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Examination It is typically a consultant specialty. In most countries, women must see a general practitioner (GP; also known as a family practitioner (FP)) first. If their condition requires knowledge or equipment unavailable to the GP, they are referred to a gynaecologist. However, in the United States, law and many health insurance plans allow gynaecologists to provide primary care, and some women select that option. As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is special in that it is quite intimate, and that it involves special equipment—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. Gynaecologists typically do a bimanual examination (one hand on the abdomen, two fingers in the vagina), to palpate the cervix, uterus, ovaries, and bony pelvis. It is not uncommon to do a rectovaginal exam for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists often have a female chaperone (nurse or medical student) 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. Advisory The Department of Plastic Surgery at the University of Virginia School of Medicine recommends that surgical devices, such as gloves, with dusting powders, including talc, should not be used during surgery because of acute and chronic problems that may occur if it finds its way into adominal cavity via the vagina. It also makes an analogy to condoms which have the very same dusting powders used on them.* Investigations Some of the investigations used in gynaecology are: Diseases The main conditions dealt with by a gynaecologist are: Obviously, there is some crossover in these areas. For example, a woman with incontinence may be referred to a urologist. Therapies Occasionally gynaecologists will use drugs, such as clomiphene (which stimulates ovulation), and, most famously, oral contraceptives (which are also used for dysmenorrhoea). Surgery, however, is the mainstay of gynaecological therapy. For historical reasons, gynaecologists are not usually considered "surgeons"—this has always been the source of some controversy—though modern advancements in both fields have blurred many of the once rigid lines of distinction. The rise of sub-specialties within gynaecology which are primarily surgical in nature (for example, urogynaecology and gynecological oncology) have strengthened the reputations of gynaecologists as surgical practitioners, and many surgeons and surgical societies have come to view gynaecologists as comrades of sorts. As proof of this changing attitude, gynaecologists are now eligible for fellowship in both the American and Royal Colleges of Surgeons, and many newer surgical textbooks include chapters on (at least basic) gynecological surgery. Some of the more common operations that gynaecologists perform include: See also | ||||||||||
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