my serious criticisms to the traditional, anti-scientific and medically
absurd integrated practice of Gynecology and Obstetrics by the same physicians,
there is still much to be said - 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"),
published in 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
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 )*. It
is by means of this process
that "scientific" dogmas are created and maintained -
just as the one that keeps Gynecology
eternally tied to Obstetrics and Surgery.
Here I would
like to 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.
Certainly this is entirely applicable to our "Gynecology-Obstetrics-Surgery"
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 groups.
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 analyse 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").
In this site, see also "The
Traditional Tie of Gynecology to Obstetrics and Surgery : Deep-rooted
conditioning coming from the past and devoid of scientific basis",
"The Obstetric Strategy in Women's
Medicine" and "Gyneco-Obstetric
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.
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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