Some of the simpler operations

As with the rest of surgery, the highest incidence of gynaecological disease, and the worst cases are to be found where there are fewest gynaecologists. In a survey of two Indian villages 55% of women had gynaecological complaints, 92% had one or more gynaecological or sexual diseases and the average number of these diseases per woman was 3.6. Only 8% of them had had any gynaecological treatment. This is some indication of how little attention is given to the reproductive health of non-pregnant women, most of whom only encounter the health care system when they are the target of family planning programs.

So there is much gynaecology to do! You can evacuate an incomplete abortion (16.2), drain and marsupialize a Bartholin's abscess (20.4), drain a pelvic abscess (6.5), and tie a patient's tubes (15.3). You may have to do an emergency hysterectomy; but you should, if possible, try to refer a ''cold' one. The standard repertoire of an expert gynaecologist includes an anterior and a posterior colporrhaphy, a Manchester repair, and a vaginal hysterectomy. These are difficult, particularly the latter two, so we have included Le Fort's operation and ventrisuspension.

Bang RA et al., ''High prevalence of gynaecological disease in rural indian women'. Lancet 1989;i:85[en]87. 7