Gynaecology is the medical specialty which concerns the physiology of the female reproductive system (vagina, uterus, ovaries, fallopian tubes, breasts) as well as the pathologies and dysfunctions that affect it.
A doctor who specialises in gynaecology and obstetrics (commonly known as a gynaecologist) is the lead physician for any female health issues. Gynaecologists provide treatment at every stage of a woman’s life, from puberty to the post-menopause age, which encompasses fertility, pregnancy, and the potentially difficult menopause transition. It is essential for women to start seeing a gynaecologist as adolescents. In fact, having healthy reproductive organs and a regular menstrual cycle is key for the overall wellbeing of the entire body. Gynaecology also deals with issues linked to reproductive health and the fertility treatments used to help patients who have problems conceiving or who may be infertile.
Throughout a woman’s life, there are many different pathologies and changes which can damage the health of the female reproductive organs and how they work. The most widespread include vaginal infections and mycosis, irregular menstrual cycles, uterine prolapse and/or urinary incontinence, growths (including tumours, cysts, nodules and fibroids), endometriosis, ovulatory dysfunction, early menopause, HPV infections and other sexually transmitted diseases. However, the role of a gynaecologist is not just to identify and treat potential pathologies. As specialists, they follow and support women throughout the most personal and intimate decision-making processes; this ranges from the most appropriate form of contraception to the best treatments to alleviate menopause symptoms, as well as the use of assisted reproductive technology and pregnancy.
Seeing a gynaecologist regularly is generally recommended from puberty onwards, or at the latest, once a woman becomes sexually active. These consultations aim not only to evaluate the health of the reproductive system but also quickly identify any abnormality or change to the reproductive organs, in order to prescribe the most appropriate treatments. Gynaecological consultations are therefore the main tool women can use to prevent or detect as early as possible any kind of abnormality, illness, or other type of problem linked to the breasts and reproductive organs.
What happens during a gynaecology consultation? If the appointment is for specific symptoms or concerns (for example, pelvic pain, vaginal bleeding, or vaginal discharge) the gynaecologist will begin by asking a series of preliminary questions to establish the overall health of the patient. These questions will give them key information (personal and family medical history, lifestyle, sexual habits) before they then carry out a clinical examination. This consists of an examination of the external genitalia and the vagina, in order to determine their physiological and pathological state.
Here is a specific list of some of the most common examinations carried out by gynaecologists during consultations, depending on the identified symptoms and specific patient’s needs:
- Screening tests for cervical cancer, particularly smear tests. A smear test is a routine examination that women will undergo throughout most of their lives. It involves taking a sample of the cervical cells which is then analysed to detect possible signs of cervical cancer. The same sample can be tested for the human papillomavirus (HPV).
- Microbiological testing to analyse samples of specific microorganisms that are linked to sexually transmitted diseases such as gonorrhoea and chlamydia. These are carried out if the patient presents any symptoms or risk factors. The samples can be taken from the urinary genital organs, such as the endocervix (sample taken through a smear test) or from a patient’s urine.
- Diagnostic imaging tests, particularly pelvic ultrasounds. This is a simple, painless examination used to effectively determine the health of the uterus and the ovaries. This examination can be used to diagnose potential gynaecological problems such as cysts or fibroids.
- Breast examination, which involves analysing the breasts from different points of view and carrying out a palpation in order to detect cysts or nodules. It is a non-instrumental clinical examination based solely on observation and an evaluation of how the mammary glands feel to the touch. The gynaecologist can also explain the benefits of self-examination to the patient. Self-examination is the first line of defence used to prevent breast cancer, as it enables any abnormal changes in the physiognomy of the breasts to be detected early on.
In-depth diagnostic tests, such as a colposcopy. A gynaecologist will perform a colposcopy to fully diagnose a patient if their smear test results come back with any abnormalities.
In addition, gynaecology is a surgical specialty; depending on the precise nature of the abnormality or pathology, the patient may be prescribed a medical or pharmacological treatment, a surgical treatment, or a combination of each. The gynaecologist can perform many different operations: for example, laparoscopic procedures to assess anatomical changes or changes to the surface of internal organs (e.g. endometriosis, phlogosis, adhesions). They can also remove myomas and fibroids and perform tubal ligations, hysterectomy procedures (removal of the uterus), ovariectomy procedures (removal of the ovaries), curettage to remove contents of the uterus (e.g. in the case of an incomplete miscarriage), as well as surgical procedures for urinary incontinence or pelvic organ prolapse.
The gynaecologist often works with other specialists if the conditions affecting the reproductive system are caused by and/or linked to changes or pathologies which affect other organs and vice versa. For example, gynaecologists work with oncologists if a patient has a tumour on or around the genital organs or the breasts. Similarly, they work with endocrinologists when treating abnormalities relating to the endocrine glands that can damage how the reproductive organs work, such as thyroid conditions or diabetes.