The Woman’s Health Examination
Obstetrics was originally a separate branch of medicine, andgynecology was a division of surgery.
Knowledge of the pathophysiology of the female reproductive tract led to a natural integration of these two areas, and obstetrics and gynecology merged into a single specialty. Obstetricians can now undergo further training in maternal fetal medicine, which deals with high-risk pregnancies and prenatal diagnosis. Likewise, gynecology nowincludes general gynecology (which deals with nonmalignant dis-orders of the reproductive tract and associated organ systems, family planning, and preconception care), gynecologic oncology, reproductive endocrinology–infertility, and pelvic reconstructive surgery and urogynecology. These areas constitute the major-ity of the requisite knowledge and skills expected of the fully trained obstetrician–gynecologist specialist.
Currently, many obstetrician–gynecologists also pro-vide complete care for women throughout their lives. Obstetrician–gynecologists should have additional knowl-edge and skills in primary and preventive health care needs of women, and be able to identify situations in which to refer patients to specialists. Obstetrician–gynecologists must be able to establish a professional relationship with patients and be able to perform a general and woman’s health history, review of systems, and physical examination. Finally, as with all physicians, obstetrician–gynaecologists must fully understand the concepts of evidence-based med-icine and incorporate them into their scholarship and prac-tice in the context of a well-established pattern of lifelong learning and self-evaluation.
The demographics of women in the United States are undergoing profound change. A woman born today will live 81 or more years, experiencing menopause at 51 to 52 years of age. Unlike previous generations, they will spend more thanone-third of their lives in menopause. The absolute number andthe proportion of all women over the age of 65 are projected to increase steadily through 2040 (Fig. 1.1). These women will expect to remain healthy (physically, intellectually, and sexually) throughout menopause. Health care providers must keep the needs of this changing population in mind in their practice of medicine, especially in the provision of pri-mary and preventive care.