginal examination for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists may have a female chaperone for their examination. An abdominal and/or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.

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Diseases

The main conditions dealt with by a gynaecologist are:

  • Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, cervix, vagina, and vulva
  • Incontinence of urine.
  • Amenorrhoea (absent menstrual periods)
  • Dysmenorrhoea (painful menstrual periods)
  • Infertility
  • Menorrhagia (heavy menstrual periods). This is a common indication for hysterectomy.
  • Prolapse of pelvic organs
  • Infections of the vagina, cervix and uterus (including fungal, bacterial, viral, and protozoal)

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

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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 and/or gonadal signals.

Surgery, however, is the mainstay of gynaecological therapy.

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Some of the more common operations that gynaecologists perform include:

  • 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)
  • Hysterectomy (removal of the uterus)
  • Oophorectomy (removal of the ovaries)
  • Tubal ligation
  • Hysteroscopy
  • Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide definitive diagnosis of endometriosis.
  • 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.
  • Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
  • Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
  • Appendectomy – often performed to remove site of painful endometriosis implantation and/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.
  • Cervical Excision Procedures (including lasersurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on.
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