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Gynecologists and Male Patients?

Thursday, December 5th, 2013

Gynecology is, by definition, the branch of medicine that deals with functions and diseases, especially of the reproductive system, specific to women and girls. However, recently, some gynecologists have been looking at this definition as more of a recommendation – and a flexible one at that. For example, a gynecologist at Boston Medical Center has added a new demographic to her patient roster: men.

Dr. Stier and other gynecologists who share her views have started caring for certain men; specifically, those at high risk for anal cancer. Anal cancer is rare, but it can be fatal and it is being seen more frequently, particularly among men and women who are HIV positive. Anal cancer is typically caused by the human papillomavirus (HPV) virus – the same virus that is often blamed for cervical cancer.

Dr. Stier sees mostly women, but last year she treated about 110 men as well. Using techniques she adapted from the ones developed to screen women for cervical cancer, she began screening men for anal cancer.

However, in September, the American Board of Obstetrics and Gynecology mandated that its members limit their practice to women with very few exceptions. In addition, they said that gynecologists were not allowed to perform the procedure Dr. Stier had been performing on men. Gynecologists, who often need their board certification to keep their jobs, cannot ignore directives like this.

Now Dr. Stier’s male patients are upset and her studies are in limbo. And she is not alone – other gynecologists who were engaging in the same practices have found themselves in similar circumstances. Researchers and doctors have asked the board to reconsider, but so far the board will not, pointing out that there are other doctors who could perform the screening procedures on men. The board also reiterates that the field of gynecology was specifically designed to treat women.

Apparently, Dr. Stier and others had not understood how absolute the definition of the field of gynecology was. But the board has drawn the line, emphasizing that its mission is treating women, not dabbling in spin-offs for their potential profitability. The screening process used by Dr. Stier, anoscopy, is not the only procedure in question nor is this the only incident of gynecologists straying from the original framework of gynecology; others had begun providing treatments such as testosterone therapy for men and cosmetic procedures such as liposuction for both men and women.

This trend is changing, however, thanks to the new rules the board posted on its website on September 12.  The new rules are explicit, specific, and outline exactly what gynecology should entail: treatment of women, with treatment of male patients limited to very specific circumstances, such as fertility evaluation, newborn circumcision, and emergency care.

Some doctors are upset by the new guidelines, including Dr. Stier, who is concerned that her male patients won’t get the follow-up they need now that she can no longer see them. However, there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.

– Yvonne S. Thornton, M. D., M. P. H.