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Gynaecology is typically considered a consultant specialty. In some
countries, women must first see a general practitioner prior to seeing a
gynaecologist. If their condition requires training, knowledge, surgical
technique, or equipment unavailable to the GP, the patient is then
referred to a gynaecologist.
In the United States, however, law and many health insurance plans
allow/force gynaecologists to provide primary care in addition to
aspects of their own specialty. With this option available, some women
opt to see a gynaecological surgeon without another physician's referral.
As in all of medicine, the main tools of diagnosis are clinical history and
examination. Gynaecological examination is quite intimate, more so than a
routine physical exam. It also requires unique instrumentation such as the
speculum.
The speculum consists of two hinged blades of concave metal or plastic
which are used to retract the tissues of the vagina and permit examination
of the cervix, the lower part of the uterus located within the upper portion
of the vagina.
Gynaecologists typically do a bimanual examination to palpate the
cervix, ovaries and bony pelvis. It is not uncommon to do a rectovaginal
examination for complete evaluation of the pelvis, particularly if any
suspicious masses are appreciated.
Male gynaecologists often have a female chaperone for their
examination. An abdominal and vaginal ultrasound can be used to
confirm any abnormalities appreciated with the bimanual examination or
when indicated by the patient's history.
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