Definition and Overview
Obstetrics and gynaecology is the field of medicine that focuses on the care of the female reproductive system. An obstetrician deals primarily with the management of pregnancy, and is responsible for overseeing the labor process and the pueperium, or the period that directly follows childbirth. A gynaecologist, on the other hand, is involved in the general health of the female reproductive system. This includes the diagnosis, treatment, and management of obstetric complications, and comes with a surgical component. Since these two sub-fields are available under a combined training programme, a physician who has completed training is called an OB/GYN and plays both roles simultaneously.
Training and certification
Physicians who wish to specialize in these fields are required to hold a medical degree and to complete an OB/GYN residency program, which has a minimum length of 4 years. The residency program will expose the physician to the different subspecialties of the field. At least six months of the residency will also be dedicated to the primary and preventive care, which includes ambulatory care, in-patient care, and performance and interpretation of pelvic and transvaginal ultrasound. Patient interaction and responsibility gradually increases with each year of residency. During the final year, the physician will serve as a chief resident.
Following the residency training, the physician will be allowed to take the certifying examination. Once the examination is passed, the physician will be granted a board certification in Obstetrics and Gynaecology, after which, further subspecialty certifications may be pursued.
In some places, OB/GYNs are required to complete recertification processes every 10 years.
Due to the wide range of this combined field, it is divided into different subspecialties, including:
Maternal and fetal medicine – This is the subspecialty that focuses on the medical and surgical management of high-risk pregnancies. Its goal is to provide the much-needed care to both mother and fetus. It also deals with medical problems during pregnancy as well as obstetrical complications. These include amniotic fluid embolism, fetal growth restriction, eclampsia, cervical insufficiency, neural tube defects, uterus malposition, perimortem caesarean delivery, preeclampsia, postpartum hemorrhage, pre-term labor, umbilical cord complications, uterine rupture, placenta previa, and so many others.
Reproductive endocrinology and infertility – This focuses on interventional treatment for infertility cases, and includes investigation of the biological causes of infertility. This subspecialty deals specifically with amenorrhea, anovulation, assisted reproduction technology, dysfunctional uterine bleeding, polycystic ovarian syndrome, prolactin deficiency, among other problems.
Gynecological oncology – This subspecialty deals with the diagnosis, staging, and treatment of cancers affecting the reproductive organs as well as the continuous and comprehensive management throughout the treatment period. It deals with uterine cancer, vaginal cancer, vulvar cancer, germ cell tumors, cervical cancer, fallopian tube cancer, and gestational trophoblastic cancer, among others. An OB/GYN who wishes to specialize in oncology should have knowledge of major cancer treatments and complications of oncology.
Female pelvic reconstructive surgery – Focused on the diagnosis and treatment of women suffering from urinary incontinence and pelvic prolapse, this is considered as a surgical subspecialty wherein surgery is the main treatment. Also known as urogynecology, it requires knowledge of different pelvic conditions such as pelvic floor dysfunction.
Laparoscopic surgery – This subspecialty deals with the use of the laparoscopic surgical technique as a minimally invasive alternative for the surgical management of gynaecological disorders.
Family planning – This subspecialty deals with contraception and termination of pregnancy.
Pediatric and adolescent gynaecology – This provides gynaecological care to young patients.
Menopausal and geriatric gynaecology – This deals with the management of menopausal symptoms among elderly women.
Each of these subspecialties has individual certification exams. Obstetrician/gynaecologists can specialize in more than one of them.
When should you see an OB/GYN
If you are in need of medical assistance due to the following reasons, it is time to visit an obstetrician/gynaecologist.
- Pregnancy, labor, and childbirth
- Irregular menstrual periods
- Sexually transmitted disease, such as genital herpes or HIV
- Urinary tract disorder
- Pelvic prolapse
- Uterine prolapse
- Bacterial vaginosis
- Benign lesions of the ovaries, cervix, or vulva
- Chronic pelvic pain
- Ectopic pregnancy
- Elective abortion
- Estrogen therapy
- Ovarian cyst
- Other infections such as cervicitis, chlamydia, pelvic inflammatory disease
An OB/GYN is also involved in the prevention of diseases and general maintenance of reproductive health. Thus, you should see an OB/GYN if you are in need of screening such as a Pap test.
Obstetricians also provide treatment and management for pregnancy complications such as breech presentation, abnormal puerperium, post-term pregnancy, pre-natal nutrition, drug use during pregnancy, and so on.
Visiting an OB/GYN
It is normal for women to feel embarrassed during a first consultation with an OB/GYN since these health professionals deal with personal and sensitive health concerns and inevitably examine the most private parts of a woman's body. Some issues, such as sexually transmitted diseases or family planning, may also be considered as private or intimate.
Since this medical specialty involves some of the most important health issues women face in their lives, such as childbirth, birth control, and menopause, it is important to find an obstetrician/gynaecologist that a patient can trust and be comfortable with. Some patients prefer to maintain a relationship with just one obstetrician/gynaecologist who can provide the care they need throughout their life.
It is also important that a woman regularly receive screening from a gynaecologist once she reaches a sexually active age, just as it is important for a pregnant woman to receive pre-natal care from an obstetrician all throughout her pregnancy.
What to expect during OB/GYN consultation
It is highly recommended that girls aged 13 to 15 have their first OB/GYN visit. The first consultation for adolescent girls will usually involve just a discussion with the doctor and will not involve a physical exam. The doctor will ask some general questions about personal and family health history.
A nurse will typically take the patient's weight and blood pressure, and additionally, a urine test, if necessary. If you are sexually active, the doctor may require additional screening tests for sexually transmitted diseases.
If there are complications or symptoms, the visit may require a physical exam, which involves examining the outside of the vagina, vulva area, vaginal opening, and reproductive organs. If you are due for a physical exam, avoid having sex or douching within 24 hours of your OB/GYN visit; sexual activity can affect the results of screening tests such as a Pap test.
- Freund K. Approach to women's health. In: Goldman L, Ausiello D, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 245.
- Schrager SB, Paladine HL, Cadwallader K. Gynecology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 25.