Surgery => Gynecology
Gynecology, study of women's diseases, with special emphasis on the female reproductive organs. Areas of special concentration for gynecologists include disorders of the uterus, or womb, the organ where an unborn fetus develops; ovaries, the organs that produce ova, or eggs, which are the female sex cells; Fallopian tubes, the channels connecting the uterus and ovaries; cervix, the organ that connects the vagina and uterus; vagina, the canal between the cervix and vulva, or external female organs; and breasts. For a more detailed discussion of the female reproductive organs.
Gynecologists are physicians who have completed advanced training in female reproductive disorders, typically a four-year program that encompasses the field of obstetrics (the medical specialty concerned with pregnancy and childbirth) as well as gynecology. Gynecologists perform routine checkups that include such tests as Pap smears and breast exams to help detect disorders of the female reproductive system. They perform a variety of surgical procedures on the female reproductive system. In addition, gynecologists often serve as the primary care physician for many of their patients. If they are licensed in obstetrics, they may also deliver babies.
THE GYNECOLOGICAL EXAM
The gynecological exam is designed as a preventive measure to screen for cervical cancer and breast cancer, as well as to detect abnormalities such as cysts in the ovaries. The exam also ensures that a woman who is sexually active uses appropriate contraception (birth control) if she does not wish to become pregnant, or it permits her to discuss family planning and fertility issues if she does want to have a child. The gynecologist also provides measures to prevent transmission or contraction of sexually transmitted diseases.
A typical gynecological exam begins with a medical history-an interview conducted by the gynecologist or another health care professional to learn the patient's medical background. The patient then undergoes routine exams, which include checking her weight and blood pressure as well as taking a urine sample to check for bladder infections, kidney disease, and pregnancy, if the patient is of childbearing age. The doctor then performs an external exam that usually includes a breast exam and may include general assessment of the heart, lungs, thyroid gland, and any other areas that the woman's medical history indicated may need special attention. Following the external exam, the doctor performs a Pap smear, removing cell samples from the cervix and vaginal secretions. These specimens are sent to a laboratory to be studied under a microscope for signs of unusual growth that may be an indication of cancer. In addition to the Pap smear, the doctor palpates the uterus and ovaries by putting two fingers in the vagina or one finger in the vagina and one in the rectum and then placing the other hand on the patient's lower abdomen and pressing the uterus and ovaries between two hands. This hands-on exam enables the physician to feel abnormal changes in the size or position of these organs. Such changes may indicate a problem.
If a woman is planning a pregnancy-or is at risk for one-the doctor may recommend testing for immunity to such infections as German Measles, which can result in birth defects if contracted during pregnancy. If the patient's family history includes hereditary disorders, such as Tay-Sachs disease (a brain disorder), the physician might also suggest screening for inherited diseases.
Often the doctor will have an assistant in the room during the exam. In part, the assistant helps with supplies needed for the exam; but in large measure the assistant's presence protects the patient, the doctor, and the clinic from any question of impropriety during the exam. Some states have laws requiring that a chaperone be present during pelvic exams. Any woman who feels uncomfortable with the exam or the setting should request that a chaperone, friend, or family member be present.
Many gynecologists recommend that a woman begin having regular gynecological exams by her mid- to late-teens, preferably before she becomes sexually active. In addition, a girl should be examined at the time of puberty (the onset of sexual maturity) if problems occur that suggest a gynecological disorder, such as failure to develop breast tissue or pubic hair by her early teens, lack of normal menstrual cycles ,or menstrual periods marked by heavy bleeding, severe cramping, or other pelvic pain. Women should have yearly gynecological exams after becoming sexually active.
CONDITIONS AND DISEASES
Gynecologists commonly treat a wide variety of disorders of the female reproductive system, including cancers, noncancerous conditions such as endometriosis, and infectious diseases, including sexually transmitted diseases.
deg; Gynecological Cancers
Gynecologists frequently detect cancers of the breast, skin, cervix, ovaries, and uterus, either during the physical exam or from results of tests such as Pap smears and pelvic ultrasounds. Each type of cancer is then evaluated to determine if a tumor has spread to other areas or remains confined to a specific location. Gynecologists may refer women with suspicious skin lesions or breast lumps to surgeons. Alternatively, they may perform diagnostic procedures such as biopsies (removing tissue samples to study under a microscope) and, if a problem is identified, refer to cancer specialists for follow-up treatment such as specialized cancer surgery, chemotherapy, or radiation therapy.
° Noncancerous Conditions
Gynecologists also treat noncancerous conditions. Fibroid tumors are fibrous growths of the muscle wall of the uterus. They are common in women 30 to 40 years old. Most benign (noncancerous) fibroid tumors simply cause the uterus to feel bigger than normal during a pelvic examination. Some, however, cause discomfort by pressing on surrounding structures such as the bladder or lower back. Fibroid tumors can also cause heavy vaginal bleeding if they are located on the interior surface of the uterus.
Ovarian cysts, fluid-filled sacs in the ovary, are common in women of reproductive age. During a normal menstrual cycle, small cysts form as ovulation occurs. Occasionally these cysts enlarge and cause pain, or benign tumors form in these cysts. Ultrasound testing can determine the nature of a cyst. Simple, fluid-filled cysts do not usually require any treatment, since they will generally go away on their own. Large, painful, or persistent cysts may require surgical removal. Cysts that have solid masses usually require surgery because they pose a risk of becoming cancerous.
Endometriosis is a common disease in which tissue similar to that of the uterine lining, or endometrium, are found throughout the abdomen. Irritation and inflammation of surrounding structures can cause severe pain, usually at the time of ovulation or menstruation. Endometriosis is associated with an increased risk of infertility, sometimes due to scar tissue that can block the Fallopian tubes and prevent a fertilized egg from implanting in the uterus. Treatment may consist of surgical removal of endometrial tissue or hormone therapy designed to shrink the tissue. The disease improves with menopause, when natural hormone levels fall.
deg; Infections and Sexually Transmitted Diseases
Gynecologists treat a number of common infections of the female reproductive organs. Many of these infections are sexually transmitted, and without treatment they can spread to the patient's sexual partner.
Chlamydia is the most common sexually transmitted disease, affecting between three and four million men and women in the United States annually. Caused by the bacterium Chlamydia trachomatis, in men chlamydia can produce a discharge from the penis, pain during urination, and swelling in the testes; in women the infection may cause a yellowish vaginal discharge or vaginal bleeding. But in most cases there are no symptoms in infected women and they may unknowingly spread the disease. The infection can be successfully treated with oral antibiotics.
Gonorrhea produces vaginal discharge, pain when urinating, vaginal bleeding, and redness and irritation of the genital area. Caused by the bacterium Neisseria gonorrhoeae, gonorrhea can infect the anus, the vagina, the throat, and the eye. Like chlamydia, gonorrhea can be completely cured with antibiotics, but up to 70 percent of women have no symptoms, enabling this infection to spread unchecked.
Trichomonas is caused by a parasite and commonly causes a heavy, odorous, greenish or yellowish vaginal discharge. It can be treated with oral or topical antibiotics. Treatment is usually necessary for both affected women and their sexual partners, since reinfection is common.
Vaginitis is inflammation of the vagina that usually causes itching and burning, or a heavy, odorous discharge. The most common causes of vaginitis are vaginal yeast, trichomonas, and bacterial infection. Treatment usually consists of topical creams, which are generally available without a prescription, or prescription oral medications.
Genital herpes causes a painful outbreak of blisters on the external genitals or on the cervix. Most individuals with genital herpes virus are infectious during outbreaks, but the virus can be transmitted even when no symptoms are present. Treatment with oral antiviral drugs can suppress the number of outbreaks but does not eliminate the virus. Use of condoms lessens the rate of spread, but condoms do not offer complete protection since the blisters and areas infected with the virus may not be covered by a condom.
Genital warts are small projections of skin around the vaginal opening in women or on the penis or scrotum in men. They are caused by one of many strains of the human papilloma virus (HPV) and are highly infectious. Many individuals exposed to the genital wart virus will not develop visible warts but will simply carry the virus in their skin cells. Viral genetic material actually incorporates itself into the skin and can remain there for years. Some women develop generalized irritation and burning of the vaginal skin from viral changes that do not create visible warts. The viral genetic material of certain strains of HPV is strongly associated with cervical and vaginal cancers, so women who have been identified as carrying the HPV virus are considered at high risk for cervical cancer.
Hepatitis B can also be acquired sexually. It is caused by a virus that can cause liver damage. There are 140,000 to 320,000 new cases of hepatitis B annually in the United States. Approximately 6 to 10 percent of people infected will become chronic carriers of the disease, presenting an enormous public health hazard as hepatitis B is highly contagious. There is no specific treatment. Public health officials hope to cut the incidence of hepatitis B through widescale vaccination of newborns, adolescents, and health care workers.
Syphilis is a bacterial disease that is usually acquired sexually. Syphilis begins with a large, ulcerated sore, called a chancre. If not treated at that stage, syphilis can eventually infect many tissues in the body, including the brain. It can be identified by a combination of physical exam, laboratory evaluation of drainage from the chancre, and blood testing. It is treated with antibiotics.
Gynecologists are trained as surgeons to perform a number of different procedures on the female genital tract. Among the most common surgical procedures performed by gynecologists are dilation and curettage (D&C), a diagnostic and therapeutic surgery in which the uterine lining is removed; episiotomy, an incision made to the vaginal opening at the time of childbirth to enlarge the birth canal; cesarean section, the surgical delivery of a newborn who cannot pass through the birth canal; hysterectomy, the removal of the uterus; and abortion. Recent surgical developments permit less invasive surgery for many gynecological problems and may change the nature of office gynecological exams. These newer technologies include more sophisticated noninvasive imaging techniques such as ultrasound and minimally invasive surgery techniques using narrow lighted tubes (endoscopes) to view the pelvic organs through the abdominal wall (laparoscopy) or through the birth canal (hysteroscopy).
Many disorders that previously required large abdominal incisions, such as hysterectomy, now can be corrected using tiny surgical instruments that fit through these endoscopic tubes, leaving only small scars and allowing shorter recovery times. Specific advances that improve evaluation and treatment of gynecological problems include laser and electrosurgical treatment of early cervical cancer, ultrasound for evaluation of pelvic abnormalities, and advanced laparoscopic and hysteroscopic surgery for treatment of a variety of gynecological abnormalities.