"Gyneco-obstetrics": What lies behind
Dr. Nelson Soucasaux , Brazilian gynecologist
There is still much to be said about the traditional and medically mistaken
"gyneco-obstetrics fusion," not only from the historical and psycho-social
points of view, but also from that of professional philosophy and "strategy."
As I remarked in my book "Novas Perspectivas em Ginecologia" ("New
Perspectives in Gynecology," 1990), women's medicine exhibits, in its
concept and practice, several serious mistakes that come from the very beginning
of the speciality and that, regrettably, continue being perpetuated despite
the evolution of medicine.
From the conceptual and psycho-social standpoint, whenever conceptual
and theoretical mistakes become extremely widespread and instituted, they
are turned into what Charles Tart has called "implicit presuppositions"
and from this moment on, they cease to be questioned. This is valid for
any area of science and implies very dangerous situations for scientific
evolution, because these presuppositions function as real ideological conditionings.
According to Tart, an implicit supposition is a genuine "act of faith"
and, as much as a supposition remains implicit, acting under the level of
consciousness, it is improbable that it will be called into question and
then the person finds himself entirely under its power (Tart, C.T "Psicologias
Transpersonales: Las Tradiciones Espirituales y la Psicologia Contemporanea,
Tomo 1" Spanish translation, Paidos, Buenos Aires, 1979). (See Note* below). I would add that, in further stages,
some of these presuppositions are frequently "rationalized" in
already conscious attempts to justify them. Many times there are even several
interests, not only of scientific or social ideologies, but also of professional
order that work with the purpose of perpetuating the positions based on
these mistakes. I think this is entirely applicable to our "gynecology-obstetrics-surgery"
In the specific case of gynecology, the speciality was already "born"
with a serious "congenital defect" because, in the history of
medicine, regrettably it originated from obstetrics and general surgery.
On the one hand, there were obstetricians who developed an interest on the
"non-obstetric" pathologies of the woman's sexual organs. On the
other hand, there were surgeons who, for several reasons, developed a special
interest in surgery of the female genitals. Such "congenital malformation"
of double origin seems to resist everything, even the evolution of medicine.
In spite of the extraordinary advancements in the field of clinical gynecology
that took place in the last decades, gynecology, which long ago could have
become independent of obstetrics and surgery, remains tied to its original
misconceptions and distortions, stubbornly insisting on not ridding itself
of them. All attempts at making scientific reason prevail and promoting
the definitive separation between gynecology, obstetrics and gynecologic
surgery (or female pelvic surgery, as the latter should be much better defined)
are immediately "suffocated" and obstructed by the official context
that rules all the area of women's medicine. (At least here in Brazil, this
is what happens all the time).
Such an abnormal attitude is maintained not only because it is strongly
rooted in several peculiarities of the mistaken medical and psycho-socio-cultural
context in which women's medicine is situated, but also for being highly
advantageous for the maintenance of several non-medical interests of a great
number of physicians who practice women's medicine. Among these interests
there is a powerful professional strategy that looks to gaining and keeping
the maximal number of patients as possible. We can also mention the very
frequent "longing for omnipotence" existing in women's medicine,
leading most of the physicians devoted to it to the medical absurdity of,
in the face of the over-specialized reality of present-day medicine, insisting
on simultaneously practicing three different specialities: gynecology, gynecologic
surgery and obstetrics. Besides being scientifically absurd, in my opinion
such an attitude can even be considered medically non-advisable, since it
is partly responsible for the increasing number of medical errors that are
occurring in the area of women's medicine.
Let us go now to a brief analysis of the "strategic reasons"
for the stubborn persistence of all these serious mistakes in the concept
and practice of women's medicine. The fact is that, in the absence of real
scientific reasons that could justify it at the light of present-day medicine,
what really exists behind the stubborn position that considers the usual
"gyneco-obstetrics fusion" as "essential" is, over and
above all, a very well-planned professional strategy in the practice of
women's medicine. And, what is worse, disguised behind pseudo-scientific
and pseudo-logical justifications - and, at least here in Brazil - counting
on the support of powerful medical institutions and very politically influential
But the most incredible thing is that the reasons for the "strategy"
are quite simple. Nowadays, a modern woman usually has, at the maximum,
two or three children in her whole life. Let us analyze this more carefully:
a woman who has three children will have had a total of three gestational
periods and three deliveries, during which she will have been under the
constant care of the obstetrician. Counting approximately 10 months for
each gestational-puerperal cycle, it is easy to see that an exclusive obstetrician
only will have this woman as patient for 30 months because, throughout most
of her life, she will have been a gynecologist's patient. As a result, to
also practice gynecology is of the greatest interest to obstetricians not
only to avoid losing their patients after childbirth, but also in order
to increase the number of patients in their offices. On the other hand,
having to face this competition on the part of the obstetricians, the gynecologists'
interest in also practicing obstetrics arises as a consequence of avoiding
the risk of losing the patients who, becoming pregnant, would have to be
recommended to the obstetricians. In this way, with the addition of other
factors, this great medical mistake called "gyneco-obstetrics"
For a detailed analysis of this subject, see my already mentioned book
"Novas Perspectivas em Ginecologia" ("New Perspectives in
Gynecology"). See also my article ""Gyneco-obstetric-surgical"
stubborness and the perpetuation of one of the greatest mistakes of
women's medicine," published here at the MUM.
Once again I emphasize that, since I live and work in Rio de Janeiro,
Brazil, I do not know exactly to which extent the criticisms contained here
are still applicable to the present-day situation of gynecology and obstetrics
in other countries - though the traditional tie between gynecology, obstetrics
and gynecologic surgery has always been the same all over the world.
Note*: Tart, C.T.-"Transpersonal Psychologies,
Tomo 1"- Harper & Row Publishers, New York, 1975.
Copyright Nelson Soucasaux 2003
Nelson Soucasaux is a gynecologist dedicated to clinical, preventive
and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina
da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several
articles published in medical journals and of the books "Novas Perspectivas
em Ginecologia" ("New Perspectives in Gynecology") and "Os
Órgãos Sexuais Femininos: Forma, Função, Símbolo
e Arquétipo" ("The Female Sexual Organs: Shape, Function,
Symbol and Archetype"), published by Imago Editora, Rio de Janeiro,
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