NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation


The "Gyneco-Obstetric-Surgical" Stubbornness and the Perpetuation of One of the Greatest Mistakes of Women's Medicine

Dr. Nelson Soucasaux, Brazilian gynecologist

"... there are neither solid 'scientific' reasons nor logical ones that can justify the insistence on the need for the usual integrated practice of gynecology and obstetrics by the same professional."

"... what seems to exist behind this stubborn position that proclaims the gynecology-obstetrics 'fusion' as being essential is, above all, a situation of 'convenience' in the practice of women's medicine. In my opinion, it is a very well-planned professional strategy for getting more patients, hidden behind pseudo-scientific and pseudo-logical justifications."

"... in a similar way to what happens in many other areas of medicine, would it not be much more reasonable for gynecology to be an essentially clinical speciality, the surgical part of it remaining as another speciality, female pelvic surgery and breast surgery?"

(Nelson Soucasaux, "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology"), Imago Editora, Rio de Janeiro, 1990, pages 33 and 112. )


Before starting this article, I must make it clear that since I live and work in Rio de Janeiro, Brazil, I do not know exactly to which extent the criticisms contained in it are still valid for the present-day situation of women's medicine in other countries - though unfortunately the traditional tie between gynecology, obstetrics and gynecologic surgery has always been basically the same all over the world. (The origin of this traditional tie between the three specialities lies in serious mistakes that are part of the history of women's medicine.)

As I observed in my aforementioned book "Novas Perspectivas em Ginecologia," contrary to many people's suppositions, the "intrusion" of obstetricians and surgeons into gynecology has always been one of the more problematic aspects of women's medicine. Obviously the obstetrician's main interest is directed to pregnant women. This means that they look at women from the point of view of obstetrics (just as gynecologic surgeons look at women from the standpoint of surgery). Nevertheless, as women's medicine, obstetrics is a speciality which by far transcends women, since it is also devoted to embryos and fetuses. (Consider the enormous development of fetal medicine, a new branch of obstetrics.) Obstetrics only takes care of women in very particular periods of their lives, periods in which women house inside their bodies beings other than women themselves and who equally are subject of the speciality. Here we already have one of the enormous differences between gynecology and obstetrics, since gynecology is exclusively devoted to women.

Considering that the great majority of modern women only want to become pregnant and have children in very few moments of their lives, it is easy to see that obstetrics is a speciality that only takes care of women in moments of exception. On the other hand and as opposed to obstetrics, gynecology takes care of women during most of their lives. In this way, as a consequence not only of the need for having more patients but also of the frequent "longing for omnipotence" existing in women's medicine, obstetricians never fail to also practice gynecology. In fact, this is a highly smart "professional strategy" for gaining and preserving the greatest number of patients as possible. Nevertheless, given the increasing complexity of modern medicine, this "strategy" inevitably implies a great loss in the quality of the medical assistance that is provided, since presently it is humanly impossible for the same physician to practice different medical specialities with the necessary competence and expertise (see Note 1, below).

In "Novas Perspectivas em Ginecologia" I made it quite clear that the enormous differences between gynecology and obstetrics concern mostly their respective clinical, physiological, pathological and therapeutic aspects, which are completely different - besides the obvious fact that, while gynecology takes care only of women, obstetrics takes care of women and fetuses. For all these reasons gynecology and obstetrics constitute, without any possibility of reasonable doubt, separate medical specialities. From the point of view of medical science, gynecology and obstetrics have much less in common than it is usually supposed, though, unfortunately, almost nobody wants to recognize this fact. Regarding what happens at least here in Brazil, all the constantly repeated opposing arguments are totally devoid of scientific basis and what they actually intend is, above all, to protect the "tradition" and some professional and "corporate" interests that cannot be publicly mentioned. (As to the increasing domain of these "corporate" interests, what presently is going on in Brazil is truly a shame.)

Considering the enormous technical progress of present-day medicine, from the standpoint of medical knowledge and training it is humanly impossible for the same physician to simultaneously and satisfactorily practice two medical specialities so complex and different as gynecology and obstetrics. Thus, mostly for technical and cognitive reasons, my opinion has always been that only gynecologists should practice gynecology, and only obstetricians obstetrics.

Even so, the insistence on the integrated practice of both specialities by the same professional persists. To my point of view, this attitude is typically illusory and even "megalomaniac." And, to make things worse, at least here in Brazil, that attitude is being stimulated and even "established" by societies of gynecology and obstetrics that, with growing stubbornness and great political power, advocate the continuation of the scientifically irrational "fusion" of both specialities.

As most women regrettably are not aware of the problems resulting from this traditional "fusion" between gynecology and obstetrics, they naively consider the integrated practice of both specialities as "ideal" and "normal." This mistake is understandable on the part of the patients, but unforgivable on the part of the medical class. By the way, sometimes we can even verify the existence of some "confusion" between gynecology and obstetrics on the part of people who are not from the medical area. This happens because most of the physicians who practice women's medicine introduce themselves as "gynecologists and obstetricians." Therefore their colleagues are those who collaborate the most for the maintenance of such "confusion," since they have the greatest interest in satisfying the naive and mistaken "aspirations" of most patients. It is obvious that, professionally, the "gyneco-obstetricians" take the maximal advantage of such position, while patients are frequently harmed without being aware of that. As a result of all of this and regarding professional competition, there is also a subtle process of "exclusion" of the gynecologists who do not practice obstetrics.

Note 1: Because of the present-day accumulation of technical medical knowledge, the possibility of each physician acquiring a complete mastery of his own speciality becomes more and more restricted. This happens because the medical specialities themselves are going through a continuous process of division into subspecialities. In this way, the traditional habit of the practice of gynecology, gynecologic surgery and obstetrics by the same physician becomes more and more impracticable and absurd because it actually implies the practice of three different specialities by the same professional. Considering the human limitations - not only cognitive, but also of training and continuous updating -, will it be possible for the same physician to practice these three areas with the necessary competence? (Here I am also criticizing the traditional view of gynecology as "surgical speciality," as a consequence of which almost all gynecologists are surgeons.)

Note 2: Regarding the aforementioned traditional view of gynecology as "surgical speciality," it is also devoid of scientific basis, since the clinical part of the speciality by far exceeds the surgical one. This is another distortion coming from the past and that, along the last decades, became entirely unjustifiable from the scientific point of view. Therefore, there are no reasons at all for the insistence on combining the practice of gynecology with the surgical activity.

Note 3: As to the already mentioned "longing for omnipotence" in women's medicine: it is clearly demonstrated by the fact that almost all physicians devoted to it insist on practicing gynecology, gynecologic surgery and obstetrics, that is, three different specialities simultaneously. For a better understanding of the subject exposed here, see chapter "O Impasse na Medicina da Mulher" ("The Impasse in Women's Medicine") from my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology"). In my own site www.nelsonginecologia.med.br, see also the topics "The Traditional Tie of Gynecology to Obstetrics and Surgery: Deep-rooted conditioning coming from the past and devoid of scientific basis" and "The Obstetric Strategy in Women's Medicine", at page "Temas Polêmicos" ("Polemical Subjects"). ( Direct links to these topics can be found below ).

_____________________________________________

Nelson Soucasaux is a gynecologist dedicated to clinical, preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993

Website: www.nelsonginecologia.med.br

Links to the articles mentioned above:

1) "The Traditional Tie of Gynecology to Obstetrics and Surgery: Deep-rooted conditioning coming from the past and devoid of scientific basis" : http://www.nelsonginecologia.med.br/temas.htm#traditionaltie

2) "The Obstetric Strategy in Women's Medicine": http://www.nelsonginecologia.med.br/temas.htm#obstrategy

E-mail: nelsons@nelsonginecologia.med.br


NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation