What is a gynecologist? What do gynecologists do?

Date: Jan-27-2015Gynecologists have also been trained in obstetrics (pregnancy and childbirth) but their main concern is the care of women's health in general, especially in relation to the female reproductive system - dealing with issues ranging from menstruation and fertility to sexually transmitted diseases and hormone disorders.

In the US, they also have a role, as general physicians, in the overall primary care of women, referring to other specialists when appropriate. Women in the States may first consult their gynecologist with a health problem, rather than 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?
Gynecologists' qualifications
How to check a gynecologist's credentials
Do women prefer to see female gynecologists?
Common conditions treated
Common procedures performed
When to see a gynecologist

What is gynecology?

Gynecology is a specialist branch of medicine practiced by obstetrician-gynecologists, who treat only 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 their reproductive organs. (Gynecologists are also trained in obstetrics - the care of women during pregnancy and childbirth, which overlaps with gynecology.)2

The US Bureau of Labor Statistics holds estimates for the number of doctors employed as obstetricians and gynecologists across the US. Estimates in May 2013 gave a figure of 21,730 such physicians employed in the nation (excluding thousands more who would have been self-employed), and their average annual salary was almost $213,000.3

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 phrase 'obstetrics and gynecology' (gynaecology being the spelling in the UK) is often abbreviated to OB/GYN or ob-gyn, and - especially in the UK - 'obs and gynae' or O&G.2

Gynecologists' qualifications

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 take in, among others, the following areas of interest:5

Preconceptional health (for women trying for a baby)

Care during pregnancy, labor and childbirth

Postpartum care (of the woman following childbirth)

Genetics, genetic counseling for some parents when planning a family, and diagnosis of conditions in the baby before birth (prenatal diagnosis)

Women's general health, including of her reproductive system (ovaries, uterus, vagina, external genitalia), her breasts and her sex life (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 women's hormonal disorders and treat their infections. There is also surgical training enabling many gynecologists to do operations that correct women's 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 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)

Immunizations

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 women who, for example, have pelvic organ prolapse, fecal or urinary incontinence, or other urinary disorders)

Genetics

Gynecological oncology (mostly managing cancers of the uterus, ovary, cervix and vulva)

Maternal-fetal medicine (care for pregnant women who have complicated medical conditions, including diabetes, kidney disease, 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

Women wishing to check the registration of their gynecologist practising in the US, or to find a new one in their area, can use an 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, found: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 best summary of gynecologists' typical areas of medical concern is given by the list of topics that they must have special knowledge and skills in to become certified by the American Board of Obstetricians and Gynecologists (ABOG):8

Gynecologists working at generalist offices have also been trained in obstetrics, so care around pregnancy and childbirth is part of their responsibility.

Benign conditions of the reproductive tract (for example, ovarian cysts, vulvar and vaginal ulcers, and other non-cancerous changes)

Bleeding abnormally from the uterus

Cancers of the reproductive tract and breasts, and pregnancy-related tumors

Congenital abnormalities of the reproductive tract (problems women 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 will also deal with women's coexisting medical diseases such as diabetes and asthma, and psychiatric conditions such as depression, personality disorders, and so on.8

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

Osteoporosis

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, of course, deal with numerous conditions relating to pregnancy and childbirth - the specialist area that obstetricians focus on. Gynecologists are trained as obstetricians themselves, and are involved in the overlap of this perinatal care.8

A typical private practice run by generalist gynecologists has a working week consisting of:1

Two to four days of office consultations for women

Up to one and a half days of surgery

Some management of labor and delivery.

Common procedures performed by gynecologists

Again, as for their medical areas of interest above, before they are 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: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 be examined intimately ('pelvic examination') if they have any concerns or symptoms.

The well-woman visit "provides an excellent opportunity" for gynecologists to counsel patients about "maintaining a healthy lifestyle and minimizing health risks," and it 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 the specific checks that are needed at particular ages.

Aside from the annual check-up, women should see their gynecologist whenever they have concerns or symptoms relating to their reproductive systems. The gynecologist is also the physician a woman can consult first for any issue they have with their general health.

Written by Markus MacGill

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.