Hysterectomy is performed for a wide range of benign and malignant conditions, such as fibroids, menorrhagia and pelvic pain, and gynaecological malignancies. One in four women has a chance of undergoing hysterectomy in her lifetime. Conventionally abdominal hysterectomy is done through the open approach. However, many patients assume that the modern laparoscopic hysterectomy is superior to the standard approach. Laparoscopic surgical centres are mushrooming in major cities. This article presents ethical considerations involved in the decision-making process of choosing from the surgical options available.
The simultaneous presence of polycystic ovary syndrome with pelvic endometriosis presents compounded gynecological effects on women with subfertility and pelvic pain as the common symptoms. We describe one such case. The molecular basis for etiology is discussed and the need for individualized treatment is suggested.
Gastrointestinal stromal tumour (GIST) is extremely rare with reported incidence of 20 per million per year. It is the most common mesenchymal tumour of the gastrointestinal tract. When it occurs at the pelvis in a female patient, it can be misleading to a gynaecological diagnosis. Non gynaecological diagnosis such as GIST must be considered in patients with pelvic mass presenting with atypical symptoms.
The application of ultrasound technology has been widely accepted in clinical settings, particularly in Obstetrics and Gynaecology. This is in light of its ability to detect early foetal malformations apart from enabling foetal monitoring throughout gestation. While ultrasonography is an imaging method that is regularly used in Obstetrics, it is questionable as to whether it is safe for foetuses. The purpose of this paper was to review the evidence regarding the thermal effects of ultrasound exposure on foetal development, particularly. It is hoped that the importance of prudent usage of prenatal ultrasonography will be impressed on clinicians and the public in order to avoid the unnecessary usage of ultrasonography when it is not medically indicated. This is so that the welfare of pregnant women will be looked after, besides contributing to the better health of the next generation by ensuring that the benefits outweigh the known risks or potential harms.
Objective: This study aims to determine the incidence rate of phlebitis among patients with peripheral intravenous catheter. Methods: An observational study was conducted in one of the hospitals in East Coast Malaysia. There were 321 data collected among patients who had peripheral intravenous catheter in medical, gynecology and orthopedic wards. The incidence of phlebitis was evaluated using modified Visual Infusion Phlebitis score checklist. Results: The incidence of phlebitis, was found out to be 36.1% (n=116/321). Most patients who developed phlebitis had visual infusion phlebitis, with a score of two (34.9%) and the rest developed phlebitis with a score of three (1.2%). Conclusion: This high incidence of phlebitis indicated a worrying outcome. Therefore, the study findings suggested that a specific guideline on post insertion management of peripheral intravenous catheter should be revised which may help in reducing more incidence of phlebitis, subsequently reduce infection in ward, and provide more safety environment in hospital and reducing cost in managing infection control.
Ignorance is not bliss when it comes to sexuality. Psychosexual problems lead to shame, fumbling, needless fears, low-self esteem and even subfertility. The demands for help appears to be increasing; as the general population become more aware of its presence and the treatment options available through the mass media and better health education. Sex therapy has traditionally been the realm of the psychiatrist but with the gynaecologist as the first contact for most women, the number of women seeking advice directly from their doctors will only increase with time. A total of 243 new cases of sexual dysfunction were treated at the sexual problem clinic in Kandang Kerbau Hospital between January 1994 and November 1996; majority of which were self-referrals (48.5%). The patient pool consisted of more males than females although the clinical setting is in an obstetrics and gynaecology teaching institute. Vaginismus and erectile problems constituted the main complaints. Erectile problems are more common in the patients above 40 years old (p < 0.001). We report here our experience of such a sexual problem clinic and hope to provide insight into this area of medicine from the perspective of a practising gynaecologist.
This study aimed to look at the prevailing practice patterns of gynaecologists with regards to prophylactic oophorectomy and usage of hormone replacement therapy. Questionnaires were sent to the first 200 gynaecologists listed in the membership list of the Obstetrical and Gynaecological Society of Malaysia. The response rate was 30%. The results showed that most gynaecologists would perform prophylactic oophorectomy after the age of 49 years. The result was equivocal for the ages between 45 to 49 years. Of those who retained the ovaries at the age of 45 to the menopause, 55% did so because the ovaries were still functional. Almost all gynaecologists would prescribe hormone replacement therapy (HRT) after oophorectomy and the most commonly prescribed form was the oral type. Thirty-five per cent of gynaecologists claimed that more than 80% of their patients were compliant to HRT. The reasons perceived for the poor compliance were mainly poor knowledge and misconception.
OBJECTIVE: To investigate the experience of medical students during a clinical attachment in obstetrics and gynaecology (O&G).
STUDY DESIGN: A questionnaire was distributed to medical students who completed their O&G posting between August 2012 and August 2013. The first part included basic demographic details (age, gender, and ethnicity) and frequency of actual clinical experience; the second part explored students' perception of their training and their relationship with other staff, in particular feeling of discrimination by specified groups of medical personnel. The responses were recorded using a Likert scale and were recategorised during analysis.
RESULTS: A total of 370 questionnaires were distributed, and 262 completed questionnaires were returned, giving a response rate of 71%. Female students had a significantly higher median (IqR) number of vaginal examinations performed 0.25(0.69) (p=0.002) compared to male students. Male students experienced a higher proportion of patient rejections during medical consultation, 87% vs. 32% of female students (p<0.001), a higher rate of refusal for clerking (71.4% vs. 57.5% of females, p=0.035) and a higher rate of patients declining consent for internal examination (93.3% vs. 67.6% of females, p<0.001). The majority of male students felt that their gender negatively affected their learning experience (87% vs. 27.4% of the female students, p<0.001). Male students reported a significantly higher proportion of discrimination against their gender by medical officers (p=0.018) and specialists/consultants (p<0.001) compared to females but there was no discrimination between genders by staff nurses or house officers. A majority (58%) of female students stated an interest in pursuing O&G as a future career compared to 31.2% of male students.
CONCLUSIONS: Our study confirmed that gender bias exists in our clinical setting as male students gain significantly less experience than female students in pelvic examination skills. We also demonstrated that compared to female students, male students experience higher levels of discrimination against their gender by trainers who are medical officers and specialists/consultants. Trainers must improve their attitudes towards male students, to encourage them and make them feel welcome in the clinical area. We must minimize gender discrimination and educational inequities experienced by male students, in order to improve their learning experience.
KEYWORDS: Gender discrimination; Obstetrics and gynaecology; Training
Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. This systematic review assesses the effectiveness of centralisation of care for patients with gynaecological cancer, in particular, survival advantage.