This article presents evidence regarding aspects of the gendered nature of care women with gynaecological cancer receive from their (usually) male surgeons and oncologists in Australia. We argue that despite women’s general preference for female gynaecologists, those with a gynaecological cancer develop a strong therapeutic relationship with their male medical specialist, not extended to their (usually) female nurses and other allied health professionals. Given the highly sensitive and sexualized nature of gynaecological cancer, this requires explanation. These findings can be partly (...) explained by examining the division of labour between nurses and doctors, specifically issues of control over this process and the development of specializations. The findings also bring into stark relief the way in which power and status differences can be used by medicine to create a positive therapeutic relationship with patients while simultaneously de-eroticizing the intimate procedures necessary in assisting women throughout their cancer treatment. Importantly, this relationship also has relevance for policy makers, particularly those concerned with the highly gendered division of labour of the medical specialty workforce in Australia. (shrink)

This article reports on moral problems that were raised by medical students as the basis for an ethical case-conference in an obstetrics and gynaecology clerkship. After introducing the issue of teaching clinical ethics, the method of our case-conference is explained. Next, the variety of topics and related moral problems are presented. The article continues with a discussion of three distinct and challenging aspects that characterise obstetrics and gynaecology as a domain for teaching clinical ethics. The conclusion puts forward (...) three significant points our review raises. (shrink)

The compilers of the Hippocratic gynaecological treatises often recommend sexual intercourse as part of treatments for women’s diseases. In addition, they often prescribe the use of ingredients that are obvious phallic symbols. This paper argues that the use of sexual therapy in the Hippocratic gynaecological treatises was more extended than previously considered. The Hippocratic sexual therapies involve a series of vegetable ingredients that were sexually connoted in antiquity, but have since lost their sexual connotations. In order to understand the sexual (...) signification of products such as myrtle and barley, one must turn to other ancient texts, and most particularly to Attic comedies. These comedies serve here as a semiotic guide in decoding the Hippocratic gynaecological recipes. However, the sexual connotations attached to animal and vegetable ingredients in these two genres have deeper cultural and religious roots; both genres exploited the cultural material at their disposal. (shrink)

Gynaecological self-help, a well-known and historical feminist practice from the Second Wave movements which aims at embodying a radical alternative to traditional reproductive politics, is resurging today in France, Switzerland and Belgium. Drawing on empirical observations and interviews, this article questions the links between feminist memory of self-help, the shaping of nostalgia and the production of a political feminist ‘we’. Born at the end of the 1960s in the United States, feminist self-help travelled internationally and was appropriated differently depending on (...) national contexts. This ‘glorious’ history of self-help and, more importantly, its narrated memory, is central to contemporary European self-help activism, as observed in the three national contexts. Drawing on this insight, this article reveals the active memory-oriented emotional work of self-help activists. It examines the ways in which nostalgia for an imagined and lost past is actively and practically produced and encouraged in social movement practices, and highlights the specificity of the kind of collective feminist identity that it shapes and promotes in contemporary self-help politics. (shrink)

Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the (...) field of obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect. (shrink)

Since the founding of the University of Limburg (1974), in The Netherlands, an innovative medical curriculum has been guided by educational principles of problem-orientation, continuous assessment, student initiative and attitude development. The teaching of medical ethics was built into the preclinical curriculum from the start. However, the clinical years remained largely unaffected, and only recently has an effort been made to extend the educational philosophy to this more or less traditional part of medical education. Within this context, an experiment of (...) clinical ethics teaching was introduced in the Obstetrics and Gynaecology (Ob/Gyn) clerkships. The objectives, methods and results of this experimental programme are described in this paper. The success of the teaching is based on three features of the programme: 1) its student-centred approach; 2) the programme is designed in a way similar to regular patient conferences; 3) the programme is taught by a team consisting of both clinician and ethicist. Before starting a longitudinal programme of ethics teaching during the clinical years, it proved very helpful to experiment with a well designed and evaluated pilot programme. (shrink)

Vesico-vaginal fistula (VVF) was a common ailment among American women in the 19th century. Prior to that time, no successful surgery had been developed for the cure of this condition until Dr J Marion Sims perfected a successful surgical technique in 1849. Dr Sims used female slaves as research subjects over a four-year period of experimentation (1845-1849). This paper discusses the controversy surrounding his use of powerless women and whether his actions were acceptable during that historical period.

Introduction The provision of abortion services in the Republic of Ireland is legally restricted. Recent legislation that has been implemented allows for abortion if there is a real and substantial risk to the woman's life, but in general Irish women must travel abroad for abortion services. The aims of this study were to investigate the clinical experiences of Irish obstetric non-consultant hospital doctors that work in this environment and to assess their attitudes towards termination of pregnancy. Methods We conducted an (...) online cross-sectional descriptive survey of 184 Irish obstetric NCHDs. Quantitate and qualitative analysis was performed. Results There was a 28% response rate. 88% of respondents thought that ToP should be permitted for fatal fetal abnormality if the parents choose, 96% if the woman's health is severely affected and 86% in cases of rape and incest. Over 90% of respondents believed a woman's health suffers because of the need to travel abroad to undergo a ToP. Physical, psychological and social reasons were explored. The research also highlights that obstetric trainees are actively involved in the provision of preabortion and postabortion care. Conclusions The clinical experiences and opinions of the respondents suggest that the current legal availability of abortion in Ireland is insufficient to guide best clinical practice and does not represent the views of those that provide obstetric care. (shrink)

Il y a trente ans, évoquant la gynécologie dans l’Antiquité, Giulia Sissa écrivait que l’utérus, « dépositaire insensé et irritable de la reproduction sociale, est le seul organe qui a forcé la connaissance médicale hippocratique à définir en son sein une véritable spécialité ». L’ouvrage de Monica H. Green reprend, en les contextualisant dans un paradigme méthodologique beaucoup plus complexe, ses études précédentes sur la figure historique et littéraire de Trotula et sur la médecine féminin...

Book reviewed in this article: Ethics in Obstetrics and Gynecology. By Laurence B. McCullough and Frank A. Chervenak.

The ArgumentThis paper describes the way in which a simple device, the pregnancy wheel, has been used by the medical profession to impose a new way of measuring and experiencing pregnancy.The change involves counting in weeks instead of counting in months and it is gradually replacing a commonsensical method that had deep physiological and cultural roots. In contrast, the medical methodology of counting forty weeks is more complicated and lacks direct connections to the events of pregnancyIn the encounter between the (...) doctor and the pregnant woman the pregnancy wheel has a variety of uses, among them determinations of the age and estimated size of the fetus.It plays an additional role, however, in the medicalization of pregnancy by providing the doctor with privileged information. It also influences modes of thinking through the way in which it deals with the question of the beginning of pregnancy, a question that has clear moral implications. (shrink)

The aim of this study was to review the typical factors related to physician’s liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain.

The American Journal of Bioethics, Volume 11, Issue 6, Page 1-2, June 2011.

ZusammenfassungEmpirische Daten belegen, dass die moderne Geburtsmedizin Schwangerschaft und Gebären vorrangig als krankhaft wahrnimmt, was zu einem Legitimationsdefizit führt: Eine primär invasive Geburtsmedizin verletzt das Prinzip der Nichtschädigung, verursacht vermeidbare Kosten und ist nicht ohne weiteres durch das Autonomieprinzip gedeckt. Von den unmittelbar Beteiligten ist diese Pathologisierung als eine solche jedoch kaum wahrgenommen worden. Daher stellt sich die Frage, wie es zur sozialen Akzeptanz einer derart drastischen Wahrnehmungsverschiebung kommen konnte. Da Begriffe unsere Wahrnehmung strukturieren, interessiert uns vor allem die konzeptionelle (...) Dimension dieser geburtsmedizinischen Verkehrung des Normalen ins Krankhafte, die in einer Reflexion auf die zwei Quellen legitimen ärztlichen Handelns erkennbar wird. Sowohl der Krankheitsbegriff als auch das moderne Verständnis von Selbstbestimmung weisen eine interne Unschärfe auf, die pathologisierende Tendenzen begünstigt. Der moderne Krankheitsbegriff erschwert eine klare Abgrenzung zwischen krank und gesund. Und Autonomie ist ein mehrdeutiges Konzept, das in einer spezifischen Auslegung die Pathologisierung fördert. Da beide Konzepte ärztliches Handeln rechtfertigen, bleibt ihr delegitimierendes Potential in der Praxis unscheinbar. Erst reflexiv und polylogisch lässt sich dieser blinde Fleck beobachten, so dass eine Korrektur der Pathologisierung möglich wird. (shrink)

This paper describes how an innocent venture outside the confines of academia to update my nursing skills completely changed the focus of my research. I was deeply involved in the theoretical development of my thesis, which I thought was a feminist exploration of the meaning of health for mid‐life women. I was immersed in feminist theory and was exploring the work of the French Feminists. I had written comprehensive draft chapters about nursing, women's bodies and science. While I was absorbed (...) in my theoretical exploration I decided to venture back into practice to improve my nursing skills. I am still unsure why I chose to do this; however, in hindsight, my theoretical exploration was inexorably pushing me in that direction. While my conscious thinking was focused on my stated topic, my subconscious (my intuition) turned me towards another. Being confronted with the reality of nursing practice through working with staff nurses in a gynaecological ward caused a major disjunction in every aspect of my research: the topic, my methodology and the setting, and the experience challenged my feelings about nurses and nursing. This inevitably led to a dramatic and fundamental change in my research. (shrink)

BackgroundObstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive medicine.MethodsThis study was directed to assess the extent and the possible effect of defensive medicine phenomenon on medical decision making among different grades of obstetric and gynaecologic Sudanese doctors, and to determine any experience of medical litigations with respect to sources and factors associated with it.ResultsA total of 117 doctors (...) were approached, their distribution according to job description was as follow: consultants registrars and specialists. The majority 89.7 % had the impression that litigation against doctors are increasing and 27.6 % had a direct experience of litigation. In this study less than one half of the surveyed doctors knew the concept of defensive medicine and 71.8 % reported practicing one or another form of defensive medicine. The different sources of the litigations reported by the doctors included: maternal death, perinatal death, other {misdiagnosis, intra-uterine fetal death, uterine perforation, rupture uterus}, fetal distress, injury to viscera and shoulder dystocia. In this study the experience of medical litigation was significantly observed among those who worked in area of blame culture. In logistic regression model, there was no significant difference between those who knew the concept of defence medicine and those who didn’t.ConclusionThere should be strategic plan to reduce the practice of defensive medicine and medical litigation against doctors. (shrink)

Rufus of Ephesus (fl. c.100c.e.) was a prolific medical author and practitioner in the Imperial period whose historical importance has been obscured by the loss of most of his works. One of the largest gaps in our knowledge of Rufus’ corpus is his gynaecological writings, none of which survives in full. This article assembles and comments on several fragments from Rufus’ lost gynaecological workOn the Retention of Menses(perhapsΠερὶ τῶν ἐπεχομένων ἐμμήνων). Comparison of overlapping passages from the authors Ibn al-Jazzār (tenth (...) century) and Aëtius of Amida (sixth century) reveals that more fragments of this work in Arabic and Greek have survived than previously thought. These fragments provide new evidence for the analysis of Rufus’ medical thought, and further our understanding of gynaecology in the Roman empire. (shrink)

Obstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive..

Women were involved in both practical and theoretical aspects of scientific endeavour in the ancient world. Although the evidence is scant, it is clear that women innovated techniques in textile manufacture, metallurgy, and medical sciences. The most extensive engagement of women in science was in medicine, including obstetrics, gynaecology, pharmacology, and dermatology. The evidence for this often comes from male medical writers. Women were also involved in the manufacture of gold alloys, which interested later alchemists. Maria of Alexandria innovated (...) equipment and techniques while also theorizing about chemical change. Many of the works ascribed to women in antiquity were not written by women. However, they do indicate what sorts of sciences were taken to be the province of women. (shrink)

Every year medical researchers make contact with a large number of cancer survivors with the aim of evaluating cancer treatment. For this reason we decided to investigate how Swedish cancer survivors perceived their participation in research studies focusing on the long-term consequences of being a survivor of gynaecological or urinary bladder cancer. Data were collected by means of two study-specific postal questionnaires, both consisting of questions covering physical symptoms, well-being and the experience of being a cancer survivor. Both questionnaires also (...) included questions evaluating the participants’ experience of being research subjects. The questionnaires were developed in close co-operation with cancer survivors. The study population consisted of 1068 cancer survivors. Of these, 95% (n=1003) reported that they thought the study was valuable and 54% (n=559) that they had been positively affected by participating. Four per cent (n=39) expressed that they had been negatively affected by their participation in the study. The vast majority of the cancer survivors thought that participating in their particular study was valuable. (shrink)