Concerning 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 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 )*. 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" subject.

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 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" is perpetuated.

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 Stubborness".

P.S.: 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.

* Tart, C.T.- "Transpersonal Psychologies, Tomo 1" - Harper & Row Publishers, New York, 1975.

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