Female Gynecologists Research Articles

1920 Problems of marriage and sexual morality: the Lambeth Conference

This article by Dame Mary Scharlieb (1845–1930) addresses issues on marriage and sexuality raised at the 1920 Lambeth Conference of Anglican Bishops. It is likely that she had a strong influence on the Bishop of London on medical issues, and, through him, on the resolutions on marriage and sexuality at this Conference. Her article, published in Theology in November 1920, is clearly a piece of its time and reflects a fascinating mixture of pro-women and conservative ethical views, tempered by her understanding of medical science as it was then: for example, she and the bishops at the Conference strongly opposed the use of contraception even within marriage (ten years later the Lambeth Conference dropped this opposition). Mary Scharlieb was a pioneer female gynaecologist. Raised as an Evangelical, she became an Anglo-Catholic after her marriage to a British lawyer who was employed in Madras. Her medical training, prompted by the lack of medical help for Indian women, began at the Madras Christian College but was completed at Mrs Garrett Anderson’s London School of Medicine for Women, leading to her appointment at the Royal Free Hospital in 1902. Her husband stayed working in India until his death, while she worked as a gynaecologist in London. She was created a Dame two years before her death. Editor.

Korean Immigrant Women’s Perceptions and Behaviors of Cervical Cancer Screening in Hawaii

Introduction: Minority immigrant women are more likely to be diagnosed with and suffer from cervical cancer compared to other minority women in the United States. Purpose: The purpose of this qualitative ethnographic study was to explore cultural health perceptions and behaviors of cervical cancer prevention among Korean immigrant women (KIW) in Hawaii. Methods: The Health Belief Model (HBM) and the Social Ecological Model (SEM) were used to guide the study. Data were collected using individual structured interviews with 20 KIW ages 21 to 65. Data were coded and analyzed to identify themes. Result: Findings revealed that participants (a) prefer a female gynecologist and Korean-speaking physicians; (b) are highly motivated to maintain physical health, including prevention; (c) prefer culturally appropriate community-based cancer prevention programs; and (d) expect innovative health maintenance approaches. Conclusion: Findings may be used by health care providers to identify culturally specific health needs of KIW related to cervical cancer screening, and to implement appropriate preventive measures for KIW to reduce cancer death.

Females as surgical oncologists in Taiwan: A nationwide population-based study.

11042 Background: Operations for malignancy are stereotypically viewed as the field of men, especially in eastern countries. In recent decades, more and more women devoted themselves to be surgical oncologists. However, they face many challenges, especially when they treating patients with sex organ-related malignancies. In the present study, we compared the disparities between female and male surgical oncologists in urology, general surgery, and gynecology by analyzing a nationwide, population-based database in Taiwan. Methods: National Health Insurance covers more than 99.6% of population in Taiwan. The system’s claim data are released as the National Health Insurance Research Database. One of its database, the Longitudinal Health Insurance Database 2000, contains all the original data of one million randomly-selected beneficiaries enrolled in year 2000. We recruited the yearly inpatient and outpatient service volumes, oncological surgical volumes, revenue, and sex ratio of patients of each female and male attending general surgeons, gynecologists, and urologists with practice more than five years from 1995 to 2013. The differences of these factors between male and female physicians in each specialty were compared with Mann-Whitney U-test. P < 0.05 was viewed as statistically significant. Results: There are 13, 87, and 191 female urologists, general surgeons, and gynecologists included, accounting for 6.7%, 7.0%, and 51.3% of physicians in each specialty in Taiwan respectively. Female urologists and general surgeons had significantly more female patients (p = 0.004 and < 0.001 respectively). Female urologists had insignificantly less patient service numbers, oncological surgical volumes, and revenues (p = 0.285, 0.718, 0.077 respectively), while female general surgeons and gynecologists performed worse than corresponding male physicians (all p value < 0.001). Of noted, female general surgeons have significantly less patient service (66.0±57.1 vs. 94.8±98.9 patients, p < 0.001) and total surgical volumes (2.30±2.50 vs. 3.28±3.33 surgeries, p = 0.001) but more oncological surgeries (0.33±0.64 vs. 0.17±0.41 surgeries, p = 0.003); however, there is no differences after exclusion of surgeries for breast cancer (0.07±0.22 vs. 0.12±0.32 surgeries, p = 0.057). Conclusions: Patients tend to seek medical help from same-sex physicians in Taiwan. Females could have a comparable career with males in urology, while gender inequality remains significant in general surgery and gynecology. Female surgical oncologists may have advantages in breast cancer treatment.

Prevalence of pelvic organ prolapse in women, associated factors and impact on quality of life in rural Pakistan: population-based study

BackgroundPelvic organ prolapse (POP) is a gynecological condition resulting from pelvic floor dysfunction in women. The objective of this study is to estimate “the prevalence of pelvic organ prolapse” associated factors, duration and impact on women’s quality of life in rural Pakistan.MethodsA cross-sectional study was conducted with a three stage random sampling strategy. Three health centers were selected and selected Lady Health Workers from each health center interviewed a random sample of women in their households. The interview used a structured questionnaire to collect symptom data. Female gynaecologists then conducted a clinical examination at the local health center on women who reported symptoms of prolapse to verify and grade pelvic organ prolapse using Baden-Walker classification system.ResultsAmong the 5064 women interviewed (95.8% response rate), 521 women had clinically confirmed POP, a prevalence of 10.3% (95% CI 9–11%). Among women with POP 37.8% had grade III or IV prolapse. Women with four or more children had the highest proportion of pelvic organ prolapse (75%) followed by women aged 36–40 years (25%).Among women with POP, 60.8% reported their quality of life as greatly or moderately affected; 44.3% had it for more than 5 years; and 78.7% never consulted a doctor.ConclusionsPelvic organ prolapse is highly prevalent in rural Pakistan, impacts on women’s everyday lives and remains mainly untreated. Measures should be taken to provide health care services to reduce this burden of disease among women.

Altered patient perceptions and preferences regarding male and female gynecologists: a comparison between 1997 and 2018

The purpose of this investigation was to explore changes in patient preference regarding gynecologist's gender. Using a standardized questionnaire, distributed in 1997 and 2018, a total of 1000 women were interviewed about preferences in terms of their choice of gynecologist and perceptions regarding gender-dependency of gynecologist's qualifications, strengths and weaknesses. Data was correlated with sociodemographics and possible influencing factors. Based on their own experience, an increasing majority did not express a preference for their gynecologist's gender (58-71%). However, the minority that still favors one gender demonstrated a significant decrease in preference of male gynecologists (14-5%), while about a quarter still generally prefer treatment by female physicians. Sub-analyses of emotional and technical treatment aspects generally confirm these trends in that more of today's patients are indifferent to their gynecologist's sex and that the remaining minority shifts towards favoring female doctors. If asked to definitely choose between female and male physicians based solely on the aspect of trust a significant change can be noted (69-30%) in favor of female doctors in 2018 as opposed to 1997 when patients were split in this regard (52%/48%). Overall bad personal experience regarding gynecological treatment has significantly decreased (36% reduction). Over the last decades, patient preference and perception of the importance of their gynecologist's gender has changed. While an increasing majority attributes equal competence in emotional, professional and interpersonal aspects to both genders, the remaining proportion of patients demonstrates a significant shift towards favoring female doctors.

Factors affecting the provision of analgesia during childbirth, Japan.

Japan’s universal health-care system means that it is a very safe country in which to give birth. Perinatal outcomes in Japan are excellent, with low infant mortality and neonatal mortality. However, childbirth remains a challenge for many Japanese women, who are faced with a scarcity of places to give birth, limited availability of analgesia and social norms that favour natural birth. The number of birth facilities in Japan continues to decrease as fewer children are born. The numbers of qualified medical staff remain inadequate, with a continuing lack of female physicians, perpetuated by a pervasive negative gender bias. Recruitment efforts are underway, but few doctors want to specialize in obstetrics or gynaecology. Furthermore, around half of female obstetricians and gynaecologists in Japan’s male-dominated medical system stop practising when they have their own children. The difficulty of obtaining analgesia during labour is another problem. Although low uptake of labour pain relief in Japan is said to be due to cultural influences, the root of the problem is a lack of qualified anaesthesiologists and the inflexibility of a system that will not allow other staff to be trained to administer labour analgesia. Problems with labour anaesthesia have been linked to 14 maternal deaths since 2010. Japanese policy-makers need to act to renovate the nation’s obstetric facilities, reorganize regional perinatal care systems, train more obstetricians and anaesthesiologists, promote task-shifting and better integrate biomedical and traditional, non-medical care for pregnant women.

Capitalizing on specialists' services in rural family health unit: Interventional study.

The objectives of the study were to explore legal and regulatory environment for the policy of specialists' visits to unit and assess the impact of gynecology specialist's visits on utilization pattern of gynecological services and clients' satisfaction. Settings The study settings were Ministry of Health/Headquarters, Giza Health Directorate, El-Badrashin Health District and Hospital, and Met-Rahinah Unit. Study design The study includes qualitative research (in-depth interviews with policymakers at all Ministry of Health levels and focus group discussions with service providers) and quantitative research (interventional operation research using separate sample pretest (n = 210) and posttest (n = 209) and family-planning service statistics). Analysis of specialist outreach services indicated integration absence between preventive and curative sectors. Capitalizing on the policy of specialists' outreach visits to the unit could support clients' access quality services and reduce referral to get specialist services in hospitals. There is a 6-month intervention of scheduled visits of a female gynecologist to a rural health unit. The intervention led to 12% increase in efficiency and utilization of services compared with the previous 6 months. Clients' satisfaction increased from 27% to 73% after the intervention (.001, OR = 7.5, CI = 4.9-11.6). Scheduled specialists' visits increase services' efficiency and clients' satisfaction.

Does Physician Gender Impact the Clinical Productivity and Salaries of Obstetrician-Gynecologists?

Background: Male medical student interest in the field of obstetrics-gynecology has significantly decreased in the last three decades. A perceived patient preference for female obstetrician- gynecologists (Ob-Gyn) and subsequent gender differences in clinical productivity and compensation may influence this trend. Objective: To explore how provider gender affects clinical productivity and salary among obstetrics- gynecology generalists. Methods: An analysis of productivity and salary data for generalist Ob-Gyns employed by an academic integrated health system was performed. Gross charges, net collections, physician payroll information, work relative value units (wRVUs), new and existing patient encounter volumes and clinical full-time equivalent (FTE) status were compared year over year by physician gender using a repeated measures ANOVA test. Results: On average, male providers earned a numerically higher salary in each year studied, but when the entire timeframe was evaluated, there was no significant difference in salary nor total productivity between women and men (p=0.19 and 0.15, respectively). There was a gender difference in how total productivity was achieved, with women seeing twice as many new patients (p= 0.0025), and men achieving higher average wRVUs per patient encounter (p=0.02). Conclusions: There was no significant difference in total productivity and there was no significant difference in salaries between male and female Ob-Gyns. However, there were differences in the type of care that contributed to productivity by gender. Female providers saw a higher proportion of new patient encounters, while male providers accrued a higher wRVU per encounter, likely as a result of higher procedure volumes. These findings are an encouraging sign that men are not disadvantaged in terms of productivity in obstetrics-gynecology and that compensation models such as the one in this system can promote fair payment in mixed-gender physician groups.</P>

Workplace Harassment and Discrimination in Gynecology: Results of the AAGL Member Survey

To characterize workplace and sexual harassment and discrimination among physicians in gynecology. A beta-tested Internet survey was distributed by e-mail using the REDCap platform. All responses were anonymous. The survey was distributed to the 7026 physician members of an international gynecologic society (AAGL), including faculty and trainees. Not applicable. The survey was distributed on 3 occasions between July and September 2018. The survey contained questions on demographics, attitudes, experiences, and sequelae regarding harassment and discrimination in the workplace. Frequency distributions and nonparametric tests were performed to determine the percentages and types of harassment and discrimination among respondents. A total of 907 physicians responded, including 603 US physicians and 304 non-US physicians; 59% identified as female and 40% as male, and 20% were trainees. Females were more likely than males to think the #MeToo movement was "justified and overdue" (p < .05), independent of age or trainee status. More females than males reported experiencing workplace discrimination (67% vs 39%; p < .001); gender-based discrimination was the most common basis for both. Females indicated decreased self-confidence and lower salary; males indicated fewer employment opportunities and lower patient volume. Harassment was reported by more females than males (53% vs 17%; p < .001), including sexual harassment (39% vs 11%, p <.05). Most experienced loss of self-confidence, felt the offender was in a position of power, and did not report the incident, often due to fear of reprisal. Multiple respondents experienced workplace-related sexual assault. Workplace harassment and discrimination are commonly experienced by female and male gynecologists and are usually related to a power differential. Improvements must be made in the workplace environment to achieve equity and a safe workplace free of harassment and discrimination.

Daily genital cares of female gynecologists: a descriptive study.

Genital hygiene can play an essential role in avoiding vulvovaginal discomfort and preventing infections. The scientific evidence on best practices on genital hygiene is scarce, and without doubt, gynecologists should be the best person to discuss and guide the subject. Evaluate the general genital female gynecologist hygiene. This descriptive analytic study identified genital hygiene and sexual practices of 220 female gynecologists, through a questionnaire with 60 self-answered questions. The data were analyzed and presented using frequency, percentage, mean and standard deviation. The studied population was constituted by middle age (37.3 years) and white (71.3%) female gynecologists. More than a half (53.6%) declared spending over 10 hours a day away from home and complained of vaginal discharge in 48.1% of the cases. Regular vulvovaginal hygiene: 17.8% reported washing genitals once a day and 52% twice a day. The use of dry paper alone was reported in 66.4% post urination and 78.5% post-evacuation. Using running water and soap was practiced by 25.9% and 21.5% respectively. Vulvovaginal hygiene related to sex: More than half of them had intercourse 1-3 times a week, and 37.4% and 24.1% had frequent oral sex and eventually anal sexof the participants, respectively. Genital hygiene before sex was positive in 52.7% of the subjects and, post-sex hygiene in 78.5% of them. Genital hygiene habits of female gynecologists can be improved, despite the high grade of scientific knowledge they hold.

Practices and knowledge of female gynecologists regarding contraceptive use: a real-world Chinese survey

BackgroundThere is no evidence of the practices of obstetricians and gynecologists (OB/GYNs) regarding contraceptive use and determinants influencing contraceptive choices, including emergency methods such as combined oral contraceptives (COCs) and levonorgestrel intrauterine system (LNGIUS). This survey determines the practices and knowledge among Chinese female OB/GYNs regarding modern contraceptive methods.MethodsA multicenter questionnaire was completed by 2000 female OB/GYNs participating in training courses organized by the gynecological endocrinology training committee of the Chinese Medical Doctor Association from February to May 2013.ResultsThis survey achieved a response rate of 51.4%. The rate of induced abortion among this group was 56.3%; this may be attributable to unreliable contraceptive methods (55.5%) and failure of reliable contraceptive methods (18.9%). Intrauterine devices (IUDs) were more commonly used by parous women than nulliparous women (42.6% vs 1.7%; p < 0.0001), followed by condom and rhythm method (24.2% vs 20.8%). However, nulliparous women commonly used rhythm method (48.3% vs 3.3%; p < 0.0001) and condoms (19.2% vs 10.5%; p = 0.008). OB/GYNs demonstrated misconceptions of OB/GYNs about COCs, such as the risk of breast cancer, amenorrhea and premature ovarian failure, and decreased fertility as reported by 37.10, 10.6, and 7.5% of the respondents, respectively.ConclusionsIUDs were commonly used by parous Chinese OB/GYNs. Unreliable contraceptive methods and misconceptions about the side effects of COCs may result in the high rate of unintended pregnancies. Hence, awareness of safe and effective contraceptive methods should be strengthened among OB/GYNs in China.

Female Gynecologists and Their Birth Control Clinics: Eugenics in Practice in 1920s-1930s China.

Yang Chao Buwei, the first Chinese translator of Margaret Sanger's What Every Girl Should Know, was the first female gynecologist to open up a birth control clinic in China. By the 1930s, other female gynecologists, like Guo Taihua, had internalized and combined national and eugenic concerns of race regeneration to focus on the control of women's reproduction. This symbiosis between racial regeneration and birth control is best seen in Yang Chongrui's integration of birth control into her national hygiene program. This article traces the efforts of pioneer gynecologists in giving contraceptive advice at their birth control clinics, which they framed as a humanitarian effort to ease the reproductive burden of working-class women. It also examines their connections with Sanger's international birth control movement, and their advocacy of contraception as practitioners, translators, and educators. The author argues that these Chinese female gynecologists not only borrowed, but adapted, Western scientific knowledge to Chinese social conditions through their writings and translations and in their clinical work.

A roadmap to improve health care services in Jodhpur city slum through resource mapping

Background: Mapping of resources helps us in identifying those resources which can be used more pragmatically, for interventions and programs related to human health especially during emergency conditions. Resource mapping identifies the resources that can realistically be used for health related interventions, programs and during an emergency. Aim and Objectives: The primary objective was to locate the basic healthcare related resources available in that area. Secondary objectives were to Understand and compare these resources along certain important dimensions using qualitative research methods and to identify possible existing gaps, share the results with the local stakeholders and suggest effective interventions. Material &amp; Methods: Manual mapping method was used to locate the available healthcare related services in urban slum area. FGDs were held to compare utilization of resources along eight dimensions. In depth interviews were held with existing healthcare service providers, stakeholders and local residents to assess their utilization and needs. Results Existing health services used by community were local herbal clinic, district hospital, Anganwadi Centre, mobile clinic, wellness clinic and All India Institute of Medical Sciences (AIIMS) Jodhpur. Conclusions The manual mapping and qualitative techniques used showed that existing resources lacked in (a) providing in situ primary care (b) clinical services by a female gynecologist (c) health education services to address existing drug addiction and substance abuse.This exercise helped in rapid need assessment and prioritizing of interventions.

Evaluation of Osteopenia and Osteoporosis among Female Doctors

Osteopenia and Osteoporosis are increasing health care problems due to increased life expectancy. Women are specially vulnerable to osteoporosis at their later ages of lives. Among the working population of Bangladesh, female doctors make a big contribution for nation, so focusing on their wellbeing is very much important. In this study BMD (Bone Mineral density) were measured among 80 female doctors&#x0D; Objective: To find out the Bone Mineral Density (BMD) among working female doctors of Bangladesh.&#x0D; Materials and Methods: A cross sectional study was conducted on 80 female doctors aged between 25-80 years at their reproductive, premenopausal and postmenopausal age group, at a conference venue over a period of two days. Measurement of bone mineral density was done by quantitative ultrasound densitometry1.&#x0D; Result: Majority of women were between 30-64 years of age; 71(88.75%) women had normal BMD, 9(11.25%) women had osteopenia and none of them had osteoporosis. Among women with age between 25-44 years age (total 30) none was suffering from osteopenia or osteoporosis. Between 45-64 years (total 47), 8(17.02%) were suffering from osteopenia and between 65-80 years (total 3), 1(33.33%) was suffering from osteopenia. Nobody had osteoporosis.&#x0D; Conclusion: Among the working female gynaecologists of Bangladesh there were no osteopenia or osteoporosis in reproductive and premenopausal (25-44 years) age group.Only 17.04% of premenopausal women and women at early menopause ( 45-64 years) suffer from osteopenia and 33.33% of women at late menopause (65-80years) had osteopenia. None had osteoporosis.&#x0D; Bangladesh J Obstet Gynaecol, 2017; Vol. 32(1): 25-28

Knowledge about cervical cancer, Pap test, and barriers to women's participation in screening in Belgrade, Serbia.

Cervical cancer (CC) is a serious public health concern in Serbia, due to opportunistic screening still being in force, which led to twice higher than the average incidence rate of cervical cancer in Europe. Despite the fact that early detection and treatment services of CC are available at no additional cost, majority of women use inadequate screening services in Serbia. This study aimed to examine the link between the knowledge about CC and Papanicolaou (Pap) test and perception of barriers to women's participation in CC screening. The study included 300 women aged 21 to 69, with a place of residence in the city of Belgrade (Serbia), who were attending for their medical examination to the University Clinic of Gynecology and Obstetrics - "Narodni front", from June through December 2014. A survey instrument to collect data was an adapted questionnaire for the assessment of knowledge about and barriers to CC and Pap test. Patients were divided into three groups: a study group consisted of women attending irregularly (over three years), women who never participated in screening, and a control group that included women regularly participating in screening. Women regularly participating in screening (52.7%) had adequate knowledge about CC and Pap test, while women who irregularly (79.4%) or never participated (71.9%) did not have any adequate knowledge. There was a significant statistical difference between the CC and Pap test awareness in a group of respondents who regularly participated in comparison to respondents who irregularly or never participated in screening (x²= 27.772, p = 0.000). Regarding knowledge about human papillomavirus (HPV), 80% of women did not know that Pap test cannot be used for detection of HPV, as well as that abnormal Pap test result may be due to HPV (61.7%). Majority of women (93.7%) had poor knowledge about Pap test role in CC early detection and considered Pap test to be used to diagnose CC. The authors found a significant statistical correlation between participation of women in screening and barriers. Women who were irregular or never participated, had barriers such as: lack of time (F = 9.51; p = 0,000), difficult access to Healthcare facilities (F = 11.29; p = 0.000), lack of knowledge about the Pap test procedure (F = 21.27,p = 0.000), discomfort (F = 9.36; p = 0.000), and anxiety of Pap test results (F = 3.35; p = 0.036). Women who regularly participated did not have prejudice when choosing a gynecologist, unlike the other two groups that preferred a female gynecologist (F = 3.61; p = 0.028). This study showed that the level of knowledge about CC and Pap test in women is an important factor associated with regular participation in screening. It is necessary to take educational measures in order to raise awareness of women regarding risk factors, as well as to overcome fear and shame, with the ultimate aim to reduce frequency and mortality rate caused by CC in Serbia.

Treatment Experiences of Women with Reproductive Cancers in Odisha, India: A Qualitative Exploration of Enablers and Barriers

Introduction:Cancer continues to be a major menace to our Indian society notwithstanding significant progress in diagnosis and treatment. In India cancer mortality rates in women are high compared to other countries, despite efforts to improve survival through the development of effective detection techniques and increased numbers of viable treatment options. Indian women’s advanced stage of disease at diagnosis is largely attributable to delay in seeking treatment. The present qualitative inquiry was conducted with the aim of capturing the treatment experiences of patients with gynecology cancer at a tertiary care hospital and understanding the barriers, enablers, stress and apprehension they experience during the treatment phases.Methods:Twenty-one in-depth interviews were conducted with women diagnosed with gynecological cancers and undergoing at least one treatment intervention in the Inpatient Department (IPD). Theme guides were developed with a review of the literature and consultation with experts in the field. Data were collected by trained investigators who were well versed with the local language and analyzed using an inductive approach. Results are presented in the form of core- and sub-themes evolved during this process.Results:Out of the 21 respondents, 19 were married and 2 were widows. Nineteen had attained more than secondary qualifications. Nearly all women described themselves as ‘housewives’. Amongst participants, 13 were diagnosed with breast cancer, 5 with ovarian cancer and 3 with cervical cancer. Thematic framework analysis of the transcripts yielded six key themes: 1) best and worst experiences during the treatment process; 2) financial and emotional stress; 3) care giving and social support; 4) satisfaction with the medical staff; 5) preferences for a female gynecologist and female gynecology ward; and 6) prompt and free treatment. Quotable quotes were presented in the table against every theme.Conclusion:Strengths in the Indian health care delivery system need to be built upon, while attention should be paid to developing effective psychosocial interventions, with a robust financial protection plan for patients and their involvement in decision making. Counselling of patients should be made part of a routine protocol.

Does the menopausal status of female gynecologists affect their prescription of menopausal hormone therapy?

Objective: To evaluate whether menopausal status and symptoms among female gynecologists would influence their clinical behavior related to menopausal hormone therapy (MHT).Methods: Female gynecologists of 11 Latin American countries were requested to fill out the Menopause Rating Scale and a questionnaire containing personal information and that related to MHT use.Results: A total of 818 gynecologists accepted to participate (86.4%). Overall, the mean age was 45.0 ± 10.7 years, 32.2% were postmenopausal, and 17.6% worked in an academic position; 81.8% reported that they would use MHT if they have symptoms, regardless of menopausal status. Academic gynecologists favor personal MHT use at a higher rate (p = 0.04) and have a higher MHT prescription rate as compared to non-academic ones (p = 0.0001). The same trend was observed among post- as compared to premenopausal ones (p = 0.01) and among those who had hysterectomy alone as compared to those experiencing natural menopause (p = 0.002). The presence of menopausal symptoms did not influence their MHT prescription. Current use of MHT and alternative therapy was higher among post- than premenopausal gynecologists (both, p = 0.0001) and among those who had undergone hysterectomy than those experiencing natural menopause. A 38.5% perceived breast cancer as the main risk related to MHT, and a high proportion prescribed non-hormonal drugs (86.4%) or alternative therapies (84.5%).Conclusion: Most female gynecologists in this survey would use MHT if menopausal symptoms were present. Postmenopausal physicians use MHT and prescribe it to their symptomatic patients at a higher rate than premenopausal physicians.

Personal and professional use of menopausal hormone therapy among gynecologists: A multinational study (REDLINC VII)

BackgroundPreviously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. ObjectiveTo determine the use of MHT and perceived related risks among gynecologists. MethodsA self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. ResultsA total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n=1837). Mean age was 48.1±11.4years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p<0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06±2.09 vs. 3.83±2.11, p<0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p<0.009) and breast cancer (women 38.5% vs. men 33.9%, p<0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p<0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. ConclusionAlthough this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.

Women and Gynaecological Cancer: Gender and the Doctor–Patient Relationship

This article presents evidence regarding aspects of the gendered nature of care women with gynaecological cancer receive from their (usually) male surgeons and oncologists in Australia. We argue that despite women’s general preference for female gynaecologists, those with a gynaecological cancer develop a strong therapeutic relationship with their male medical specialist, not extended to their (usually) female nurses and other allied health professionals. Given the highly sensitive and sexualized nature of gynaecological cancer, this requires explanation. These findings can be partly explained by examining the division of labour between nurses and doctors, specifically issues of control over this process and the development of specializations. The findings also bring into stark relief the way in which power and status differences can be used by medicine to create a positive therapeutic relationship with patients while simultaneously de-eroticizing the intimate procedures necessary in assisting women throughout their cancer treatment. Importantly, this relationship also has relevance for policy makers, particularly those concerned with the highly gendered division of labour of the medical specialty workforce in Australia.

EFFECT OF SOCIAL MARKETING CAMPAIGN ON CHILD HEALTH CARE UTILIZATION IN RURAL SECTOR IN SHARKIA GOVERNORATE

Introduction: Primary health care (PHC) facilities are widely distributed throughout Egypt but they often seem to operate at suboptimal level. Therefore this study was carried out in a trial to increase the rate of utilization of PHC in rural sector of Sharkia Governorate using a social marketing campaign. Objectives of study: To assess the rate of utilization of child PHC services in rural sector of Sharkia Governorate, to determine causes of underutilization and to assesss the effect of social marketing campaign on utilization of health services. Method: Design: Pre- Post interventional study. Setting: El-Sharkia Governorate, Hehya district, El-Shabraween village. Sampling: multi-stage random sampling. Procedure: the study evaluated the utilization of all provided PHC services in El-Shabraween unit before and after a social marketing campaign using personal interviews of 205 households and the unit records. It also highlighted the causes of underutilization of the PHC unit. Results: There is a significant increase in El-Shabraween outpatient consumers from 23% before to 58.8% after the campaign. The percent proportion of recorded diarrhea cases among (U5) children to total U5 sick children increased from 35.1% to 46.3% after the campaign. Causes of underutilization were: lack of different specialty consultants (62.4%), followed by deficient skills of doctors (51.2%) and irregular presence of female gynecologist (42.0%). Conclusion and Recommendation: Social marketing can improve health care utilization in rural sector, so it's recommended to disseminate the marketing materials on a wider scale to attract more customers, also better training of physicians in family units, continuous presence of a female gynecologist for better maternal care, a recommendation for the MOHP to financially support marketing campaigns for better results and further studies in this area should be carried out. Key words: Utilization, Child Health Care, Social Marketing.