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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.