Gynecology
An obstetrician/gynecologist, commonly referred to as an OB/GYN, is a medical doctor who specializes in the female reproductive system. These physicians treat all the associated disorders and diseases specific to women. OB/GYN doctors also specialize in health maintenance, disease prevention, diagnosis and treatment.
Doctors who choose this specialty start with a medical degree in internal medicine, but then take an additional four years of training. During their training, OB/GYN physicians learn about reproductive and primary health care for women. The fields of study focus on women’s issues, making them valuable partners for consultation with other physicians. Internists, family doctors and general practitioners rely on these specialists for their expert advice and diagnostic skills.
Most practicing OB/GYNs continue to study to keep up with the changing technologies of the health care field. Some choose to:
- Pursue further specialization within their field
- Care for especially high-risk patients
- Focus on surgery to correct physical problems
- Fight diseases of the female reproductive system
- Concentrate on other aspects of the reproductive process
Obstetrics and Gynecology as a Career
The field of gynecology is quite diverse. Doctors in this specialty can choose to help women who suffer from a large number of problems arising from their reproductive systems. Most local Manhattan OB/GYNs see a wide range of problems in their offices every day. They can perform surgery, manage labor and even deliver babies. These doctors give women preventative exams, including those a primary care physician would do.
A gynecologist can be your primary care doctor, or you may be referred to an OB/GYN by your internist or family doctor for a specific reason. An OB/GYN can identify any reproductive system problems that may exist, including infertility, abnormal bleeding and pelvic pain. Other conditions that can be diagnosed in your OB/GYN’s office or with further testing include:
- Pelvic masses
- Pelvic organ prolapse
- Abnormal pap smears
- Endometriosis
- Breast disorders
- Incontinence
Typical Gynecological Procedures
OB/GYNs perform most minor procedures right in the office, including complete physical examinations. Your gynecologist may decide that an in-office procedure is appropriate to diagnose certain conditions as soon as possible, rather than waiting for an appointment and lab results. For example, an ultrasound procedure can be done for both obstetric and gynecologic diagnosis in the office. This test provides a visual picture of your inner pelvic area.
Other diagnostic tests that can be done in the office include:
- Pap smear: This common test checks the inside walls of your cervix to screen for abnormal cells.
- Colposcopy: This test provides a closer examination of the tissues following an abnormal pap smear.
- Endometrial biopsy: This is a screening technique that’s used to look for abnormal tissues.
- Diagnostic laparoscopy: This test is used to identify problems inside your reproductive system, including your uterus.
- Diagnostic hysteroscopy: This is another diagnostic procedure to examine the inside of your uterus.
- Vulvar biopsy: This is a screening test to detect cancer around your labia.
Your OB/GYN routinely performs many other procedures on an outpatient basis, such as:
- Laser surgery: This procedure can be minimally invasive, depending on its purpose.
- Tubal ligation: A procedure that surgically blocks your fallopian tubes, permanently preventing pregnancy.
- Operative laparoscopy: This surgical procedure corrects the problems inside your reproductive system discovered during a diagnostic laparoscopy.
- Endometrial ablation: This procedure uses a laser or other device to destroy the lining of your uterus to treat abnormal bleeding.
In-Patient Care
Gynecologists do perform surgeries that require at least an overnight stay in the hospital. In some cases, these procedures require general anesthesia. In other cases, your OB/GYN may feel it’s safer for you to stay in the hospital for observation after a specific procedure. Your doctor always tells you if your procedure requires you to be an inpatient.
Some examples of inpatient surgery are hysterectomies, whether performed abdominally, vaginally or laparoscopically. The different techniques depend upon your specific situation. Other in-patient procedures may include:
- Myomectomy: This surgical procedure removes fibroid cysts from your uterus.
- Dilation and curettage: A D&C involves dilating your cervix and cleaning out the contents of your uterus, usually after a miscarriage.
- Cervical cerclage: This procedure uses a suture to keep your cervix closed during pregnancy, which can prevent premature opening and miscarriage.
- Amniocentesis: This involves inserting a needle into your uterus during pregnancy to draw out fluid to be analyzed and screened for possible issues with your fetus.
- Cesarean section: This is needed when your baby must be surgically removed from your uterus to prevent injury to you or your child.
- Forceps or vacuum delivery: When your baby is delivered vaginally, but you need some extra help forcing it out of the birth canal, this procedure can help.
- Circumcision: This is specifically a male procedure.
Subspecialty Fellowships
There are four subspecialty fellowships that an OB/GYN can pursue. These fellowships take an additional three years on top of the four-year core OB/GYN training program. One of the three years of the fellowship must be devoted to research. The four fellowships are:
- Gynecologic oncology
- Reproductive endocrinology
- Female pelvic medicine and reconstructive surgery
- Maternal fetal medicine
Gynecologic oncology deals primarily with cancers of the reproductive organs: the uterus, ovaries, cervix and vulva. Reproductive endocrinology involves the entire field of infertility and all of the treatments and procedures used to resolve infertility issues. Female pelvic medicine and reconstructive surgery treats women who have pelvic organ prolapse, incontinence, and other disorders of the urinary tract. Maternal fetal medicine deals primarily with women who have health issues that make their pregnancies complicated or risky.
In General
Close to 90 percent of doctors in the gynecological specialty are generalists and begin their practices after four years of residency and training in the field. If they’re in private practice, they usually have office hours two to four days a week, with the other days devoted to labor and delivery.
A OB/GYN generalist typically is part of a group, but some have their own solo practices. OB/GYNs form group practices to make it easier for them to cover all of the different aspects of the female reproductive system, from labor and delivery to infertility treatments and biopsies. You can get the best care from an experienced OB/GYN who understands the diverse set of problems that women deal with throughout their lives.
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