TheKahun Gynaecological Papyrus, dated to about 1800 BC, deals with gynecological diseases,fertility, pregnancy,contraception, etc. The text is divided into thirty-four sections, each section dealing with a specific problem and containingdiagnosis and treatment; noprognosis 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 at times seen as the source of complaints manifesting themselves in other body parts.[6]
Ayurveda, an Indian traditional medical system, also provides details about concepts and techniques related to gynaecology, addressing fertility, childbirth complications, and menstrual disorders among other things.[7][8] These writings provide a post and prenatal care, integrating lifestyle practices, meditations and yoga, and a dietary regime for overall well-being.
TheHippocratic 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 with his descriptions of biology primarily found inHistory of Animals, Parts of Animals, Generation of Animals.[9] Thegynaecological treatiseGynaikeia bySoranus of Ephesus (1st/2nd century AD) is extant (together with a 6th-centuryLatin paraphrase byMuscio, a physician of the same school). He was the chief representative of the school of physicians known as the"methodists."
During the Middle Ages, midwives dominated women's health concerns through experienced-based knowledge, traditional remedies, and herbal medicines. Midwifery was often regarded unscientific and was challenged with the rise of gynecology as an official medical field. The Renaissance period, 16th century, brought about a resurgence of classical scientific advancements, including the ride of medical advancements in the field of gynecology and obstetrics. Figures likeAmbroise 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.[10]
As medical institutions continued to expand in the 18th-19th centuries, the authority of midwives was further challenged by men involving themselves in women's health practices and research.[11] The formalization of midwifery training by male doctors and advancements in medical knowledge of women's health and anatomy was seen during this period. Figures such asWilliam Smellie,William Hunter,Paul Zweifel, Franz Karl Naegele, andCarl Crede contributed to understandings of childbirth and women's health in Europe.[10] In the early 18th and 19th century United States, the field of gynecology held close ties to slavery and the Black women's reproduction. Figures such as Henry Campbell and Robert Campbell worked as genealogical surgeons on enslaved women, publishing their work in accredited medical journals that while advanced gynecological knowledge, simultaneously laid the foundation for medical racism, medical ethics atrocities, and discrimination that fueled rationale for slavery.[11] Others, such as Dr.Mary Putnam Jacobi, challenged the exclusion of women from medical education and shifted gynaecology to a scientific practice.[12]
By the early 20th century, the American Gynecological Society was founded (1876), and later theAmerican College of Obstetricians and Gynecologists (1951). There was also advances in antiseptic techniques, anesthesia, and diagnostic tools, like the Pap smear, which transformed gynaecological care.[13] However, medical racism continued with forced sterilizations and eugenic policies that disproportionately targeted minorities. Now, healthcare focusing on informed consent, culturally competent care, and health equity.
J. Marion Sims is widely regarded as the father of modern gynecology.[14] Isolated precedents exist for some of his innovations; however, he was the first to have published medical contributions such as development of theSims' position (1845), theSims' speculum (1845), the Sims’ sigmoid catheter, and gynecological surgery. He was the first to develop surgical techniques for the repair ofvesico-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 theWoman's Hospital of New York in 1857. He was elected president of theAmerican Medical Association in 1876. Sims died in 1883 and was the first American physician of whom a statue was erected in 1894.[15]
Sims’ legacy is widely controversial as he developed this new specialty experimenting on Black enslaved women, as recounted in his autobiography.[16][17] In this era,anesthesia was unprecedented and a focus in research. Its use was novice and considered dangerous. Sims developed various of his techniques and instruments by operating on slaves, many of whom were not given anesthesia.[18][19] On one of the women, namedAnarcha, he performed 30 surgeries without anesthesia.[20] In addition, during the antebellum era, medical racism funded and founded science that supported the belief that Black people had higher pain tolerance, and white women proved unable to endure the pain.[17] The lack of voluntary, informed consent and experimentation on Black enslaved women’s bodies during the antebellum era went ethically unquestioned in the medical community, and contributed to medical racism that perpetuated beliefs on pain tolerance, race, and gender that persist today.[17]
Throughout his career, he was invited by European Royalty to treat their female relatives of gynecological problems. His medical knowledge had been produced globally without acknowledgement of the methods delaying these techniques.[17] When he left Alabama in 1853, a local newspaper called him "an honor to our state."[21] Currently, Sims’ experimentation on Black enslaved women is widely discoursed and criticized in theJournal of Medical Ethics and academic scholars.[22][23]
The birth control trails were initiated byGregory Pincus, an American biochemist that contributed to the development of the first oral contraceptive pill.[24] Clinical trials of these contraceptions took place inPuerto Rico, commonwealth of the United States, with the rationale of a necessary population control that closely followedeugenic ideology.[25][26][27] The place of the trials was also facilitated by Puerto Rico’s ambiguous political relationship to the United States.[28] Furthermore, Puerto Rican women were already practicing other forms of brith control, thus Pincus established these trials to expand accessible contraceptives and develop an oral pill.[29] Trials began inRio Piedras in 1956, and women were offered the pill, developed and named Envoid in 1960, on the basis that it prevented pregnancy without knowing the pills were unapproved by theFood and Drug Administration (FDA) in the United States.[30] Dr.Edris Rice-Wray, a professor at the Puerto Rico Medical School was aware and vocal of the negative side effects of the pill.[31]However, the side effects were dismissed without further testing on the safety of the contraceptive.[31]
Today, this event still affects many Puerto Rican women with reproductive health complications and permanent sterilization as a consequence of the trials.[32] Although these trials do not follow modern medical ethic practices, these trials spearheaded the development of the first oral contraceptive and currently propel the establishment of equity rubrics and further medical ethics research in the field of gynecology.[33] The women affected by these trials have been outspoken about their experiences with forced sterilization and birth control trials through a variety of medias, such as interviews, books, and documentaries likeLa Operación byAna Maria Garcia.
The historic taboo associated with the examination offemale genitalia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygrier shows a "compromise" procedure, in which thephysician is kneeling before the woman but cannot see her genitalia. Modern gynaecology no longer uses such a position.
In some countries, women must first see ageneral practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynaecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynaecologist. In other countries, laws may allow patients to see gynaecologists without a referral. Some gynaecologists provideprimary care in addition to aspects of their own specialty.[34] With this option available, some women opt to see a gynaecological surgeon for non-gynaecological problems without another physician's referral.
As in 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 also requires unique instrumentation such as thespeculum. 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 thecervix, the lower part of theuterus 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 bonypelvis. It is not uncommon to do arectovaginal examination for a complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists may have a femalechaperone for their examination. An abdominal or vaginalultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.
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 asantibiotics,diuretics,antihypertensives, andantiemetics. Additionally, gynaecologists make frequent use of specializedhormone-modulating therapies (such asClomifene citrate andhormonal contraception) to treat disorders of the female genital tract that are responsive topituitary orgonadal signals.
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 theAmerican College of Surgeons andRoyal 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:[38]
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)
Diagnosticlaparoscopy – used to diagnose and treat sources of pelvic and abdominal pain. Laparoscopy is the only way to accurately diagnose pelvic/abdominalendometriosis.[39]
Exploratorylaparotomy – may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs.
Cervical Excision Procedures (includingcryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified onPap smear.
Newer advancements in gynecology are using integration of AI in clinical practice, specifically with diagnostics and predictive analytics. AI algorithms are able to interpret complex gynecological imaging and pathology data, which improves diagnostic accuracy. These technologies are especially used in identifying cervical and ovarian cancers and predicting treatment outcomes.[40]
In terms of surgery, research has lead to minimally invasive approaches, such as vaginal natural orifice transluminal endoscopic surgery (vNOTES). This technique allows surgeons to access the pelvic cavity through the vaginal canal, reducing recovery times, postoperative pain, and complication rates in comparison to traditional methods.[41]
In the UK, theRoyal 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.[42]
In the United States, obstetrics and gynecology requires residency training for four years. This encompasses comprehensive clinical and surgical education.OBGYN residents participate in a yearly in-training exam that is administered by the Council on Resident Education in Obstetrics and Gynecology (CREOG). Research suggests that combining curriculum and focused mentorship can improve residents' performance on the exam and overall educational outcomes.[43]
Improved access to education and the professions in recent decades has seen women gynaecologists outnumber men in the once male-dominated medical field of gynaecology.[44] In some gynaecological sub-specialties, where an over-representation of males persists, income discrepancies appear to show male practitioners earning higher averages.[45]
Speculations on the decreased numbers of male gynaecologist practitioners report a perceived lack of respect from within the medical profession, limited future employment opportunities and questions to the motivations and character of men who choose the medical field concerned with female sexual organs.[46][47][48][49][50]
Surveys of women's views on the issue of male doctors conducting intimate examinations show a large and consistent majority found it uncomfortable, were more likely to be embarrassed and less likely to talk openly or in detail about personal information, or discuss their sexual history with a man. The findings raised questions about the ability of male gynaecologists to offer quality care to patients.[51] This, when coupled with more women choosing female physicians[52] has decreased the employment opportunities for men choosing to become gynaecologists.[53]
In theUnited States, it has been reported that four in five students choosing a residency in gynaecology are now female.[54] In several places inSweden, to comply with discrimination laws, patients may not choose a doctor—regardless of specialty—based on factors such as ethnicity or gender and declining to see a doctor solely because of preference regarding e.g. the practitioner's skin color or gender may legally be viewed as refusing care.[55][56] InTurkey, due to patient preference to be seen by another female, there are now few male gynaecologists working in the field.[57]
There have been a number of legal challenges in the US against healthcare providers who have started hiring based on the gender of physicians. Mircea Veleanu argued, in part, that his former employers discriminated against him by accommodating the wishes of female patients who had requested female doctors for intimate exams.[58] A male nurse complained about an advert for an all-female obstetrics and gynaecology practice inColumbia, Maryland, claiming this was a form of sexual discrimination.[59] In 2000, David Garfinkel, a New Jersey-based OB-GYN, sued his former employer[60] after being fired due to, as he claimed, "because I was male, I wasn't drawing as many patients as they'd expected".[58]
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