Determining What a Gynecologist Does and When To Go and See One
Article by TLV Medical Center
In some countries, women must first see a general practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynecologist. In the United States, however, law and many health insurance plans allow gynecologists to provide primary care in addition to aspects of their own specialty. With this option available, some women opt to see a gynecological surgeon for non-gynecological problems without another physician’s referral.
As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynecological 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.
Gynecologists 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 arectovaginal examination for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynecologists 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.
Some of the more common operations that gynecologists 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 (a type of permanent sterilization)
- Hysteroscopy (inspection of the uterine cavity)
- Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide a 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 ofhysterectomy or Caesarean section. May also be performed as part of a staging operation for ovarian cancer.
- Cervical Excision Procedures (including cryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.
Diseases Treated by a Gynecologist
Examples of conditions dealt with by a gynecologist 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)
- Menorrhagia (heavy menstrual periods); a common indication for hysterectomy
- Prolapse of pelvic organs
- Infections of the vagina (vaginitis), cervix and uterus (including fungal, bacterial, viral, and protozoal)
- Other vaginal diseases
There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a urologist.
For a Gynecologist in Tel Aviv visit TLV Medical Center