Gynecology

Gynaecology literally means 'the science of women', but in medicine this is the specialty of diseases of the female reproductive system (uterus, vagina and ovaries).

Examination
Gynaecology is a consultant specialty. 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 flat metal, which are used to open the vagina, to permit examination of the cervix uteri. Gynaecologists may also weight loss pills do a bimanual examination (one hand on the abdomen, two fingers in the vagina), to palpate the uterus and ovaries. They may occasionally do a rectal exam. Male gynaecologists often have a female chaperone (nurse or medical student) for their examination. Virgins are not usually examined vaginally. An abdominal ultrasound is used normally to confirm the bimanual examination.

Investigations
Some of the investigations used in gynaecology are:
 * 1) abdominal ultrasound, to give a low-power view of the pelvic organs.
 * 2) vaginal ultrasound. A probe is passed into the vagina, which allows a detailed view of the uterus and its contents. Good in early pregnancy.
 * 3) blood tests. Levels of hormones such as estradiol, luteinizing hormone, follicle stimulating hormone and progesterone are measured.
 * 4) hysteroscopy -- a fine tube is passed organic nuts into the uterus via the cervix under a general anaesthetic.
 * 5) laparoscopy -- tubes are passed into the peritoneal cavity, which is then insufflated with carbon dioxide. This is commonly used to diagnose endometriosis.

MRI and CT scans are not used. Pelvic X-ray is rare. It can be used to delineate the uterine cavity with an injected dye (hysterosalpingogram) and to measure the pelvic girdle.

Diseases
The main conditions dealt with by a gynaecologist are:
 * 1) cancer of the cervix. The Papanicolaou (Pap) smear is a means of detecting this, by obtaining a sample of cervical epithelial cells and roupas da moda examining them under a microscope for malignant changes. All women are encouraged to have pap smears at regular intervals (2 years in Australia) after commencing intercourse.
 * 2) incontinence of urine.
 * 3) amenorrhoea (absent periods)
 * 4) dysmenorrhoea (painful periods)
 * 5) infertility
 * 6) menorrhagia (heavy periods). This is a main indication for hysterectomy.

Obviously there is some crossover in these areas. Amenorrhoea in a young girl may be referred to a paediatrician, incontinence 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).

However, surgery is the main area of therapy. For historical reasons, gynaecologists are not actually surgeons (this is the source of some tension).

Operations that gynaecologists do include:
 * 1) termination of pregnancy
 * 2) dilation and curettage (removal of the uterine contents, for various reasons, including miscarriage and menorrhagia; procedurally very similar to the above);
 * 3) hysterectomy (removal of the uterus);
 * 4) colposuspension ('tightening' of the ligaments around the vagina, a common therapy for incontinence and discomfort in older women);
 * 5) Large Loop Excision of the Transition Zone (LLETZ), where the surface of the cervix, containing pre-cancerous cells identified on Pap smear are removed).

=Gynecology Glossary=

A
amenorrhea - absence or cessation of menstrual periods. amenorrhea, primary - from the beginning and lifelong; menstruation never begins at puberty. amenorrhea, secondary - due to some physical cause and usually of later onset; a condition in which menstrual periods which were at one time normal and regular become increasing abnormal and irregular or absent. anovulation - failure of the ovaries to produce or release mature eggs.

B
benign - cell growth that is not cancerous, does not invade nearby tissue, or spread to other parts of the body. biological therapy (Also called immunotherapy, biotherapy, or biological response modifier therapy.) - uses the body's immune system, either directly or indirectly, to fight cancer or to lessen side effects that may be caused by some cancer treatments. biopsy - removal of sample of tissue via a hollow needle or scalpel.

C
cancer - abnormal cells that divide without control, which can invade nearby tissues or spread through the bloodstream and lymphatic system to other parts of the body. carcinogen - a substance that is known to cause cancer. cervicitis - an irritation of the cervix by a number of different organisms. Cervicitis is generally classified as either acute or chronic. cervix - the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body. chemotherapy - treatment to destroy cancer cells with drugs. chlamydial infection - very common sexually transmitted disease or urinary tract infection caused by a bacteria-like organism in the urethra and reproductive system. climacteric (Also called perimenopause.) - the transition period of time before menopause, marked by a decreased production of estrogen and progesterone, irregular menstrual periods, and transitory psychological changes. clinical trials - organized research studies that provide clinical data aimed at finding better ways to prevent, detect, diagnose, or treat diseases. cold knife cone biopsy - a procedure in which a laser or a surgical scalpel is used to remove a piece of tissue. This procedure requires the use of general anesthesia. colony-stimulating factors - substances that stimulate the production of blood cells. colposcopy (Also called colposcopic biopsy.) - a procedure which uses an instrument with magnifying lenses, called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed. computed tomography (Also called CT or CAT scan.) - a non-invasive procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray. The CT scan may indicate enlarged lymph nodes - a possible sign of a spreading cancer or of an infection. cone biopsy (Also called conization.) - a biopsy in which a larger cone-shaped piece of tissue is removed from the cervix by using the loop electrosurgical excision procedure or the cold knife cone biopsy procedure. The cone biopsy procedure may be used as a treatment for precancerous lesions and early cancers. cryosurgery - use of liquid nitrogen, or a probe that is very cold, to freeze and kill cancer cells. culdocentesis - a procedure in which a needle is inserted into the pelvic cavity through the vaginal wall to obtain a sample of pus. cyst - a fluid-filled or semi-solid sac in or under the skin. cystitis - inflammation of the urinary bladder and ureters.

D
dilation and curettage (Also called D & C.) - a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). dysmenorrhea - pain or discomfort experienced just before or during a menstrual period. dysmenorrhea, primary - from the beginning and usually lifelong; severe and frequent menstrual cramping caused by uterine contractions. dysmenorrhea, secondary - due to some physical cause and usually of later onset; painful menstrual periods caused by another medical condition present in the body (i.e., pelvic inflammatory disease, endometriosis). dyspareunia - pain in the vagina or pelvis experienced during sexual intercourse.

E
ectopic pregnancy (Also called tubal pregnancy.) - pregnancy that develops outside the uterus, usually in one of the fallopian tubes. endocervical curettage (ECC) - a procedure which uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This type of biopsy is usually completed along with the colposcopic biopsy. endometrial ablation - a procedure to destroy the lining of the uterus (endometrium). endometrial biopsy - a procedure in which a sample of tissue is obtained through a tube which is inserted into the uterus. endometrial hyperplasia - abnormal thickening of the endometrium caused by excessive cell growth. endometrial implants - fragments of endometrium that relocate outside of the uterus, such as in the muscular wall of the uterus, ovaries, fallopian tubes, vagina, or intestine. endometrial resection - a procedure to remove the lining of the uterus (endometrium). endometriosis - condition in which tissue resembling that of the endometrium grows outside the uterus, on or near the ovaries or fallopian tubes, or in other areas of the pelvic cavity. endometrium - mucous membrane lining of the inner surface of the uterus that grows during each menstrual cycle and is shed in menstrual blood. endoscopy - use of a very flexible tube with a lens or camera (and a light on the end), which is connected to a computer screen, allowing the physician to see inside the hollow organs, such as the uterus. Biopsy samples can be taken through the tube. estrogen - a group of hormones secreted by the ovaries which affect many aspects of the female body, including a woman's menstrual cycle and normal sexual and reproductive development. estrogen replacement therapy (ERT) - use of the female hormone estrogen to replace that which the body no longer produces naturally after medical or surgical menopause. excisional - cutting away cancerous tissue with a scalpel or other instruments to completely remove it and possibly some surrounding tissue. There are many types of excisional surgeries, each named for the particular area of the body in which they are performed, or the particular purpose for which they are performed. expectant management (Also called expectant therapy.) - "watchful waiting" or close monitoring of a disease by a physician instead of immediate treatment. extragenital - outside of, away from, unrelated to the genital organs.

F
fallopian tubes - two thin tubes that extend from each side of the uterus, toward the ovaries, as a passageway for eggs and sperm. fecal occult blood test - test to check for hidden blood in stool. fertile - able to become pregnant. fibroids - noncancerous growths in, on, or within the walls of the uterus. fibroid embolization - a new experimental technique which involves identifying which arteries are supplying blood to the fibroids and then blocking off these arteries, which cuts off the fibroids blood supply and causes them to shrink. Physicians are still evaluating the long-term implications of this procedure on fertility and regrowth of the fibroid. follicle-stimulating hormone (FSH) - hormone secreted by the pituitary gland in the brain that stimulates the growth and maturation of eggs in females and sperm in males, and sex hormone production in both males and females.

G
genital herpes - a sexually transmitted disease caused by the herpes simplex virus. genital warts - a sexually transmitted disease caused by the human papillomavirus (HPV). genitals - external sex organs. grading - a process for classifying cancer cells to determine the growth rate of the tumor. The cancer cells are measured by how closely they look like normal cells.

H
hormone replacement therapy (HRT) - use of the female hormones estrogen and progestin (a synthetic form of progesterone) to replace those hormones the body no longer produces after menopause. hormone therapy - treatment of cancer by removing, blocking, or adding hormones. hormones - chemical substances created by the body that control numerous body functions. human papillomaviruses (HPVs) - a group of viruses that can cause warts. Some HPVs are sexually transmitted and cause wart-like growths on the genitals. HPV is associated with some types of cancer. hyperplasia - an abnormal increase in the number of cells in a tissue or an organ (i.e., cervix or the lining of the uterus). hysterectomy - surgery to remove the uterus. hysterosalpingography - x-ray examination of the uterus and fallopian tubes that uses dye and is often performed to rule out tubal obstruction. hysteroscopy - visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.

I
imaging - tests or evaluation procedures that produce pictures of areas inside the body. immune system - group of organs, antibodies, and cells that defends the body against infection or disease. immunotherapy (Also called biological therapy.) - treatment that uses the body's natural defenses to fight cancer. infertility - not being able to produce children. interferon - a biological response modifier that stimulates the growth of certain disease-fighting blood cells in the immune system. interleukin-2 - a biological response modifier that stimulates the growth of certain blood cells in the immune system that can fight cancer. invasive cancer - cancer that begins in one area and then spreads deeper into the tissues of that area.

L
labia - the folds of skin at the opening of the vagina (and other organs). laparoscopic lymph node sampling - lymph nodes are removed through a viewing tube called a laparoscope, which is inserted through a small incision in the abdomen. laparoscopy - use of a viewing tube with a lens or camera (and a light on the end), which is inserted through a small incision in the abdomen to examine the contents of the abdomen and remove tissue samples. laparotomy - a surgical procedure that involves an incision from the upper to lower abdomen; often used when making a diagnosis by less invasive tests is difficult. loop electrosurgical excision procedure (LEEP) - a procedure which uses an electric wire loop to obtain a piece of tissue. luteinizing hormone (LH) - hormone secreted by the pituitary gland in the brain that stimulates the growth and maturation of eggs in females and sperm in males. lymph nodes (Also called lymph glands.) - small organs located in the channels of the lymphatic system which store special cells to trap bacteria or cancer cells traveling through the body in lymph. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen. lymphatic system - tissues and organs, including bone marrow, spleen, thymus, and lymph nodes, that produce, store, and carry white blood cells to fight infection and disease.

M
magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure, especially the brain and spinal cord. The MRI may show abnormal nodules in bones or lymph nodes - a sign that cancer may be spreading. malignant - cancerous cells are present. mammogram - x-ray of the breast tissue. menarche - a young woman's first menstrual period. menopause - end of menstruation; commonly used to refer to the period ending the female reproductive phase of life. menorrhagia - the most common type of abnormal uterine bleeding (also called dysfunctional uterine bleeding) characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe and relentless that daily activities become interrupted. menses - menstrual flow. menstruation - a cyclical process of the endometrium shedding its lining, along with discharge from the cervix and vagina, from the vaginal opening. This process results from the mature egg cell (ovum) not being fertilized by a sperm cell as it travels from one of the ovaries down a fallopian tube to the uterus, in the process called ovulation. metastasis - spread of cancer from one part of the body to another. metrorrhagia - any irregular, acyclical nonmenstrual bleeding from the uterus; bleeding between menstrual periods. monoclonal antibodies - substances that can locate and bind to cancer cells wherever they are in the body.

O
obstetrician/gynecologist (OB/GYN) - physicians who specialize in general women's medical care, diagnosis and treatment of disorders of the female reproductive system, and care of pregnant women. oligomenorrhea - infrequent or light menstrual cycles. oncologist - physician who specializes in treating cancer. oophorectomy - surgery to remove one or both ovaries. ovaries - two female reproductive organs located in the pelvis. ovulation - release of a mature egg from an ovary. ovum - a mature egg cell released during ovulation from an ovary.

P
Pap test (Also called Pap smear.) - Test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation. pathologist - physician who identifies diseases by studying cells and tissues under a microscope. pelvic examination - an internal examination of the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. pelvic inflammatory disease (PID) - inflammation of the pelvic organs caused by a type of bacteria. pelvic lymph node dissection - removal of some lymph nodes from the pelvis. pelvis - a basin-shaped structure that supports the spinal column and contains the sacrum, coccyx, and hip bones (ilium, pubis, and ischium). perimenopause (Also called climacteric.) - the transition period of time before menopause, marked by a decreased production of estrogen and progesterone, irregular menstrual periods, and transitory psychological changes. perineal - related to the perineum. perineum - area between the anus and the sex organs. peripheral stem cell support - procedure to replace blood-forming cells destroyed by cancer treatment. Stem cells in the blood that are similar to cells in the bone marrow are removed from the patient's blood before treatment and given back to the patient after treatment. placenta - organ that develops in the uterus during pregnancy; links the blood supplies of a pregnant woman to the fetus to provide nutrients and remove waste products. polymenorrhea - too frequent menstruation. polyps - a growth that projects from the lining of mucous membrane, such as the intestine. postmenopausal bleeding - any bleeding that occurs more than 6 months after the last normal menstrual period at menopause. premenstrual dysphoric disorder (PMDD) - a much more severe form of the collective symptoms known as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) is considered a severe and chronic medical condition that requires attention and treatment. premenstrual syndrome (PMS) - a group of physical and emotional symptoms that some women experience during their menstrual cycle. Although the symptoms usually cease with onset of the menstrual period, in some women, symptoms may last through and after their menstrual periods. progesterone - female hormone. progestin - synthetic form of the female sex hormone progesterone.

R
radiation therapy (Also called radiotherapy.) - treatment with high-energy rays (such as x-rays or gamma rays) to kill cancer cells; may be by external radiation or by internal radiation from radioactive materials placed directly in or near the tumor. radionuclide scan - an imaging scan in which a small amount of radioactive substance is injected into the vein. A machine measures levels of radioactivity in certain organs, thereby detecting any abnormal areas or tumors. rectum - lower end of the large intestine, leading to the anus. recur - to occur again; reappearance of cancer cells at the same site or in another location. risk factor - activity or factor that may increase the chance of developing a disease.

S
salpingectomy - surgical removal of one or both fallopian tubes. salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries. Schiller test - a diagnostic test in which the cervix is coated with an iodine solution to detect the presence of abnormal cells. sexually transmitted disease (STD) - infection spread through sexual intercourse and other intimate sexual contact. screening - checking for disease when there are no symptoms. stage - the extent of a cancer, whether the disease has spread from the original site to other parts of the body. surgery - operation to remove or repair a part of the body, or to find out if disease is present. systemic treatment - treatment using substances that travel through the bloodstream and reach cancer cells all over the body.

T
tamoxifen - an anticancer drug used in hormone therapy to block the effects of estrogen. tissue - group or layer of cells that together perform specific functions. total hysterectomy - the removal of the uterus, including the cervix; the fallopian tubes and the ovaries remain. total hysterectomy with bilateral salpingo-oophorectomy - the entire uterus, fallopian tubes, and the ovaries are surgically removed. transvaginal ultrasound (Also called ultrasonography.) - an ultrasound test using a small instrument, called a transducer, that is placed in the vagina. trichomoniasis - very common type of vaginitis caused by a single-celled organism usually transmitted during sexual contact. tumor - abnormal mass of tissue that results from excessive cell division; may be benign (not cancerous) or malignant (cancerous).

U
ultrasound - an imaging technique that uses sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys. urethra - narrow channel through which urine passes from the bladder out of the body. urethritis - infection limited to the urethra. uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum.

V
vagina (Also called the birth canal.) - the passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix (the opening of the womb, or uterus) and the vulva (the external genitalia). vaginal atrophy - often a symptom of menopause; the drying and thinning of the tissues of the vagina and urethra. This can lead to dyspareunia (pain during sexual intercourse) as well as vaginitis, cystitis, and urinary tract infections. vaginal hysterectomy - the uterus is removed through the vaginal opening. vaginitis - inflammation, redness, or swelling of the vaginal tissues; usually resulting from a bacterial infection. vaginitis, atrophic - a form of noninfectious vaginitis which usually results from a decrease in hormones because of menopause, surgical removal of the ovaries, radiation therapy, or even after childbirth - particularly in breastfeeding women. Lack of estrogen dries and thins the vaginal tissue, and may also cause spotting. vaginitis, bacterial - very common vaginal infection characterized by symptoms such as increased vaginal discharge or itching, burning, or redness in the genital area. vaginitis, noninfectious - a type of vaginitis that usually refers to vaginal irritation without an infection being present. Most often, the infection is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products. It may also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners. vaginitis, viral - very common vaginal infection, often sexually transmitted, that is caused by one of many different types of viruses (i.e., herpes simplex virus, human papillomavirus). vulva - external, visible part of the female genital area. vulvitis - an inflammation of the vulva, the soft folds of skin outside the vagina. This is not a condition but rather a symptom that results from a host of diseases, infections, injuries, allergies, and other irritants.

W
white blood cells - cells that help the body fight infection and disease.

X
x-ray - electromagnetic energy used to produce images of bones and internal organs onto film.

Y
yeast infection (Also called Candida.) - one type of vaginitis caused by the Candida fungus characterized by itching, burning, or redness of the vaginal area.