Debate: All their patients are female, so should all gynaecologists be women?

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Indy Lifestyle Online
Four out of five senior gynaecologists are men, who by definition have no idea how it feels to be examined in this way. So can they ever be up to the job? Amanda Knight's experiences as a patient have left her convinced that they can never truly empathise with their patients. But Dr Laura Cassidy believes that men are among the best in the profession

A man can never understand what it means to have female parts, argues Amanda Knight

In the darkened room are three men and me. I am lying, yelping in pain, as the most senior, a gynaecological registrar, impales me roughly on a "transvaginal ultrasound", aided by an anglepoise that shines straight between my legs. The other two, a junior casualty doctor and a medical student (about whose presence I have never been consulted) look on impassively. A nurse sits at my shoulder doing her level best to soothe.

I have just suffered a miscarriage at eight weeks, am still upset, in pain and bleeding, have endured a four-hour wait in casualty, and am also frantically checking my watch, because, as I have been trying to impress on this clueless crew, if I don't pick up my daughter from nursery in half an hour's time, nobody will.

The examination mercifully over, my dignity in tatters, my thighs streaked with blood, I sit up and collapse in tears in the nurse's arms. I who, rather pathetically, likes to pride herself on being a "good" patient. Three pairs of eyes look on in utter bafflement, as if for all the world they cannot fathom a reason for my displeasure. They who have already tried to get me to agree that I am "hospital phobic", because of my anxiety to leave to fetch my daughter and my expressed preference against submitting to probably unnecessary surgery (a D&C).

None the wiser for their probing, they make me another appointment (as if!), and scribble a prescription. I've never got dressed so fast, but even so, by the time I flash past reception the nurse, God bless her, has managed to get the prescription filled so that I can hotfoot it to the nursery.

I still have flashbacks to that nightmarish scene. And still I do not cease to be astonished that people who do this for a living can be so insensitive without, apparently, having any idea they are getting it wrong.

I've had another, successful, pregnancy since then. Because of a somewhat chequered medical history, I was seen throughout by hospital doctors, and because of the kind of world we live in, all but one of these doctors was male. On the whole, my dignity survived intact. As I've said, I like to be a well-behaved patient. And yet. I've seen nothing before or since to alter my view of male gynaecolologists as detached, arrogant, with a misplaced confidence in their grasp of female matters.

Maybe my sensibilities were still a little raw, but could the consultant have been showing off just a little to the awkward (male) medical student when he yanked my clothes down just a little further than the examination of my belly required? And why, when I regularly saw senior medics from one of the finest teaching hospitals in the country, did I still feel the need to phone the midwives for advice on the birth and on those particularly female concerns?

Male gynaecologists lack not only the relevant body parts (a disadvantage in itself) but also the ability, or even the inclination, to appreciate the significance of those parts to those who do possess them.

Amanda Knight is the mother of two children.

Some of the best gynaecologists ever have been men, says Dr Laura Cassidy.

It's true that some women do feel more comfortable talking about gynaecological and obstetric matters to a female doctor, and prefer to have intimate examinations performed by a woman rather than a man. There are other women, however, who actually prefer to have a male gynaecologist. It's really a case of how well a doctor and patient communicate with each other, and some women actually communicate better with the opposite sex.

Yes, there should be female gynaecologists available to women who don't feel comfortable with a male doctor. I know men who wouldn't dream of having a female GP - they know they'd feel uncomfortable undressing in front of a woman, or being examined by one. One of the issues we're talking about here is opportunity - the opportunity to see the doctor of your choice, and all patients should have that.

But it's wrong to say there should be no male gynaecologists, or that male gynaecologists are bad. I know male doctors who are very dextrous and very good communicators, and as a result they make excellent gynaecologists.

There are many skills required, and not everyone has the same skills - male or female. Empathy is one. It's very important to be able to put yourself in a woman's place, but you don't have to be of the same sex to empathise. We have to be dextrous, and have certain surgical skills. Intellectual skills are equally important. In order to progress a speciality there must be people who can take that step into the future, and I believe that men are braver than women when it comes to taking that step. Over the last 30 years, most of the major advances for the benefit of the patient have been made by men, not women.

For example, we wouldn't have ultrasound scanning now if it weren't for the work of Professor Ian Donald. Another man, Patrick Steptoe, made the link between laparoscopy (keyhole surgery) and infertility, and in doing so was responsible for the first test tube baby. Then there is Lord Robert Winston, who is a pioneer of specialist infertility services.

In general, history will show that men have been more innovative than women in the field of gynaecology and obstetrics. Perhaps they've had more opportunity to do so, as 20-30 years ago there were very few female gynaecologists. Even today, only 20 per cent of consultants are women. It was 12-13 per cent six years ago, so we are growing in number. But one of the reasons why there are fewer female gynaecologists is that it is a very time-consuming speciality, and you'd be awfully hard pressed to find enough women who'd give all their time and effort to it.

You'd hope that the people who've taken up gynaecology - 80 per cent of whom are men - have done so because they have a particular aptitude for and empathy with that specialty. I think it would be unwise and unfair to deny them the ability to practise what they do best.

Dr Laura Cassidy is a consultant obstetrician and gynaecologist at the Clyde Hospital in Greenock.

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