Gynaecology’s gender question

When US gynaecologists were told to stop treating men,it led to a debate on male-female boundaries.

Written by New York Times | Published: December 29, 2013 5:09:50 am

Denise Grady

Should gynaecologists be allowed to treat men? A medical specialty board stirred up a hornet’s nest in September when it warned gynaecologists that if they accepted male patients,they could lose their certification. Protests erupted from patients and doctors who said the policy,set by the American Board of Obstetrics and Gynaecology,interfered with medical care and research.

Since then,the board,based in Dallas,has backed off twice. In November,it gave gynaecologists permission to screen and treat men at high risk for anal cancer. Then,the board said that gynaecologists who had been treating men with chronic pelvic pain could continue to see their patients. But with few exceptions,the policy stands: No male patients.

The board’s pronouncements have puzzled many,including physicians,who wonder what harm there is in gynaecologists’ treating men and whether a specialty board has the authority to impose such a rule. The board said that the ban was part of a larger effort to preserve the integrity of the gynaecology specialty and protect patients from doctors who had begun to practice types of medicine for which they had not been trained or certified. In interviews,two board members — executive director Dr Larry C Gilstrap and director of evaluation Dr Kenneth L Noller — said that too many gynaecologists had been straying into areas like testosterone therapy for men,liposuction,plastic surgery for women and men. The board members said some of these doctors were behaving unethically.

But apparently,before the notice came out,some gynaecologists were screening men at high risk for anal cancer,while others were treating men with chronic pelvic pain,often resulting from injuries to or irritation of pudendal nerve. In both conditions,the affected body parts and treatments are the same in men and women,but gynaecologists have more treatment experience than most doctors.

Both groups of doctors,and some of their patients,asked the board to make an exception. Initially,it declined,insisting that male patients could be referred to other doctors. But members changed their minds in November with regard to anal cancer screening. The disease is usually caused by a sexually transmitted virus. The permission granted for treating pelvic pain is limited and applies only to “current patients,” defined as those whom the doctors had seen or for whom they had scheduled appointments on or before December 18. Stephanie Prendergast,a physical therapist in San Francisco and president of the Pelvic Pain Society,said the board’s permission was good news but that she wished it had been extended to new patients as well.

Arthur L Caplan,director of the division of medical ethics at NYU Langone Medical Center,said,“I think using the male-female boundary — it’s old-fashioned and should change.”

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