Editing Gynaecology (section)

==Examination==
[[File:Gynaecology-1822.jpg|thumb|The historic taboo associated with the examination of [[Female reproductive system (human)|female genitalia]] has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygrier shows a "compromise" procedure, in which the [[physician]] is kneeling before the woman but cannot see her genitalia. Modern gynaecology no longer uses such a position.<ref>{{Cite web |last=Modesty |first=Medical Patient |title=History of Modern Gynecology |url=https://patientmodesty.org/moderngynecologyhistory.aspx |archive-url=http://web.archive.org/web/20250226210059/http://patientmodesty.org/moderngynecologyhistory.aspx |archive-date=2025-02-26 |access-date=2025-04-13 |website=patientmodesty.org}}</ref>]]

In some countries, women must first see a [[general practitioner]] (GP; also known as a family practitioner (FP)) prior to seeing a gynaecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynaecologist. In other countries, laws may allow patients to see gynaecologists without a referral. Some gynaecologists provide [[primary care]] in addition to aspects of their own specialty.<ref>{{Cite journal |last1=Beyer |first1=M |last2=Gerlach |first2=Fm |last3=Flies |first3=U |last4=Grol |first4=R |last5=Król |first5=Z |last6=Munck |first6=A |last7=Olesen |first7=F |last8=O’Riordan |first8=M |last9=Seuntjens |first9=L |last10=Szecsenyi |first10=J |date=August 2003 |title=The development of quality circles/peer review groups as a method of quality improvement in Europe. |url=https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmg420 |journal=Family Practice |language=en |volume=20 |issue=4 |pages=443–451 |doi=10.1093/fampra/cmg420 |pmid=12876119 |issn=1460-2229}}</ref> With this option available, some women opt to see a gynaecological surgeon for non-gynaecological problems without another physician's referral.

As in all of medicine, the main tools of diagnosis are clinical history, examination and investigations.<ref>{{Citation |last1=Balogh |first1=Erin P. |title=The Diagnostic Process |date=2015-12-29 |work=Improving Diagnosis in Health Care |url=https://www.ncbi.nlm.nih.gov/books/NBK338593/ |access-date=2025-04-13 |publisher=National Academies Press (US) |language=en |last2=Miller |first2=Bryan T. |last3=Ball |first3=John R. |last4=Care |first4=Committee on Diagnostic Error in Health |last5=Services |first5=Board on Health Care |last6=Medicine |first6=Institute of |last7=The National Academies of Sciences |first7=Engineering}}</ref> Gynaecological examination is quite intimate, more so than a routine physical exam. It also requires unique instrumentation such as the [[speculum (medical)|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 and one or two fingers in the vagina) to palpate the cervix, uterus, [[Ovary|ovaries]] and bony [[human pelvis|pelvis]].<ref>{{Citation |last=Long |first=W. Newton |title=Pelvic Examination |date=1990 |work=Clinical Methods: The History, Physical, and Laboratory Examinations |editor-last=Walker |editor-first=H. Kenneth |url=https://www.ncbi.nlm.nih.gov/books/NBK286/ |access-date=2025-04-13 |edition=3rd |place=Boston |publisher=Butterworths |isbn=978-0-409-90077-4 |pmid=21250129 |editor2-last=Hall |editor2-first=W. Dallas |editor3-last=Hurst |editor3-first=J. Willis}}</ref> It is not uncommon to do a [[rectovaginal examination]] for a complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists may have a female [[chaperone (clinical)|chaperone]] for their examination. An abdominal or vaginal [[obstetric ultrasonography|ultrasound]] can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.<ref>{{Citation |last1=Karena |first1=Zalak V. |title=Sonography Female Pelvic Pathology Assessment, Protocols, and Interpretation |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK585034/ |access-date=2025-04-13 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=36251809 |last2=Mehta |first2=Aditya D.}}</ref>