Features and methods of conducting a gynecological examination. Psychological harm of vaginal examinations

The history of medicine indicates that in ancient times the development of obstetrics, gynecology and surgery went hand in hand; in the books of Moses, the Prophets, the Talmud, etc. there is clear information about midwives, menstruation, women's diseases and methods of treating them.

The first information about obstetrics and the treatment of female diseases is contained in medical texts of the ancient East: Chinese hieroglyphic manuscripts, Egyptian papyri (“gynecological papyrus” from Kahun, 19th century BC, and the G. Ebers papyrus, 16th century BC. BC), Babylonian and Assyrian cuneiform tablets (II-I millennium BC), Indian Ayurvedic texts. They talk about women's diseases (uterine displacement, tumors, inflammation), diet for pregnant women, normal and complicated childbirth. The samhita of the famous surgeon of ancient India Sushruta mentions the incorrect position of the fetus in the uterus and the operations of turning the fetus on the stem and head, as well as the extraction of the fetus, if necessary, through fetal-destroying operations.

In Ancient Egypt all advances in medicine were associated with the name of the god Imhotep. Temples were built in his honor, in which priests healed those suffering from various ailments, guided by the instructions of Imhotep. Imhotep was supposed to send dreams to those who were suffering or in pain. He was a doctor for both deities and people. The protector of women in labor and babies was the goddess Tauert, depicted as a monster with the head of a hypopotamus, the body of a horse and the paws of a lion.

Medical practice in Ancient Egypt was subject to strict moral standards. By observing them, the doctor did not risk anything, even if the treatment failed. However, violation of the rules was severely punished, including the death penalty. Each Egyptian doctor belonged to a certain college of priests. Doctors specialize in certain types of diseases (“uterine” doctors, eye doctors, dental doctors), and special clinics for gynecology, surgery and eye diseases appear. Manuscripts of the 2nd millennium BC also contained detailed instructions on how to treat wounds, fractures, etc. Information about various diseases and their treatment is found in the “Gynecological Papyrus” from Kahun, the “Veterinary Papyrus,” the papyri of Erus, Brugsch, etc.

Currently, there are 10 main papyri known, wholly or partially devoted to healing. In the Ebers papyrus, the gynecological section contains information about recognizing the timing of pregnancy, the sex of the unborn child, as well as “a woman who can and cannot give birth.” The Berlin and Kahun papyri describe a simple way to determine the sex of an unborn child. It is suggested to moisten barley and wheat grains with the urine of a pregnant woman. If the wheat germinates first, a girl will be born, if barley, a boy will be born. American researchers from Georgetown University conducted such tests and received statistically significant confirmation of their effectiveness. However, this fact does not yet have a rational explanation. If the born child was very noisy (the reasons were not sought), then to calm him down they were given a mixture of poppy seeds and mouse droppings.

Egyptian doctors were aware of some women's diseases: irregular menstruation, prolapse of the vaginal walls, and uterine prolapse. What treatment Egyptian doctors used for these diseases is unknown.

Egyptian healers knew several hundred medicinal plants, many of which - castor oil, flaxseed, wormwood and opium - are used in medicine, including gynecology, even today. Egyptian doctors prepared decoctions, pills, ointments, and healing suppositories from them. The bases for preparing medicines were milk, honey, beer, water from sacred springs, and vegetable oils.

Greek doctors practiced in all specialties. They provided obstetric care only in cases of difficult childbirth. They knew some surgical methods of delivery, in particular, they knew about caesarean section, which was not performed on the living at that time. The ancient Greek myth about the birth of the god of medicine Asclepius himself, who was extracted from the corpse of his mother by his father Apollo, also tells about this operation on a dead woman in order to extract a living child.

Assisting in childbirth in Ancient Greece was carried out exclusively by women, whom the Greeks called “umbilical cord cutters” (“omphalotomoi”). If the birth was difficult and the midwife saw that she could not provide assistance on her own, she turned, as was the case in India, to a male doctor. The activities of Greek midwives were quite diverse: they not only provided assistance during childbirth and the postpartum period, but also engaged in termination of pregnancy. In Ancient Greece, termination of pregnancy in the early stages was not pursued. This operation was allowed by the famous ancient Greek philosopher and naturalist Aristotle, believing that in the early period of pregnancy the fetus does not yet have consciousness. It is unknown by what means the abortion was performed.

Ancient Greek medicine preached the empirical direction of medicine in collaboration with philosophy. A student of the Kos Medical School, Hippocrates (460-377 BC) in his writings mentions palpation and internal gynecological examination, methods for diagnosing pelvic tumors, methods for determining location disorders (prolapse and prolapse) of the female genital organs. It is known that in Pompeii they used a vaginal speculum for internal examination, which could be opened using a screw.

Judging by the books of Hippocrates, knowledge of gynecology was quite extensive at that time (400 BC), and in gynecological examinations even then they resorted to palpation and manual diagnosis; Manual examination techniques were considered necessary to determine the displacement, prolapse and inclination of the uterus, the presence of tumors, and the suffering of the uterine cervix and sleeve. “The Hippocratic Collection” contains a number of special works: “On the Nature of Women”, “On Women’s Diseases”, “On Infertility”, etc., which contain descriptions of the symptoms of uterine diseases and methods of removing tumors using forceps, a knife and a hot iron.

The ancient Greeks knew about caesarean section, but performed it only on a dead woman in order to extract a living baby (according to mythology, this is how the god of healing Asclepius was born). Note that the first reliable information about a successful cesarean section on a live woman in labor dates back to 1610, it was performed by the German obstetrician I. Trautmann in Wittenberg.

In the final period of the history of ancient Greece - the Hellenistic era (when Alexandrian doctors began to perform anatomical dissections), the practice of obstetrics and gynecology began to emerge as an independent profession. Thus, a famous obstetrician of his time was the student of Herophilus Demetrich from Apamea (2nd century BC). He studied the development of pregnancy, the causes of birth pathology, gave an analysis of various types of bleeding and divided them into groups. Another Alexandrian physician, Cleophant (2nd century BC), compiled an extensive work on obstetrics and women's diseases.

Among the Romans Along with individual outstanding researchers (Galen, Soranus, Archogenes, etc.), religious cults continued to exist with the worship of gods borrowed from the ancient Greeks. Thus, the Greek god-healer Asclepius was transferred to Rome under the name of Aesculapius - the god of medicine; the goddess of fever appears, the goddess of menstruation Fluonia, the goddess of the uterus - Uterina and the goddesses of childbirth - Diana, Cybele, Juno and Mena.

Very valuable special works by Roman doctors on obstetrics and women's diseases have survived to this day. Among them is the work of the female midwife Aspasia (2nd century), who held the title of doctor. She outlined her theoretical and practical knowledge in a book that has come down to your time. In it, Aspasia covered a number of issues, in particular about pregnancy hygiene, caring for a patient during a natural and artificial miscarriage, correcting a displaced uterus, and dilating the veins of the external genitalia. The indications and methods for examining the uterus by palpation and, for the first time, by using a vaginal speculum are outlined. The book contains information about condylomas, as well as hernias. Aspasia knew surgical methods for treating some female diseases. She promptly removed hypertrophied labia minora and clitoris, removed polyps of the cervical canal of the uterus, etc.

The classical works of famous doctors of ancient Rome are also known - A.K. Celsus, Soranus from Ephesus, Galen from Pergamon. They knew various methods of obstetric and gynecological examination, operations of turning the fetus on its leg, removing it by the pelvic end, embryotomy; they were familiar with genital tumors (fibroids, cancer), uterine displacements and prolapses, and inflammatory diseases.

In ancient times, gynecological instruments were already used; Thus, during the excavations of Pompeii, a three-leaf sleeve mirror was found, which opened with a screw; Paul of Aegina mentions the sleeve mirror. In the I-II centuries. AD In Rome, the surgeon and obstetrician Archiven worked, who was the first to use a mirror when examining the vagina and cervix, which he called dioptra (Greek dioptra; from diopleuo - to see everywhere). Speculums and other surgical instruments were discovered during excavations of the ancient Roman cities of Pompeii and Herculaneum, buried under the ash of Mount Vesuvius in 79 AD.

After Hippocrates, gynecology, like all medicine, continued to develop, although rather slowly; but from the middle of the 7th century there was almost complete stagnation in its development: among the Arabs and Mongols who dominated at that time, religion did not allow a male doctor to see a sick woman. In Islamic countries, as is known, male doctors could not touch a sick woman, it was also forbidden to use human corpses to study anatomy, so gynecology was at a descriptive level, however, it was the Arab Abu al-Qasim (936-1013) who first described the clinic of ectopic (ectopic) pregnancy, and Ibn-Zohr (1092-1162) published recipes for contraceptives.

Methods of treating female diseases that were practiced in ancient times are local: smoking, douching, pessaries, cupping, poultices, lotions, etc.; and internal: laxatives, emetics, herbs and roots special for women, etc.

The frequency of gynecological examinations is determined by the woman’s age, health status, and the presence or planning of pregnancy. The doctor interviews the patient, conducts an examination on the chair and takes smears.

Features and methods of conducting a gynecological examination

A visit to a gynecologist is a necessary measure to prevent diseases of the reproductive system. Timely detection of pathologies helps to carry out treatment in the early stages and prevent the development of complications that can cause infertility. Girls begin to visit a doctor at the age of 13–15; the first gynecological examination should be carried out no later than 21 years.

Before visiting the doctor, it is necessary to perform hygiene procedures; it is not recommended to use deodorizing agents; you should wash with regular soap. The day before the scheduled examination, you should not douche, put tampons, or have sexual intercourse. Failure to comply with these rules may distort the results of the study.

The best period to visit a gynecologist is considered to be the first week after the end of menstruation, but you can undergo an examination on any other day when there are urgent complaints. If a woman has taken antibiotics, then she should go to the clinic 1–2 weeks after the end of therapy. Anti-inflammatory drugs can change the composition of the vaginal microflora.

Immediately before visiting a gynecologist, you should empty your bladder and, if possible, your bowels.

You should take the following with you to your doctor's appointment:

clean socks or shoe covers;
diaper;
sterile gloves;
disposable vaginal speculum (according to Cusco).

At the pharmacy you can purchase a gynecological kit, which, in addition to the indicated items, includes instruments for taking a smear (Ayre spatula, cytobrush), laboratory glasses for applying vaginal secretions. Most modern clinics have the necessary equipment and do not need to bring it with them. This must be clarified when making an appointment with a gynecologist.

Principles of inspection

Consultation and examination with a doctor is recommended for all girls who have started menstruation and sexual relations. Menstrual irregularities, inflammatory and infectious diseases of the gynecological area, and pregnancy planning may also be reasons for enrolling in the clinic.

Speculums of various sizes are used to examine the vagina and cervix (1–6). The instrument is selected individually for each woman, taking into account the manipulations performed. To examine pregnant women, a pelvis meter and an obstetric stethoscope are used. Girls aged 12–17 years old are examined only the external genitalia or have a rectal examination.

Patient interview

First, the doctor collects anamnesis, asks questions of interest, and listens to complaints. This data will help establish the correct diagnosis and prescribe treatment. Most often, the gynecologist asks at what age menstruation began, and how long ago the last critical days ended, whether the menstrual cycle is regular, whether sexual relations are present, and when the first sexual intercourse occurred.

Women explain the reason for their visit: it could be a preventive examination, symptoms of a disease, planning a pregnancy or suspicion of conception that has already occurred, selection of contraceptives. You should answer your doctor’s questions honestly, without hesitation, as this will help you quickly establish a diagnosis and carry out treatment.

It is important to inform the doctor about the number of births, abortions or terminated pregnancies, past gynecological diseases, the presence of chronic ailments, allergies to medications, and congenital pathologies.

General examination

After the interview, a general examination is carried out. The gynecologist evaluates the condition of the skin, hair, body weight, and measures blood pressure. Characteristic external signs may indicate the presence of hormonal disorders. For example, acne and increased body hair growth appear with increased levels of androgens in the blood. Against this background, the woman’s health deteriorates and problems arise with conceiving a child.

Hair loss, swelling of the face, and excess weight may indicate a decrease in thyroid function and the development of diabetes. For this reason, the doctor may prescribe an additional consultation with an endocrinologist and testing for thyroid hormone levels.

Breast examination

The next step is an examination of the mammary glands. To do this, the patient undresses to the waist and lies down on the couch. The doctor palpates the breast in various positions. This procedure is necessary to identify seals and nodes. The doctor pays attention to the condition of the nipples, skin, swelling of the mammary glands, and the presence of discharge.

During the examination, fibrocystic mastopathy and a tumor may be detected. The ovaries are often involved in the pathological process (polycystic disease). These diseases can cause dysfunction of the reproductive system, lead to infertility, deterioration of a woman’s well-being, and disruption of the menstrual cycle. In this regard, examination of the mammary glands is a mandatory measure.

Examination on a gynecological chair

A gynecological examination begins with an assessment of the condition of the external genitalia. If a woman suffers from sexually transmitted or infectious diseases, then the labia will be swollen, the skin will be inflamed and red. With candidiasis, a characteristic whitish, cheesy coating appears. External manifestations also include the formation of condylomas and rashes of various types.

The doctor assesses the condition of the clitoris, labia majora and minora, vestibule of the vagina, skin of the perineum, and can diagnose vaginal prolapse.

The next step is an intravaginal examination. For this procedure, the doctor uses a special metal or plastic mirror. The instrument is carefully inserted into the vagina and expands its walls. Such manipulation is necessary to check the condition of the mucous membranes and cervix for the presence of erosion or other pathological processes. Intravaginal examination is not performed on girls who have not had sexual intercourse.

Then the gynecologist, using a special spatula, collects secretions from the cervical canal and vaginal walls (smear). The material is sent to the laboratory to be examined for pathogenic microflora.

If cervical erosion is present, colposcopy is performed and a piece of damaged tissue is taken for cytological examination. This way cancer cells are detected. If there are no signs of an oncological process in the material, then cauterization of the erosion is indicated.

Bimanual examination

After examination with a gynecological speculum, a manual examination is performed. The doctor inserts his fingers into the vagina, and with the other hand he probes the uterus and appendages from the outside through the abdominal wall. In a healthy woman, the procedure does not cause pain, in case of inflammatory diseases.

A bimanual gynecological examination allows you to determine the depth of the vaginal vaults and detect an increase in the size of the uterus, ovaries, and fallopian tubes. This is how fibroids, ectopic pregnancy, ovarian cysts, pregnancy, endometriosis and other pathologies are diagnosed. In some cases, inflammation of the bladder or rectum, damage to the periuterine tissue, and accumulation of exudate in the tissues can be detected.

Rectal examination

The rectal method is carried out by inserting a finger of one hand into the rectum, while the doctor palpates the patient’s abdomen with the other hand. This examination is an alternative to intravaginal examination; indications for the procedure are the following situations:

examination of girls under 17 years of age;
atresia, vaginal stenosis;
uterine cancer;
assessment of the condition of the uterosacral ligaments;
parametrites;
ovarian tumors.

A rectal examination helps assess the condition of the pelvic floor ligaments, the extent of the inflammatory or oncological process.

Examination of virgins on a gynecological chair

When examining girls under 17 years of age, the doctor determines the degree of sexual development: growth of the mammary glands, pubic and armpit hair growth. Physical characteristics and sexual characteristics must correspond to calendar age.

Girls who have not had sexual intercourse are not examined using a mirror. The gynecologist checks only the condition of the external genitalia. If there are complaints or there is a suspicion of an inflammatory process, then the examination is performed rectally.

The doctor carefully inserts a finger into the rectum and palpates the groin area with the other hand. This allows you to determine the size of the uterus, ovaries and appendages. The hymen is not broken.

If a vaginal examination is required, a special baby speculum is used. The instrument has a special structure and minimally injures the hymen. Vaginoscopy of the vagina can also be performed using a device equipped with a video camera.

Additional Research

In some cases, instrumental studies are required to make a correct diagnosis. The doctor gives a referral for ultrasound, hysteroscopy or laparoscopy. Using ultrasound, the condition of the mammary glands, endometrium of the uterus, the size and shape of the ovaries, and fallopian tubes are determined. prescribed for polycystic disease, ovarian apoplexy.

If there is a suspicion of a cancerous tumor, a biopsy or computed tomography is indicated. CT allows you to obtain clearer data on the condition of the reproductive organs. For symptoms of endocrine disorders, an analysis of hormone levels in the blood is required.

How often should you be examined?

Examination of girls under 17–18 years of age must take place with the consent of their parents; only the condition of the external genitalia is diagnosed. If inflammatory diseases are a concern, a rectal examination may be performed.

Women suffering from chronic illnesses need to be examined by a gynecologist more often. The doctor selects a treatment regimen, monitors the course of the disease and the progress of recovery. In case of infertility or at the stage of pregnancy planning, the doctor must monitor the woman’s condition, so the patient will have to appear at the clinic more often.

An examination by a gynecologist is a necessary measure to prevent pathologies in the organs of the reproductive system. Identifying them at an early stage helps to provide timely treatment and prevent the development of complications.

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Gynecology includes a complex of tests and diagnostic methods that every woman will have to undergo more than once. An examination by a gynecologist is especially important for that category of women who suspect they have a gynecological disease, are planning motherhood, or are preparing to become a mother. Let's look at exactly what mandatory tests and studies are included in an examination by a gynecologist, how they are carried out and what they can show.

THE COST OF AN APPOINTMENT WITH A GYNECOLOGIST IN OUR CLINIC IS 1000 rubles.

External gynecological examination

External examination is a simple but very important gynecological examination, which is carried out both as a preventative measure and for direct diagnosis of pathology (in the presence of characteristic complaints or symptoms). During this examination, the doctor pays special attention to all organs located in the anogenital area - the pubis, external and internal labia, anus. After this, the internal condition of the vagina is assessed (examination of the cervix).

During a superficial examination of the genital organs, the doctor, first of all, focuses on such points as:

skin condition (dry, oily, greasy, etc.);
the nature of the hairline (sparse or thick hair, condition of the hair roots, presence of power lines, etc.);
the presence of bulges or any tumors on the surface of the genital organs;
redness, swelling of areas of the skin or the entire organ.

During a more detailed examination, the doctor spreads the external labia and conducts a visual analysis of the state of the genital anatomical structures, assessing:

clitoris;
inner labia;
opening of the urinary canal;
vagina (outside);
hymen (in teenagers).

During such an examination, the doctor may notice pathological discharge, which will indicate some kind of disorder in the woman’s body. In such a situation, an additional bacterial culture test or smear microscopy is necessarily prescribed. This will allow you to accurately determine the presence of the disease and find out its causative agent.

Gynecological examinations for women and girls are different!

Gynecological examination with colposcopy

During this procedure, a gynecologist examines the woman's internal organs - the cervix, vagina and vulva. The examination is carried out using a special device - a colposcope. A gynecological examination with a colposcope is an accessible and informative procedure. The process is absolutely painless.

When colposcopy is prescribed, contraindications

As a rule, examination with a colposcope is recommended every six months, but it is not mandatory for healthy women. Colposcopy is required if significant abnormalities are detected as a result of the analysis of the LBC smear or PAP test.

Colposcopy is also prescribed if:

warts in the genital area;
cervical erosion;
inflammation of the cervix at any stage;
suspicion of presence cancer in the vagina;
uterine cancer;
significant changes in the shape and size of the vulva;
cancerous tumor on the vulva;
precancer, vaginal cancer.

There are no contraindications for this study, but the doctor will not do the examination on critical days and during pregnancy unless there are serious indications for this.

The gynecologist will prescribe an examination with a colposcope during pregnancy if the procedure cannot be postponed until the baby is born, due to a serious threat to the health of the expectant mother. Naturally, the examination by a gynecologist will be carried out with special care so as not to provoke a miscarriage.

Preparation for colposcopic examination

Before performing a colposcopy, the gynecologist will give the following recommendations:

Abstinence from sexual activity, even with a regular partner, for at least three days before the study;
If there are any diseases or inflammatory processes on the genitals, the woman is strictly recommended to refrain from treating them with suppositories and other vaginal remedies. Treatment can be continued after a gynecological examination.
If you are hypersensitive to pain, you can take it before the examination. painkiller tablet. Your doctor will prescribe pain medication.

As for the date of appointment for colposcopy, it is determined solely by the gynecologist.

How is a gynecologist examined with a colposcope?

Colposcopy is a routine gynecological examination with enhanced imaging. It is carried out in a completely non-contact way, using a modern device with a built-in microscope and static lighting, with lenses. An examination by a gynecologist in a modern clinic using a colposcope is the norm in Europe!

The device is installed on a special tripod in front of the woman’s vaginal opening. Next, the gynecologist, using a built-in microscope, examines the vaginal tissues under very high magnification, which makes it possible to note even the smallest changes in them. Lighting also helps the gynecologist. The gynecologist, by changing the angle of the light source, can examine scars or folds on the vaginal lining from all angles.

Typically, colcoscopy is performed with a detailed examination of the cervix and vulva. To better examine the surfaces, the gynecologist first removes the discharge using a tampon. Then, to prevent subsequent discharge, the surface of the cervix is lubricated with a 3% solution of acetic acid. If such preparation is not carried out, then, unfortunately, it will not be possible to obtain accurate results. There is no need to be afraid of this moment - the most a woman feels during a gynecological examination is a slight burning sensation in the vagina.

What will an examination with a gynecologist with a colposcope show?

As mentioned earlier, a colposcope allows the doctor to examine even the smallest changes in the structure and color of the epithelial cells of the vagina, which means it is able to detect any ailments at an early stage of development.

One of the most common diseases detected by a gynecologist with a colposcope is cervical erosion. Characteristic symptoms of erosion are uneven coloring, disruption of the epithelial layer, bleeding, etc.
Another disease that can be detected with a colposcope is ectopia. With ectopia, the doctor observes significant changes in the shape and color of the epithelium. This is a precancerous condition.
A pathology that is easily detected during examination with a colposcope is polyps. These are outgrowths of different sizes and shapes. Polyps are dangerous and can quickly increase in size, so they are removed.
No less dangerous are papillomas that populate the walls of the vagina. These formations can develop into cancer. Papillomas easily reveal themselves when a 3% acetic acid solution is applied to them - they turn pale.
During colposcopy, the doctor may see thickening of the inner lining of the vagina, which indicates the presence of leukoplakia. If treatment for this pathology is not started in time, tumors may form on the cervix.

The most dangerous disease detected by colposcopic examination during examination by a gynecologist is cervical cancer. If this disease is detected, a biopsy is performed immediately without fail.

Complications, consequences after a gynecological examination with colposcopy

Colposcopy usually does not cause any complications. The normal condition of a woman after a colposcopy procedure is light bleeding.

In rare cases, one of the bleeding options may occur. In this case, you need to urgently contact a gynecologist. Another unpleasant symptom of incipient inflammation is severe cutting pain in the lower abdomen.

Examination by a gynecologist with biopsy

The most important test prescribed for girls and women in gynecology is a biopsy. A biopsy is not considered a mandatory test during a gynecological examination, and is carried out on an individual doctor’s prescription. Its task is to confirm or refute the diagnosis of cancer. If the gynecologist recommends a biopsy, there is no need to panic - often the examination shows that the tumor is associated with inflammation or other processes.

Preparing and performing a biopsy

Diagnostics does not require additional preparation and involves taking biomaterials from the woman’s internal genital organs. A gynecological examination with biopsy is painless and lasts no more than 20 minutes. The tissues are examined under a microscope in the laboratory. The gynecologist will be able to announce the results of the study only after 2 weeks.

In total, there are about 13 different types of biopsies, only 4 of them are used in gynecology. These techniques are the most effective and informative when examining the female reproductive system:

Incision type - made by scalpel incision of internal tissues;
Targeted type - carried out by colposcopy or hysteroscopy;
Aspiration type - extraction of the material necessary for research by aspiration - vacuum suction;
Laparoscopic type - taking material for research using special equipment. This analysis is taken from the ovaries.

Before the biopsy, you will need to donate blood and urine to exclude complications after the procedure.

Contraindications and complications after a gynecological examination with biopsy

A biopsy performed by a good gynecologist under sterile conditions is safe. But it also has contraindications. A biopsy cannot be done if it is diagnosed:

blood clotting disorder;
internal bleeding;
allergies to the drugs used - anesthesia, aseptic treatment, etc.

After a biopsy, a woman may feel tolerable pain in the vaginal area or lower abdomen. However, the nature of the pain should be strictly pulling. In case of cutting pain, usually accompanied by bleeding, the patient should immediately contact a gynecologist for a re-examination.

You will need to refrain from strenuous physical activity and intimate contact for several days. If no abnormalities are observed in a woman’s body after this procedure, this does not mean that you can violate the gynecologist’s instructions and not come for a re-examination by the gynecologist.

As you can see, an examination by a gynecologist, even in its minimal form, provides extensive information about women’s health!

Treatment of female diseases has been known since ancient times. However, in many nations, due to cultural characteristics, a male doctor was not allowed to work with a woman. At the same time, the woman could not obtain a medical education. Thus, for a long time, among the Arabs, Mongols and a number of other peoples, female healers were engaged in curing female diseases. Contrary to the opinion of a number of our contemporaries, traditional medicine does not at all possess the secrets of curing any diseases. Moreover, ignorance and lack of understanding of basic things related, for example, to hygiene, led to the fact that poor-quality treatment only aggravated the disease.

On the contrary, other nations fully recognized the right of a male doctor to treat a woman, including for specifically female ailments. Even the ancient Egyptians knew some treatment techniques that allowed them to fight gynecological diseases. In Ancient Greece, thanks to the famous Hippocrates and his students and followers, they also knew how to treat women's diseases. For diagnosis, both palpation and manual examination were used, with the help of which the presence of tumors, prolapse and inclination of the uterus, etc. were determined. Douching, smoking, cupping, poultices, and much more could be used for treatment. Medicines were made from herbs and roots. During the excavations of Pompeii, a gynecological medical instrument was even found - a tricuspid sleeve speculum.

In the Middle Ages the situation changed. In Europe, medicine for a long time was in the hands of the Christian church, so society did not see anything wrong with allowing an educated male monk who had vowed to renounce carnal lusts to treat a woman. However, superstitions and mysticism had a negative impact on the development of gynecology. According to Christian tradition, Eve, the foremother of all women, committed the first sin by succumbing to the persuasion of the serpent in the Garden of Eden and tasting the forbidden fruit. As a result, specifically female diseases were sometimes viewed as special punishments sent to a woman from above, for example, for debauchery. Therefore, often monks, instead of using medicines, tried to fight the disease with the help of prayers. As a result, the patient only felt worse, which, in the traditions of the era, could be interpreted as a sign of extremely serious sinfulness, which even such holy people as monks could not cope with.

Only during the Renaissance did truly scientific science begin to develop in Italy. This process was greatly influenced by Arab medicine, which at that time was more developed in many areas than European medicine. By the way, it should be noted that in some areas of the Arab world the training of female doctors was sometimes even allowed, which also contributed to the development of gynecology.

And yet, gynecology finally broke away from mysticism and superstition only in the 18th-19th centuries. It was from this time that its rapid development and improvement began. In these centuries, scientific gynecology.

The art of obstetrics, or obstetrics, has ancient origins. We invite the reader to take a short excursion into history. Perhaps much of the obstetrics of the past will seem hopelessly outdated. But we should not forget that the new is often the well-forgotten old...

The modern birthing position (lying down) was first used in France in the 17th century. It is believed that it all started with Louis XIV, who wanted to hide behind a curtain to see the birth of a child from one of his mistresses, for which purpose the woman was placed on her back during childbirth.

And if you remember the entire history of mankind, then until the 19th century, women in Holland, for example, gave birth on special obstetric chairs. Their prototype was delivery on the knees, which was often practiced in Europe in the 16th-17th centuries. In Holland, women who gave birth on their knees were called “living obstetric chairs.” In America, the position of the woman in labor on her side during the second stage of labor was practiced. In many countries (for example, in Central Asia), legends about women giving birth in a squatting position are still alive. And among the Aztecs, the goddess of childbirth is depicted as a woman squatting, with the head of a baby born and located between her legs.

Primitive communal system

It can be assumed that during the period of matriarchy, all possible assistance to a woman in labor was provided by the woman, the eldest in the family. It is possible that in that distant time a woman gave birth without any help, biting the umbilical cord herself, as animals do. This can be confirmed by the life and customs of some native tribes of Brazil, where to this day women give birth this way. The domestication of wild animals and the transition to shepherding led to a dominant position in the family of men - matriarchy was replaced by patriarchy. With constant communication with animals, the shepherd had to provide assistance to animals in case of difficult childbirth. The experience of treating animals was eventually transferred to people.

It is believed that primitive healers even knew how to perform operations. This is how one of the travelers describes a caesarean section, which he observed in a family of aborigines of Central Africa (some of the tribes there still live according to the laws of the primitive communal system): “A 20-year-old woman, a first-born woman, completely naked, lay on a slightly inclined board, the head of which rested against the wall of the hut. Under the influence of banana wine, she was half asleep. She was tied to her bed with three bandages. The operator with a knife in his hands stood on the left side, one of his assistants held his legs in his knees, the other fixed the lower abdomen. After washing his hands and the lower abdomen of the patient first with banana wine and then with water, the operator, uttering a loud cry, which was echoed by the crowd gathered around the hut, made an incision along the midline of the abdomen from the pubic joint almost to the navel. With this incision he cut both the abdominal wall and the uterus itself; one assistant, with great skill, cauterized the bleeding places with a hot iron, another parted the edges of the wound to enable the surgeon to remove the child from the uterine cavity. Having removed the placenta and the resulting blood clots through the incision, the operator, with the assistance of his assistants, moved the patient to the edge of the operating table and turned her on her side so that all the fluid could flow out of the abdominal cavity. Only after all this were the edges of the wound connected using seven thin, well-polished nails. The latter were wrapped with strong threads. A paste was applied to the wound, which was prepared by carefully chewing two roots and spitting the resulting pulp into a pot; a heated banana leaf was placed on top of the paste and the whole thing was strengthened with a kind of bandage.”

Slave system

Currently known monuments of medical literature of that era are various Egyptian papyri, including the “gynecological papyrus” from Kahun (XXX century BC), Chinese hieroglyphic manuscripts (XXVII century BC), Babylonian cuneiform records (XXII century BC), the Indian book “Ayur-Veda” (“Knowledge of Life”) in several editions (IX-III centuries BC).

Against the background of the general development of human society, in connection with the development of sciences and general medicine, obstetrics is also being further developed. For the first time, questions arise about the cause of difficult childbirth, and rational methods of delivery appear.

Different peoples of the ancient world had different knowledge of obstetrics. Thus, among the Egyptians, Jews and Chinese, obstetric care was entirely in the hands of women (midwives). Since ancient times, the Chinese have maintained the tradition of childbirth in a sitting position. The ancient Egyptians had a special class of women who helped women in labor. To find out if a woman was pregnant, she was given a drink made from a special herb (boo-doo-doo-ka) and the milk of the woman who gave birth to a boy. If the drink caused vomiting, pregnancy was assumed, otherwise pregnancy was not present. The sex of the unborn child was also determined using a unique method. To do this, they took grains of barley and wheat, moistened them with the urine of a pregnant woman and monitored their germination. If wheat sprouted first, it was predicted that there would be a girl, if barley - a boy. Egyptian doctors were aware of some women's diseases: irregular menstruation, prolapse of the vaginal walls, and uterine prolapse.

In China, when assisting a woman in labor, midwives often used amulets and special manipulations, but some also used obstetric instruments, the exact information about which has not reached us.

The obstetric knowledge of the ancient Jews was not much different from the knowledge of the Egyptians and Chinese. It is known that to determine pregnancy, they forced a woman to walk on soft soil: if a deep mark remained, then pregnancy existed.

In Ancient India there was no special class of midwives - any woman experienced in this matter could provide assistance to a woman in labor; in cases of difficult labor, the midwife sought help from a male doctor. Whether because of this, or for some other reasons, the obstetric knowledge of Indian doctors was greater than that of the Egyptians, Chinese and Jews. Judging by the literary sources that have reached us, Indian doctors initiated the study of obstetrics and were the first to propose rational methods of assistance during childbirth. Thus, Sushruta for the first time mentions incorrect positions of the fetus, in which he recommends turning it onto the stem and onto the head.

Ancient Greece

Greek doctors practiced in all specialties; they provided obstetric care only in cases of difficult childbirth. They knew some surgical methods of delivery, they knew about caesarean section, which was not performed on the living at that time. The ancient Greek myth about the birth of the god of medicine Asclepius himself, who was extracted from the mother’s corpse by his father Apollo, also tells about this operation on a dead woman in order to extract a living child.

The activities of Greek midwives were quite diverse: they not only provided assistance during childbirth and the postpartum period, but also carried out abortions. In Ancient Greece, termination of pregnancy in the early stages was not pursued. This operation was allowed by the famous ancient Greek philosopher and naturalist Aristotle, believing that in the early period of pregnancy the fetus does not yet have consciousness. It is unknown by what means the abortion was performed.

If for some reason the birth had to be secret, midwives performed the delivery at home (naturally, this was very expensive). In childbirth at home with a midwife, one can see a prototype of a maternity hospital. Midwives of that time already had significant knowledge. Thus, they determined pregnancy by a number of objective signs: absence of menstruation, lack of appetite, drooling, nausea, vomiting, and the appearance of yellow spots on the face. But along with this, they also resorted to rather ridiculous means: they rubbed a red stone in front of the woman’s eyes; if dust got into her eyes, the woman was considered pregnant, otherwise pregnancy was denied. They tried to determine the sex of the fetus by the inclination of the pregnant woman's nipples: inclination downward indicated pregnancy with a girl, upward inclination indicated pregnancy with a boy.

Ancient Rome

The Romans had religious cults with the worship of gods borrowed from the ancient Greeks. Thus, the Greek god-healer Asclepius is transferred to Rome under the name of Aesculapius - the god of medicine; the goddess of fever appears, the goddess of menstruation Fluonia, the goddess of the uterus - Uterina and the goddesses of childbirth - Diana, Ki-bela, Juno and Mena. Moreover, the specialization of “divine” obstetric care among the Romans reached special development. Thus, each position of the fetus in the uterus had its own goddess: Prose was in charge of the birth of the fetus forward with the head, and Postvert was in charge of childbirth during foot and breech presentation (when the legs or buttocks are born first), as well as in transverse positions. Children born with their legs forward received the name Agrippa. In all cases of childbirth, the midwife was required to make various offerings to the appropriate goddess.

Of the doctors of Ancient Rome, especially famous names have been preserved in the history of medicine: the Roman Celsus and the Greeks Philumenus, Soranus and Galen. Providing assistance during childbirth in Rome, as in Greece, was carried out primarily by female midwives (midwives). The doctor was invited only in cases of pathological childbirth, when the midwife saw that she could not cope on her own. Among the women midwives there were also outstanding ones who left a mark on history with their activities. These included Aspasia (2nd century AD), who held the title of doctor. She outlined her theoretical and practical knowledge in a book that has survived to this day. In it, Aspasia covered a number of issues, in particular about pregnancy hygiene, caring for a patient during a miscarriage, correcting a displaced uterus, dilating the veins of the external genitalia, candilomas, and hernias. The book outlines indications and methods for examining the uterus and vagina by palpation and using a vaginal speculum.

Middle Ages

Medicine during this period was strongly influenced by religion, and therefore developed rather poorly. The Church propagated absolutely fantastic ideas like the dogma of the “immaculate conception.” Any critical statements about such views on the part of scientists and doctors led to their persecution, expulsion from their native country and torture by the Inquisition. It is quite clear that such a situation had a disastrous effect on the development of obstetric science. And yet medicine continued to develop. Thus, in Byzantium in the 9th century, a higher school was first founded, in which scientific disciplines were studied, including medicine. History has preserved for us the names of the Byzantine doctors Oribasius, Paul (from Aegina) and others, who continued to develop the legacy of their predecessors.

The centers of higher education, including medical education, were universities, which began to appear in the 11th century. There were very few university students. The basis of all sciences was theology. The dominant form of ideology at that time was religion, which permeated all teaching, which proceeded from the position that all possible knowledge was already taught in the Holy Scriptures.

However, although in the early and middle periods of feudalism (from the 5th to the 10th centuries and from the 11th to the 15th centuries) religion and scholasticism were a brake on the development of science, among the doctors there were those who not only studied from the books of Hippocrates, Soranus, Celsus, Paul, but also continued to study nature and its phenomena. Yet obstetrics remained at a very low stage of development. Obstetrics in the Middle Ages was considered low and indecent for male doctors. Childbirth was still handled by midwives. Only in the most difficult cases, when the woman in labor and the fetus were in danger of death, did the midwives call for help from a male surgeon, who most often used a fetal-destroying operation. In addition, the surgeon was not invited to every woman in labor, but mainly to wealthy women. The rest were satisfied with the help of the “grandmother” and, instead of actual obstetric care, received from them spoken water or an amulet. It is not surprising that with such assistance and failure to comply with basic hygiene requirements, mortality during childbirth and the postpartum period was very high. Correction of fetal malposition by rotation, a great achievement of antiquity, was forgotten or not used by most doctors.

Renaissance

While the Catholic Church of the feudal period was the greatest obstacle to progress, the bourgeoisie of the period of the birth of capitalism was especially interested in the development of the sciences, in particular the natural sciences. A new direction in medicine appeared in the works of Paracelsus, Vesalius and others. The innovators of the progressive movement sought to develop medical science on the basis of experience and observation. Thus, one of the greatest physician-reformers of the Renaissance, Paracelsus (1493-1541), rejected the teaching of the ancients about the four juices of the human body, believing that the processes occurring in the body are chemical processes. The great anatomist Vesalius (1514-1564) was the first to correctly describe the structure of a woman’s uterus. Another famous anatomist, the Italian Gabriel Fallopius (1532-1562), described in detail the fallopian tubes that received his name (fallopian tubes).

During this period, anatomy began to develop rapidly. This led to a large number of discoveries also in the field of gynecology. It is necessary to list the scientists who made significant contributions to the development of gynecology and obstetrics. The Roman professor of anatomy Eustachius (1510-1574) very accurately described the structure of the female genital organs, based on the massive dissection of corpses in hospitals. Arantius (1530-1589), a student of Vesalius, dissecting the corpses of pregnant women, described the development of the human fetus and its relationship with the mother. He saw one of the main reasons for difficult childbirth in the pathology of the female pelvis. Botallo (1530-1600) described the blood supply to the fetus. Ambroise Pare (1517-1590) - the famous French surgeon and obstetrician - restored and improved the forgotten method of turning the fetus onto its stem, used in the transverse position of the fetus. He recommended using the rapid release of the uterus from contents to stop uterine bleeding, and he was the first to invent a breast pump. The German surgeon Trautmann was one of the first to successfully perform a caesarean section on a live woman in labor in 1610.

In the 16th century, the first atlases and manuals for midwives appeared. The rapidly developing science and medicine of this period made it possible to carry out quite complex abdominal and gynecological operations. Original methods for removing abscesses from the pelvic cavity and reconstructive surgery performed for uterine prolapse were proposed. Obstetrics also came under this influence. For the first time, Chamberlain (Chamberlain), and later Geister, proposed the use of obstetric forceps for difficult childbirth. Anatomical concepts such as the size of the pelvis were studied, which subsequently made it possible to more or less accurately predict the course of labor and, accordingly, to be prepared for possible complications. Leeuwenhoek's invention of the microscope made it possible to study in more detail the microstructure of the female genital organs, on the basis of which initial ideas about the function of various parts of the reproductive tract began to emerge.

Development of obstetrics in Russia

Obstetrics in Rus' originated during the period of the clan system among the ancient Slavs, about whose life there is very little information. If medical care at that time was provided by a healer, who was called a “baliy” or “witch,” then in the field of obstetric care such a figure should be considered a midwife. The experience of midwives passed from generation to generation. Each locality and even each midwife had its own obstetric technology. In addition, the midwife not only took birth, but was also a necessary assistant in the peasant household, a protector and guardian of mother and child. The life of the mother and child was directly dependent on her talent, intuition and experience. The state did not take any part in the organization of obstetric care.

Over the course of hundreds of years, the practice of Russian folk obstetrics has accumulated a number of useful techniques and manipulations, which were partly included in scientific obstetrics; at the same time, useless and often dangerous techniques were used, with which scientific obstetrics subsequently waged an intensified struggle.

During childbirth, the woman in labor was surrounded only by women: the midwife, mother, and sister. Men never interfered in the birth process. The tasks of midwives, in addition to the first care of the baby, were to fulfill established customs, beliefs, and conspiracies from ancient times. So that the birth would be “untied,” the midwife would unravel the woman’s braids, untie all the knots on her clothes, walk with the woman in labor until she was completely exhausted, hang her up by her arms, shake her, and knead her stomach. Moreover, the more the midwife knew of similar techniques that supposedly speed up childbirth, the more experienced and knowledgeable she was considered.

Only Peter I issued laws concerning the activities of midwives, who had not previously been subject to any control. In 1704, a decree was issued prohibiting, on pain of death, the killing of born monsters, which was practiced by midwives and did not contradict the views established among the people.

To increase the population, a little later, Peter I organized the first shelters for newborns, whom mothers wanted to get rid of for various reasons. These shelters were the prototype of future educational homes.

In 1771, a maternity hospital for poor women in labor with 20 beds was founded at the orphanage in St. Petersburg. The breeder Porfiry Demidov donated money for the construction of this first large maternity hospital. The maternity hospital and the Midwifery School were combined into a single obstetric institution, in which there were departments for poor women in labor, for those giving birth illegally, as well as a “secret department” for people under investigation, syphilitic women, etc.

Among Russian obstetricians and gynecologists there were many prominent scientists who headed numerous scientific schools that were recognized both here and abroad. However, in Russia there were only 12 obstetric departments. A huge territory of the country, with the exception of large cities, remained without qualified obstetric and gynecological care; the vast majority of births occurred outside of medical facilities and even without medical supervision, and the need for such care was met only to a negligible extent.

So, in 1903, 98% of women in Russia gave birth without any obstetric care. But even in such large cities as St. Petersburg, despite the fact that by the end of the 19th century the city already had a sufficient number of maternity hospitals and doctors, wealthy women preferred to give birth at home, albeit under the supervision of midwives. City and district maternity hospitals were intended mainly for the poor. Only after the 1917 revolution did maternity hospitals become the main place of birth. Of course, the fact that the general public gained access to medical care saved the lives of many women.

In the issue of organizing obstetric education in Russia, a particularly important role should be given to P. Z. Kondoidi (1710-1760). He was the first to organize the teaching of obstetrics in Russia and correctly assessed the importance of organizing obstetric care for the population, gave detailed and precise instructions for theoretical and practical teaching, and established exact deadlines for training and examinations. The entire course of study took 6 years. After the first 3 years of training, independent practice was allowed, but under the supervision of an experienced grandmother. It was assumed that the schools would provide midwives not only to large cities, but also to the entire country.

Due to a lack of funds, “babichi” schools in St. Petersburg and Moscow were opened only in 1757, when the government found it possible to allocate 3,000 rubles annually to each of these schools for the “babi’s business”. Great difficulties were encountered in recruiting students to schools. When, on the basis of a decree approved by the Senate, the registration of grandmothers living in St. Petersburg and Moscow was carried out, there were 11 of them in St. Petersburg, and 4 in Moscow. In addition, there were 3 in St. Petersburg and 1 grandmother in Moscow, who could only practice under the supervision of more experienced. Thus, for two large capital cities of the Russian Empire there were only 19 women with one or another obstetric qualification. But nevertheless, schools began their work. Many of the maternity women among whom the students practiced were so poor that they were unable to pay for the most necessary medicines. P.Z. Kondoidi found a solution to this question as well. According to his proposal, in 1759 the Senate decided that, based on prescriptions from obstetricians, the capital's pharmacies would dispense necessary medicines and things free of charge to poor mothers and newborn babies at the expense of the residual amounts determined by the Senate for the “woman's business.”

The most outstanding representative of Russian obstetrics is N. M. Ambodik-Maksimovich (1744-1812), deservedly called the “father of Russian obstetrics.” N. M. Ambodik was an encyclopedist scientist. He is credited with creating Russian medical terminology. He was the author of several dictionaries (surgical, anatomical-physiological and botanical). He wrote the first original Russian manual on obstetrics in six parts with an excellent atlas “The Art of Midwifery, or the Science of Womanhood.” This was the best guide until the middle of the 19th century. In it, N.M. Ambodik covered in detail all the issues of obstetrics at his current level of knowledge, and also touched on some elements of gynecology (anatomy, physiology, pathology of the female body and female hygiene).

Delivery room in... bathhouse

The Russian bathhouse was an integral part of everyday life. They often gave birth there. Traditional healers highly valued the healing power of the bath, its beneficial effect on humans associated with profuse sweating, which helps remove various harmful substances through the skin. In addition, the bathhouse was a sterile space from a bacteriological point of view. In addition, it was a separate room, unlike other overcrowded ones in which large families lived. It was also important that there was a sufficient amount of warm water in the bathhouse. All this created good conditions not only for the mother in labor, but also for the newborn.

Consultant: Elena Andreeva. Obstetrician-gynecologist, 1st category, medical genetic center, Gomel