Gynaecology
Gynaecology is the area of medicine concerned with conditions affecting the female reproductive system. It is sometimes combined with the field of obstetrics, which focuses on pregnancy and childbirth, thereby forming the combined area of obstetrics and gynaecology.
Gynaecology encompasses preventative care, sexual health and diagnosing and treating health issues arising from the female reproduction system, such as the uterus, vagina, cervix, fallopian tubes, ovaries, and breasts; subspecialties include family planning; minimally invasive surgery; paediatric and adolescent gynaecology; and pelvic medicine and reconstructive surgery. Transgender, intersex and nonbinary individuals can in some instances require gynaecological care.
Etymology
The word gynaecology comes from the oblique stem of the Greek word γυνή meaning, and -logia meaning. Literally translated, it means. Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.History
Antiquity
The Kahun Gynaecological Papyrus, dated to about 1800 BC, deals with gynaecological diseases, fertility, pregnancy, contraception, etc. The text is divided into thirty-four sections, each dealing with a specific problem and containing diagnosis and treatment; no prognosis is suggested. Treatments are non-surgical, consisting of applying medicines to the affected body part or delivering medicines orally. During this time, the womb was sometimes seen as the source of problems manifesting in other body parts.Ayurveda, an Indian traditional medical system, also provides details about concepts and techniques related to gynaecology, addressing fertility, childbirth complications, and menstrual disorders among other things. These writings provide a post and prenatal care, integrating lifestyle practices, meditations and yoga, and a dietary regime for overall well-being.
The Hippocratic Corpus contains several gynaecological treatises dating to the 5th and 4th centuries BC. Aristotle is another source for medical texts from the 4th century BC with his descriptions of biology primarily found in History of Animals, Parts of Animals, Generation of Animals. The gynaecological treatise Gynaikeia by Soranus of Ephesus is extant. He was the chief representative of the school of physicians known as the "methodists."
Middle ages and renaissance period
During the Middle Age midwives dominated women's health concerns through experienced-based knowledge, traditional remedies, and herbal medicines. Midwifery was often regarded unscientific and was challenged with the rise of gynaecology as an official medical field. The Renaissance period, 16th century, brought about a resurgence of classical scientific advancements, including the rise of medical advancements in the field of gynaecology and obstetrics. Figures like Ambroise Pare were imperative in improving obstetrics techniques during this period. Peter Chamberlen developed the forceps, an important surgical tool that transformed childbirth and lessened maternal mortality.18th, 19th and 20th centuries
As medical institutions continued to expand in the 18th-19th centuries, the authority of midwives was challenged by men who dominated medical professions. The formalization of midwifery training by male doctors and advancements in medical knowledge of women's health and anatomy occurred during this period. Figures such as William Smellie, William Hunter, Paul Zweifel, Franz Karl Naegele, and Carl Crede contributed to the understanding of childbirth and women's health in Europe.In the early 18th and 19th centuries, in the United States, the field of gyneacology, as with most medical specialities, had ties to black women and therefore slavery. Brothers Henry and Robert Campbell were editors of the first medical journal in the deep south. Henry worked as gynaecologist including on enslaved women, whilst publishing medical case narratives of operations in the journal the brothers edited. This created a conflict of interest. Others, such as Dr. Mary Putnam Jacobi, challenged the exclusion of women from medical education and shifted gynaecology to a scientific practice.
J. Marion Sims is regarded as the father of modern gynaecology. Some of his medical contributions were published, such as development of the Sims' position, the Sims' speculum, the Sims' sigmoid catheter, and gynaecological surgery. He was the first to develop surgical techniques for the repair of vesico-vaginal fistulas, a consequence of protracted childbirth which at the time was without treatment. He founded the first women's hospital in the country in Alabama 1855 and subsequently the Woman's Hospital of New York in 1857. He was elected president of the American Medical Association in 1876. Sims died in 1883. His statue was removed from Central Park, after a unanimous vote in 2018.
Sims' legacy is controversial and debated as he conducted experimental operations on black enslaved women, as recounted in his autobiography. In this era, anaesthesia use was novice and considered dangerous. Sims developed his techniques and instruments by operating on women, without anaesthesia. The ethical issues this created are discussed in the Journal of Medical Ethics and by academic scholars, some of whom have different opinions in regards to consent and why anaesthesia was not used, whilst showing that white women were also subject to experimental procedures. When he left Alabama in 1853, a local newspaper called him "an honor to our state."
In terms of common procedures used within the now recognized specialism of gynaecology, the first hysteroscopy was completed in 1869 by Pantaleoni, to treat an endometrial polyp, using a cystoscope.
Obstetrics and gynaecology were recognized as specialties in the mid-19th century, in the United Kingdom. Specialist societies came into being but it became clear that to become disciplines in their own right a separate college was required. William Fletcher Shaw and William Blair-Bell worked to establish The British College of Obstetricians and Gynaecologists in 1929, this later became the Royal College of Obstetricians and Gynaecologists.
George Nicholas Papanicolaou, from Greece, is credited with discovering the pap smear test, he identified differences in the cytology of normal and malignant cervical cells by viewing swabs smeared on microscopic slides. His first publication of the finding in 1928 went relatively unnoticed. It wasn't until he collaborated with Dr Herbert Traut at an American hospital and they published a book, Diagnosis of Uterine Cancer by the Vaginal Smear that this medical advancement became widely known about. By the 20th century, the American College of Obstetricians and Gynecologists was founded. There were advances in antiseptic techniques, anaesthesia, and diagnostic tools, which transformed gynaecological care.
Some discrimination continued in the United States with forced sterilizations and eugenic policies that disproportionately targeted minorities. In addition to black women, coerced sterilization was used as a method to restrict perceived undesirable groups from reproducing, such as immigrants, poor people, unmarried mothers, disabled and mentally ill people. Between 1909 and 1979, an estimated 20,000 forced sterilizations occurred in California, primarily in state run mental institutions and prisons. Healthcare later became more focused on the importance of informed consent. Since the 1950's an emphasis on a patients right to choose whether to have treatment or not has existed, albeit with a reliance on those with medical knowledge to advise the best course of treatment. Technological advances have in more recent decades enabled patients themselves to obtain medical information more easily.
In Canada, The Royal College of Physicians and Surgeons did not formally recognize obstetrics & gynaecology as specialist fields until 1957. Obstetrics and gynaecology were considered part of the division of surgery. During the 1940's, practitioners focused on obstetrics and gynaecology began identifying the need for a separate organization to deal with this specialism and the idea to form the Society of Obstetricians and Gynaecologists of Canada was conceived.
Ian Donald, a gynaecologist from the United Kingdom was an early pioneer of the use of sonography within gyneacology and obstetrics. He gained knowledge of radar technology in the air force and working with an engineer called Tom Brown and an engineering company, they developed a compact 2D ultrasound machine. In 1958, he published a paper in the Lancet.
Birth control trials
Women like Margaret Sanger dedicated themselves to making contraception legal and available. She had worked as a nurse caring for women who had illegal abortions, this created a desire to engage in later activism related to birth control. In 1951 she met Gregory Pincus, a human reproduction medical expert who worked to create a contraceptive pill. She also found a sponsor for the project and trials, Katharine McCormick.The trials for birth control were controversial for a number of reasons. In 1954, due to anti-birth control laws, the first trials in Massachusetts were positioned as being fertility trials. Gregory Pincus and John Rock conducted these trials. Oral progesterone was tested on fertility patients, with consent, however the oral contraceptive was also tested on 28 psychiatric patients at Worcester State Hospital. No direct consent was given by these people, instead relatives gave consent on their behalf. They discovered that women stopped ovulating and that this occurred only whilst taking this. To get FDA approval, a larger clinical trial was needed.
To expand this research, further clinical trials of took place in Puerto Rico, a territory of the United States. Puerto Rico was densely populated with significant poverty, had no anti-birth control laws and already had services offering birth control. Trials began in Rio Piedras in 1956, and women were offered the pill, called Envoid in 1960, on the basis it prevented pregnancy but without knowing it did not have FDA approval. Three women died in the trial and criticisms include that side effects were not taken as seriously as they should have been. Dr. Edris Rice-Wray, a professor at the Puerto Rico Medical School was aware and vocal of the negative side effects of the pill. Although these trials did not follow modern medical ethical practices, they spearheaded the development of the first oral contraceptive.