Introduction To Gynaecology

Introduction To Gynaecology

Gynaecology is the study of diseases affecting the female reproductive system.

As the genital tract is closely linked anatomically with the urinary tract and the large bowel, certain disorders of the urethra, bladder and rectum may lead the woman to a gynaecologist.

General causes of gynaecological problems

  • Congenital abnormalities: eg absence of the vagina, ovaries, uterus or divided uterus.
  • EnvironmentThis can cause physical or mental stress or anxiety that can lead to absence of menstruation.
  • Pathological agentsIn relation with entry of pathogenic micro-organisms which may lead to vaginitis, vulvitis etc.
  • TraumaGenetic organs may be traumatized by instruments leading to fistula.

Clinical methods of assessing a gynaecological patients.

  • History taking

The most important information is always provided by the patient or relatives. History taking tactics are required for it is concerned with discussing intimate matters. Therefore, privacy is essential in order to get reliable information from the patient.

  1. Personal dataThis includes name, age, address, next of kin, occupation, religion, tribe etc.
  2. Presenting complaints: eg Pain onset
  • Where it is felt
  • Intensity
  • Defecation or micturition
  • Dyspareunia

      3. History of presenting complaints.

  1. Obstetric history: Number of pregnancies, abortion, type of delivery, history of trauma, prolonged labour etc.
  2. Menstrual cycle: Menarche, regularity, duration and length of cycles, volume of blood loss etc. 
  3. Social history: Look out for marital status, life style, smoking, alcohol, occupation etc. 
  4. Past medical and surgical history: Has she ever suffered from a serious disease eg. Tuberculosis, had an accident which involved the spine, pelvis and lower limbs or any operation on her pelvic organs.
  5. Gynaecological history: Has she ever had any gynaecological condition like fibroids, rectal vaginal fistula, vesicle vaginal fistula, perennial tears, abortions etc., any operations on the cervix or dilation and curettage. 

        4.  Examination 

  1. General examination

The general examination is important in gynaecology. This is done from head to toe. Note. 

  • General appearance of the patient
  • Behavior
  • Look out for signs of anaemia
  • Examine breasts: Look for signs of pregnancy and any discharge.  Examine the breast to exclude malignancies.
  • Abdomen It is inspected for size and shape and palpated for tumours.
  • Pelvic examination: This is the last examination done to confirm the diagnosis already suspected during history taking.


  • The patient should consent for the examination, if not married, parents can consent for her because the hymen can be broken.
  • The patients bladder and bowels must be empty.
  • Good light is also needed.

      2. Vaginal examination

Each part of the genital tract should be examined in a logical sequence;

  • Vulva
  • Vagina
  • Cervix (inspect for tears, prolapse etc.)
  • Body of the uterus
  • Pouch of Douglas

NB: The cervix and uterus should be examined for size, shape, position and tenderness.

Special procedures and investigations

These are useful to fill gaps which remain after history taking during clinical assessment.

  1. EvacuationIt refers to removal of the contents of a cavity. It is done when pelvic examination has not been possible. Its disadvantage is that important signs of tenderness are missed out. (examination is done under anaesthesia)
  2. Curettage:  Refers to scrapping of the internal surface of an organ or body cavity by means of a spoon shaped instrument called a curette. It is done to; Remove retained products of conception and to obtain a specimen for diagnostic purposes
  3. Biopsy:  This is the removal of a small piece of leaving tissue from an organ or part of the body for microscopic examination so as to exclude certain diseases. It can be obtained from the cervix, endometrium etc.
  4. Ultra sound scanThe use of ultrasound produces images of structures in the human body using sound waves of high frequency. This is now used widely to detect diseases of the pelvic organs and pregnancy.
  5. HysterosalpingographyRefers to x-ray imaging of the uterus and fallopian tubes. It is useful in diagnosing;
  • Tubal obstruction
  • Peritubal and intrapelvic adhesions
  • Malformations of the uterus
  • Small intracavity tumours
  • Detect the internal os of the cervix causing abortion and premature labour.

      6. LaparoscopyExamination of abdominal structures by means of a laparoscope (type of endoscope). This is passed through a small incision in the wall of the abdomen. Used when;

  • Taking a biopsy
  • Aspirating cysts
  • Dividing adhesions
  • Collecting ova for vitro fertilization


  • Hysterectomy: This is surgical removal of the uterus.

    Types of hysterectomy

  1. Wertheim’s hysterectomyIt’s a radical operation performed for cervical cancer involving removal of the entire uterus, the connective tissue and lymph nodes close to it, fallopian tubes, ovaries and the upper part of the vagina.
  2. Subtotal hysterectomySurgical removal of the body of the uterus leaving the neck (cervix) in place.
  3. Total hysterectomySurgical removal of the entire uterus.


  • Fibroids 
  • Cancers
  • Raptured uterus
  • Salpingectomy : Refers to surgical removal of the fallopian tubes.


  • Raptured ectopic pregnancy
  • Chronic salpingitis
  • Vesico-vaginal fistula repair :This is an operation done to repair an abnormal communication between the bladder and vagina.
  • Oophorectomy :This is the surgical removal of the ovary(s)


  • Tumours of the ovary
  • Chronic oophoritis
  • Myomectomy : Refers to surgical removal of one or more fibroids from the uterus.
  • Rectal vaginal fistula : An operation done to repair an abnormal communication between the rectum and vagina.
  • Mastectomy : Surgical removal of the breast.


  1. Radical mastectomySurgical removal of the breast with the skin and all lymphatic tissue of the armpit. It is performed when breast cancer has spread to involve the lymph nodes.
  2. Simple mastectomySurgical removal of the breast retaining the skin and if possible the nipple. It is performed for extensive but not necessarily invasive tumours.
  • Tubal ligation :An operation done by tying and cutting of fallopian tubes which is used as a permanent family planning method.
  • VulvectomySurgical removal of the vulva.


  1. Simple vulvectomyExcision of the labia majora, minora and clitoris to eradicate a non-malignant growth.
  2. Radical vulvectomyExcision of the labia majora, minora, clitoris and all regional lymph nodes on both sides together with the skin covering these areas. It is carried out in malignant growths.
  • Dilatation and curettage

An operation in which the cervix(neck) neck of the uterus is dilated using a dilator (heggar’s dilators) and the endometrium is lightly scrapped off with a manual curette or removed by suction using an aspirator.


  • Removal of any retained products after abortion
  • Obtaining endometrial biopsy for histological examination.
  • Perineoplasty: An operation done to enlarge the vaginal opening by incising the hymen and part of the perineum.
  • Perineorrhaphy: Surgical repair of a damaged perineum. The damage is usually as a result of a tear sustained during child birth.

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