Gynecology — Find Specialists & Top Hospitals Worldwide | MyMedicPlus

Gynaecology is the medical and surgical specialty focused on the health of the female reproductive system, encompassing the uterus, ovaries, fallopian tubes, cervix, vagina, and vulva, as well as conditions affecting the pelvic floor, urinary system, and breasts within the context of women's health. The specialty addresses the full lifecycle of reproductive health — from adolescence through the menopausal transition and beyond.

In most countries, gynaecology is practised in combination with obstetrics as the combined specialty of Obstetrics and Gynaecology (OB/GYN), though many specialists choose to focus their practice primarily on one or the other. Pure gynaecologists who do not provide obstetric care focus on the diagnosis and management of gynaecological conditions in non-pregnant women.

Several important subspecialties have developed within gynaecology. Gynaecologic oncology specialises in cancers of the female reproductive tract — cervix, uterus (endometrium), ovary, vagina, and vulva. Urogynaecology (also called female pelvic medicine and reconstructive surgery, FPMRS) manages pelvic organ prolapse and urinary incontinence. Reproductive endocrinology and infertility (REI) addresses hormonal causes of infertility and oversees assisted reproductive technologies. Minimally invasive gynaecological surgery (MIGS) subspecialists perform complex laparoscopic and robotic operations for endometriosis, fibroids, and other pelvic conditions. Maternal-foetal medicine (MFM) specialists manage high-risk obstetric cases.

Gynaecology is unique among specialties in that it provides both primary preventive care — well-woman examinations, cervical cancer screening, contraceptive counselling, sexually transmitted infection testing — and complex surgical management of uterine, ovarian, and pelvic conditions within the same specialty framework.

Gynaecologists diagnose and manage a wide range of conditions affecting the female reproductive system and pelvic floor:

• Dysmenorrhoea (painful periods): Primary dysmenorrhoea (without identifiable pathology) and secondary dysmenorrhoea due to endometriosis, fibroids, or adenomyosis; managed with NSAIDs, hormonal therapies, or surgical treatment of the underlying cause.
• Menorrhagia (heavy menstrual bleeding): Excessive menstrual blood loss impairing quality of life and causing iron deficiency anaemia; causes include fibroids, polyps, adenomyosis, coagulopathy, and structural uterine abnormalities.
• Amenorrhoea: Absence of menstruation (primary — never had periods; secondary — cessation for 3+ months); may reflect hypothalamic-pituitary dysfunction, ovarian failure, hormonal imbalance, or anatomical obstruction.
• Polycystic ovary syndrome (PCOS): The most common endocrine disorder in women of reproductive age, causing menstrual irregularity, androgen excess (hirsutism, acne), polycystic ovaries, and insulin resistance.
• Endometriosis: Growth of endometrial-like tissue outside the uterus on the ovaries, fallopian tubes, bowel, bladder, and pelvic peritoneum, causing chronic pelvic pain, dysmenorrhoea, dyspareunia, and infertility.
• Uterine fibroids (leiomyomata): Benign smooth muscle tumours of the uterus, extremely common (present in 70–80% of women by age 50); may cause menorrhagia, pelvic pressure, urinary frequency, and infertility depending on size and location.
• Ovarian cysts: Benign functional cysts (follicular or corpus luteal), dermoid cysts (teratomas), endometriomas, or serous cystadenomas; differentiated from malignancy by ultrasound features, CA-125, and risk scoring systems.
• Pelvic inflammatory disease (PID): Upper genital tract infection (endometritis, salpingitis, tubo-ovarian abscess) caused by ascending sexually transmitted bacteria; requires prompt antibiotic treatment to prevent tubal damage and infertility.
• Cervical dysplasia and HPV-related disease: Precancerous changes (CIN grades 1–3) detected by cervical smear and colposcopy; CIN2/3 is treated with LLETZ (large loop excision of the transformation zone) to prevent progression to cervical cancer.
• Pelvic organ prolapse: Descent of the uterus, bladder (cystocele), rectum (rectocele), or small bowel into the vaginal canal due to pelvic floor weakness after childbirth or with ageing.
• Urinary incontinence: Stress urinary incontinence (leakage with cough, sneeze, or exercise) and urgency urinary incontinence (overactive bladder); managed medically, with pelvic floor physiotherapy, or surgically.
• Gynaecological cancers: Cervical, endometrial (uterine), ovarian, vaginal, and vulvar cancers — from screening and diagnosis through surgical staging and adjuvant treatment coordination.

Gynaecologists perform a range of diagnostic and surgical procedures:

• Cervical smear (Pap test) and HPV testing: Cytological examination of cervical cells to screen for precancerous changes and HPV infection; performed in the clinic without anaesthesia as part of well-woman care.
• Colposcopy: Magnified examination of the cervix after an abnormal smear, with targeted biopsies of suspicious areas; used to grade cervical intraepithelial neoplasia (CIN) and plan treatment.
• Large loop excision of the transformation zone (LLETZ / LEEP): Excision of the cervical transformation zone using an electrosurgical loop under local anaesthesia; treats CIN2 and CIN3 with high cure rates and preserves fertility in most cases.
• Hysteroscopy: Direct visualisation of the uterine cavity with a narrow telescope passed through the cervix; diagnostic for polyps, fibroids, adhesions, and uterine anomalies; operative hysteroscopy allows simultaneous resection of polyps, submucosal fibroids, and uterine septa.
• Laparoscopy: Keyhole surgical inspection of the pelvis and abdomen under general anaesthesia; diagnostic (unexplained pelvic pain, suspected endometriosis, infertility evaluation) and operative (treatment of endometriosis, ovarian cystectomy, ectopic pregnancy).
• Endometrial biopsy (pipelle): Office-based sampling of the endometrial lining using a thin plastic cannula to investigate abnormal uterine bleeding or postmenopausal bleeding; screens for endometrial cancer and hyperplasia.
• Dilation and curettage (D&C): Mechanical dilation of the cervix and scraping of the uterine cavity to diagnose and treat conditions causing abnormal bleeding, or to complete management of miscarriage.
• Hysterectomy: Surgical removal of the uterus (total — including cervix; subtotal — body only); approaches include abdominal, vaginal, laparoscopic, and robotic. Performed for menorrhagia refractory to other treatment, fibroids, endometriosis, prolapse, and gynaecological cancers.
• Myomectomy: Surgical removal of uterine fibroids while preserving the uterus; performed hysteroscopically (submucosal fibroids), laparoscopically, or by open abdominal surgery depending on fibroid size, number, and location.
• Endometrial ablation: Minimally invasive destruction of the endometrial lining using thermal, radiofrequency, or microwave energy to treat menorrhagia; preserves the uterus but eliminates future pregnancy potential.

Regular gynaecological care provides both preventive screening and management of symptomatic conditions throughout a woman's reproductive life and beyond.

Seek urgent gynaecological evaluation for: postmenopausal vaginal bleeding (any bleeding after 12 months of amenorrhoea requires endometrial assessment to exclude uterine cancer); sudden, severe pelvic pain suggesting ruptured ovarian cyst, ovarian torsion, or ectopic pregnancy — all potential surgical emergencies; heavy vaginal bleeding requiring pad changes every hour for two or more consecutive hours; and fever with pelvic pain and purulent vaginal discharge suggesting pelvic inflammatory disease requiring urgent antibiotic treatment to prevent tubal damage.

Routine gynaecology referral is appropriate for: dysmenorrhoea causing school or work absence that has not responded to NSAIDs and oral contraceptive pills; heavy periods causing anaemia or significantly impairing quality of life; pelvic pain lasting more than 6 months; suspected endometriosis or adenomyosis; a pelvic mass identified on ultrasound requiring characterisation; an abnormal cervical smear result requiring colposcopy; recurrent vaginal infections not responding to standard treatment; menopausal symptoms significantly affecting quality of life; and incontinence or prolapse symptoms affecting daily activities.

All women should have an initial gynaecological assessment by age 21 (or earlier if sexually active), including cervical cancer screening according to national guidelines — typically from age 21 (USA) or 25 (UK) — and contraceptive counselling. Annual well-woman examinations provide the opportunity for preventive screening, STI testing, breast examination, and opportunistic health promotion.

Gynaecologists and OB/GYNs in the USA complete a 4-year medical degree (MD or DO) followed by a 4-year residency in obstetrics and gynaecology. The residency provides comprehensive training in all aspects of reproductive medicine including normal and high-risk obstetrics, gynaecological surgery, gynaecologic oncology, urogynaecology, infertility, and reproductive endocrinology. Resident operative experience includes hysterectomy, laparoscopy, caesarean section, and vaginal delivery skills.

Board certification is conferred by the American Board of Obstetrics and Gynecology (ABOG) through a written examination after residency and an oral examination approximately 2 years into independent practice. Recertification every 6 years ensures ongoing competency.

Four recognised ABOG subspecialties each require a 3-year fellowship after OB/GYN residency: gynaecologic oncology (cancers of the female reproductive tract); maternal-foetal medicine (high-risk pregnancy); reproductive endocrinology and infertility (REI — hormonal disorders and ART); and female pelvic medicine and reconstructive surgery (urogynaecology — pelvic floor and incontinence). Minimally invasive gynaecological surgery (MIGS) is a newer fellowship pathway specifically focused on advanced laparoscopic and robotic procedures for endometriosis and fibroids.

In the UK, OB/GYN specialty training runs for 7 years (ST1–ST7) under the JRCPTB, leading to CCT in Obstetrics and Gynaecology. Subspecialty training in gynaecological oncology, urogynaecology, reproductive medicine, and maternal-foetal medicine is available through the Royal College of Obstetricians and Gynaecologists (RCOG) subspecialty training programmes.

Women can self-refer to a gynaecologist for routine well-woman care including cervical screening, contraception, and menstrual health. For complex conditions, specialist referral from a primary care physician is appropriate. Verify ABOG board certification through the ABOG website. When selecting a gynaecologist, consider whether you need a general gynaecologist for routine care, or a subspecialist — a gynaecologic oncologist for cancer, a urogynaecologist for prolapse or incontinence, or a fertility specialist (REI) for infertility.

For your first appointment, bring information about your menstrual cycle (cycle length, duration, flow, and associated symptoms), complete obstetric and gynaecological history (prior pregnancies, deliveries, contraceptive use, prior cervical smear results, STI history, pelvic surgeries), a list of medications and allergies, and any relevant imaging reports (pelvic ultrasound).

For cancer screening, follow your national cervical cancer screening programme guidelines: in the USA, cervical screening begins at age 21 with cytology every 3 years, or co-testing (cytology plus HPV) every 5 years from age 25–65. HPV vaccination (Gardasil 9) is recommended for all adolescents aged 9–12, and catch-up vaccination is recommended for individuals aged 13–26. Endometrial cancer screening is not recommended routinely for the general population — any postmenopausal bleeding requires prompt gynaecological assessment.