As I observed in my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology"), contrary to many people's suppositions, the intrusion of obstetricians and surgeons into Gynecology has always been one of the more problematic aspects of Women's Medicine throughout time. Obviously the obstetricians main interest is directed to pregnant women. They look at women from the point of view of Obstetrics. Nevertheless we must remark that, as Women's Medicine, Obstetrics is a speciality which by far transcends women, since it is also devoted to embryos and fetuses. ( As to this subject, presently we must consider the enormous development of Fetal Medicine, a new branch of Obstetrics. ) We must also remark that Obstetrics only takes care of women in very peculiar periods of their lives, periods in which women house inside their bodies beings other than women themselves and who equally are subject of the speciality. Here we already have one of the enormous differences between Gynecology and Obstetrics, since Gynecology is exclusively devoted to women.

Considering that the great majority of modern women only want to become pregnant and have children, as they actually do, in very few moments of their lives, it is easy to realize that Obstetrics is a speciality that only takes care of women in moments of exception. On the other hand and contrary to Obstetrics, Gynecology takes care of women during most of their lives. In this way, as a consequence not only of the need for having more patients but also of the frequent "longing for omnipotence" existing in Women's Medicine, obstetricians never fail to also "practice Gynecology"... In fact, this is a highly smart "professional strategy" for gaining and preserving the greatest number of patients as possible. Nevertheless, given the increasing complexity of modern Medicine, this "strategy" inevitably implies a great loss in the quality of the medical assistance that is provided, since presently it is humanly impossible for the same physician to practice two different medical specialities with the necessary competence and expertise.

In "Novas Perspectivas em Ginecologia" I made it quite clear that the enormous differences between Gynecology and Obstetrics concern mostly their respective clinical, physiological, pathological and therapeutic aspects, that are completely different - besides the obvious fact that, while Gynecology takes care only of women, Obstetrics takes care of women and fetuses. For all these reasons Gynecology and Obstetrics constitute, without any possibility of rational doubt, separate medical specialities. In my opinion, all the constantly repeated opposing arguments are totally devoid of scientific basis and what they actually intend is, above all, to protect the "tradition" and some professional and "corporate" interests that cannot be publicly confessed.

Considering the enormous technical progress of present-day Medicine, from the point of view of medical knowledge and training it is humanly impossible for the same physician to simultaneously and satisfactorily practice two medical specialities so complex and different as Gynecology and Obstetrics. Even so, the irrational insistence on the integrated practice of both specialities by the same professional persists... To my point of view, this attitude is typically illusory and even "megalomaniac". And, to get things worse, at least here in Brazil that attitude is being more and more stimulated and even "established" by societies of Gynecology and Obstetrics that, with growing stubbornness and great political power, advocate the continuation of the scientifically irrational "fusion" of both specialities.

As most women regrettably are not aware of the problems resulting from this traditional "fusion" between Gynecology and Obstetrics, they naively consider the integrated practice of both specialities as "ideal" and "normal". This mistake is understandable on the part of the patients, but unforgivable on the part of the medical class. By the way, sometimes we can even verify the existence of some "confusion" between Gynecology and Obstetrics on the part of people who are not from the medical area. This just happens because most of the physicians who practice Women's Medicine introduce themselves as "gynecologists and obstetricians"... Therefore the colleagues are those who colaborate the most for the maintenance of such "confusion", since they have the greatest interest on satisfying the naive and mistaken "aspirations" of most patients. It is obvious that, professionally, the "gyneco-obstetricians" take the maximal advantage of such position, while patients are frequently harmed without being aware of that ... As a result of all of this and regarding professional competition, there is also a subtle process of "exclusion" of the gynecologists who do not practice Obstetrics.

Note 1: Because of the present-day accumulation of technical medical knowledge, the possibility of each physician acquiring a complete mastery of his own speciality becomes more and more restricted. This happens because the medical specialities themselves are going through a continuous process of division into subespecialities. In this way, the traditional bad habit of the practice of Gynecology, Gynecologic Surgery and Obstetrics by the same physician becomes more and more impracticable and absurd because it actually implies the practice of three different specialities by the same professional. Considering the human limitations - not only cognitive, but also of training and continuous updating -, will it be possible for the same physician to practice these three areas with the necessary competence ?

Note 2: As to the already mentioned "longing for omnipotence" in Women's Medicine, it is clearly demonstrated by the fact that almost all physicians devoted to it insist on practicing Gynecology, Gynecologic Surgery and Obstetrics, that is, three different specialities simultaneously. For a better understanding of the subject exposed here, see chapter "O Impasse na Medicina da Mulher" ("The Impasse in Women's Medicine") from my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology"). In this site, see also the topics "The Traditional Tie of Gynecology to Obstetrics and Surgery : Deep-rooted conditioning coming from the past and devoid of scientific basis" and "The Obstetric Strategy in Women's Medicine" - both at page "Temas Polêmicos" ("Polemical Subjects") -, and "Gyneco-Obstetrics: What lies behind".

Note 3: Since I live and work in Rio de Janeiro, Brazil, I do not know exactly to which extent my criticisms are still valid for the present-day situation of Women's Medicine in other countries ( though the traditional tie between Gynecology and Obstetrics has always been basically the same all over the world ).

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, 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, 1990, 1993.

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Email: nelsons@nelsonginecologia.med.br