Gynecologists are doctors who specialize in women's health in general, especially in relation to the female reproductive system.
These specialists have also been trained in obstetrics (pregnancy and childbirth) but their main concerns are issues ranging from menstruation and fertility to sexually transmitted diseases and hormone disorders.
In the US, gynecologists also have a role, as general physicians, in the overall primary care of women, referring their patients to other specialists when appropriate. Some women in the US consult their gynecologist first with a health problem, rather than seeking advice from a general practitioner.
Use this page for more detailed information about gynecologists, their training, and the medical conditions and surgical procedures they are involved with.
Contents of this article:
What is gynecology?
Gynecology is a specialist branch of medicine practiced by obstetrician-gynecologists, who treat patients who were born female or have female body parts (whether or not they identify as women). Obstetrician-gynecologists are physicians - medically trained doctors - who have undertaken specialist training in obstetrics and gynecology.1
Gynecologists specialize in the female reproductive system, but also care for women's overall health.
A gynecologist is a doctor who treats medical conditions and diseases that affect women and female reproductive organs. (Gynecologists are also trained in obstetrics - the care of women going through pregnancy and childbirth, which overlaps with gynecology.)2
Statistics published in May 2014 by the US Bureau of Labor Statistics reveal that there are 21,740 people employed in the US as obstetricians and gynecologists (excluding thousands more who are self-employed). Their mean average annual salary was $214,750, and their mean hourly rate $103.25.3
Every year, the American Board of Obstetrics and Gynecology examines more than 30,000 obstetrician-gynecologists and sub-specialists in the field for re-certification.4
The specialism of obstetrics and gynecology (spelt gynaecology in the UK) is often abbreviated to OB/GYN or ob-gyn, and - especially in the UK - 'obs and gynae' or O&G.2
All gynecologists certified in the US first graduated from an "acceptable medical school" - they are fully trained medical doctors with a license to practice. In addition to this, after leaving medical school and choosing to become gynecologists, they have followed an ob-gyn residency program for their specialty training.5
Gynecologists-in-training go through four years of specialization during the residency program. Fully qualified gynecologists have therefore had at least eight years of medical study and training.5
The four years of specialist training include, among other things, the following areas of study:5
- Preconceptional health (for people trying to become pregnant)
- Care during pregnancy, labor and childbirth
- Postpartum care (care of a person after they have given birth)
- Genetics, genetic counseling for some parents when planning a family, and diagnosis of conditions in the baby before birth (prenatal diagnosis)
- Female general health, including hormones, organs and tissues of the reproductive system (ovaries, uterus, vagina, external genitalia), breasts and sexual function
- Screening for female cancers (although ob-gyn specialists in the US also screen other cancers, or are responsible for referring to other specialists).
The training also means gynecologists are qualified to manage female hormonal disorders and treat their infections. There is also surgical training enabling many gynecologists to do operations that correct female pelvic, reproductive or urinary tract problems, including cancers of the ovaries, uterus, cervix, and so on.5
Gynecologists in the US are also consulted by many women as the main point of care for their overall wellbeing - so the four years of specialization also includes training on preventive medicine, including:5
- Routine examinations and tests (health screening)
- Overall medical care for women, not solely concerned with their reproductive systems.
Before a gynecologist can be listed by the American College of Obstetricians and Gynecologists, they must sit a further examination, in addition to their eight years of general medical and specialist training, which enables them to achieve full certification from the American Board of Obstetricians and Gynecologists (ABOG).5
ABOG certification is awarded after success in two tests, one written - a multiple-choice test covering a long list of obstetric and gynecology topics - and one oral. The half-day oral test includes a selected review of the gynecologist's first year of clinical cases - so fully qualified, board-certified gynecologists all have experience of treating women, and have undergone a total of nine years or more of medical and gynecological training.5
After the four years of specialist training and the further year to become certified as gynecologists, some go on to specialize even further, after completing one of the following subspecialty fellowships, which run for three years, including one year doing research:1
- Female pelvic medicine and reconstructive surgery (helping people who, for example, have pelvic organ prolapse, fecal or urinary incontinence, or other urinary disorders)
- Gynecological oncology (mostly managing cancers of the uterus, ovary, cervix and vulva)
- Maternal-fetal medicine (care for those who experience complications during pregnancy, including diabetes, kidney disease or preterm labor)
- Pediatric and adolescent gynecology
- Reproductive endocrinology and infertility (fertility specialists, including those who offer in vitro fertilization, IVF).
How to check a gynecologist's credentials
Anyone wishing to check the registration of their gynecologist practicing in the US, or to find a new one in their area, can use the online directory maintained by the American College of Obstetricians and Gynecologists (ACOG).6
Searches can be by state, zip code, or doctor's last name, and all gynecologists who have chosen to be listed in the directory must be fellows of the ACOG, have an active US license to practice medicine, and have certification from the American Board of Obstetrics and Gynecology.6
Do women prefer to see female gynecologists?
A survey undertaken in 2002, of 537 women living in the US, in Brooklyn, New York, explored their preferences for a gynecologist's sex, because there had been a "reported increase in women's desires to have female medical providers." The results, published in the Journal of Women's Health & Gender-Based Medicine, showed that:7
"Only a minority of these women feel strongly about their preference, and women with male providers are as satisfied as are women with female providers."
A slight overall majority of women who were asked in New York preferred a female gynecologist, but this varied by religious group, with the proportions preferring a woman specialist breaking down as follows:7
- 56% of Protestants
- 58% of Catholics
- 58% of Jews
- 74% of Hindus
- 89% of Muslims.
Common conditions treated by gynecologists
The major areas of medical concern for gynecologists, in which they are required to have specialist knowledge and skills to become certified by the American Board of Obstetricians and Gynecologists (ABOG), include:8
- Benign conditions of the reproductive tract (for example, ovarian cysts, vulvar and vaginal ulcers, and other non-cancerous changes)
- Abnormal bleeding from the uterus
- Cancers of the reproductive tract and breasts, and pregnancy-related tumors
- Congenital abnormalities of the female reproductive tract (problems people were born with)
- Cytology abnormalities (cell abnormalities, including those related to cancer)
- Ectopic pregnancy (the fertilized egg does not implant normally in the uterus, but outside it, usually in a fallopian tube between ovary and uterus)
- Emergency care (for conditions involving bleeding, for example)
- Endometriosis (a chronic condition in which tissue similar to the lining of the uterus, endometrium, is found elsewhere in the body)
- Fibroids/myomas of the uterus (non-cancerous growths in the muscle layer of the wall of the uterus)
- Pelvic inflammatory diseases (including abscess)
- Pelvic pain - both acute (including appendicitis) and chronic
- Pelvic problems, with the tissues supporting the pelvic organs (ligaments, fascia, and muscles; including defects in the pelvic floor and the condition known as pelvic relaxation)
- Premalignant conditions of the reproductive tract and breasts (examples include endometrial hyperplasia and cervical dysplasia)
- Sexually transmitted infections
- Urinary and fecal incontinence.
Gynecologists working at generalist offices have also been trained in obstetrics, and are, therefore, also responsible for care around pregnancy and childbirth.
Gynecologists in the US have wider responsibilities for women's health - about 90% go into practice as generalists after their four-year ob-gyn residency.1 They usually set up in office in groups and adopt roles in women's preventive medicine and other primary care work that is also in the realm of general practitioners, including the diagnosis and treatment of relatively uncomplicated medical issues such as headache, low back pain, acne, and so on.1,8
Areas of special care also include screening at yearly health assessments - for example, mammography, colonoscopy, blood pressure monitoring, immunizations, diet (including calcium, folic acid) - and care of the following:8
- Amenorrhea (absence of menstrual bleeding/missing periods)
- Benign breast disorders
- Cardiovascular disease
- Diabetes, thyroid disorders
- Disorders of reproductive physiology and hormones (for example, anovulation, galactorrhea, hirsutism, hyperandrogenism)
- Domestic violence and sexual assault
- Early pregnancy loss
- Family planning (contraception, sterilization, pregnancy termination)
- Gynecology care for specific age groups - pediatric, adolescent and geriatric
- Lifestyle advice (smoking cessation, weight loss, and so on)
- Menopause and peri-menopause
- Menstruation problems
- Polycystic ovary syndrome
- Sexuality, including lesbian and bisexual health issues, and sexual dysfunction
- Vaginal discharge
- Vulvar pain and diseases (such as ulcers, skin conditions, cysts).
Gynecologists also deal with numerous conditions relating to pregnancy and childbirth - the specialist area on which obstetricians focus. Gynecologists are also trained as obstetricians, and are involved in perinatal care.8
A typical working week for a generalist gynecologist in private practice consists of:1
- Two to four days of office consultations with patients
- Up to one and a half days of surgery
- Some management of labor and delivery.
Common procedures performed by gynecologists
Before becoming certified by the American Board of Obstetricians and Gynecologists (ABOG), gynecologists must also have special knowledge and skills to do with diagnostic and surgical procedures including:8
- Diagnostic procedures such as colposcopy (microscopic examination of the cervix) and endometrial biopsy (taking a sample from the lining of the uterus)
- Gynecological surgery - both minor (for example, sterilization) and major (for example, myomectomy to remove fibroids in the uterus)
- Hysteroscopy (using an endoscope to see into the uterus) for both diagnostic and surgical purposes
- Infertility operations
- Laparoscopy (keyhole abdominal procedure) for both diagnostic and surgical purposes
- Preoperative evaluation and preparation
- Postoperative care, including treating complications such as pulmonary embolus
- Ultrasound scanning - for diagnosis and for guiding procedures.
Gynecologists can also become involved with concurrent surgical conditions such as small bowel obstruction, and there are many operations that obstetricians perform in the care of women before, during and after childbirth, in which specialists focusing on gynecology have been trained and may be involved.8
When to see a gynecologist
Women should see their gynecologist routinely - the American College of Obstetricians and Gynecologists (ACOG) recommends an annual examination, and sets out guidelines for what this should cover.9
Women are recommended to see their gynecologist once a year, and may undergo a pelvic examination if they have any concerns or symptoms.
The ACOG recommends a well-woman visit annually as it "provides an excellent opportunity" for gynecologists to counsel patients about "maintaining a healthy lifestyle and minimizing health risks." This annual consultation should include:9
- Screening, evaluation and advice
- Immunizations based on age and risk factors
- A physical examination, which will include measuring standard vital signs, body mass index, palpating the abdomen and inguinal lymph nodes, and assessing overall health
- Some women will have a pelvic examination (of their external and internal genitalia if they have concerns or symptoms) or a breast examination (to check for lumps or irregularities; every one to three years from the ages of 20 to 39, and every year from the age of 40).
See the ACOG's recommendations for details of which checks are recommended at which ages.
Any patient with concerns or symptoms relating to the female reproductive system should see their gynecologist in addition to the annual check-up. A gynecologist can also be consulted first for any issue to do with general health; patients need not consult a separate primary physician.