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Between a Man and His Gynecologist

"You've got your mother in a whirl, she's not sure if you're a boy or a girl."

"You've got your mother in a whirl, she's not sure if you're a boy or a girl." David Bowie

We live in an age where the boundaries of yesterday are left in tatters before our feet today. Gay sex in prime time has become mundane, and lately we are seeing television series with story lines centered around the romantic adventures of transgender protagonists.

But why did it take a letter-writing campaign to force the hand of the American Board of Obstetrics and Gynecology (ABOG) to reverse its policy against treating men, a policy that used the threat of stripping gynecologists of their board certification should they dare to treat a man?

The April 15, 2014 edition of Annals of Internal Medicine gives a nice history of the ban on treating men, and its reversal.

Of course, a reasonable first response to this issue would be to wonder aloud why a man needs to see a gynecologist. Well, concurrent with the rise in the practice of anal sex, the incidence of anal cancer is increasing in men and women, and gynecologists have become fairly exclusively well-versed in the use of high resolution anoscopy (HRA). HRA utilizes colposcopic techniques that require training for which gynecologists are perfectly positioned—as they are experts in colposcopy, for obvious reasons. In addition, many gynecologists have training in the art of vasectomy. Vasectomy is a safe and cost-effective method of contraception, but generally performed by urologists in more affluent areas. There may not be that many urologists in a lower-income or more rural area, and thus a gynecologist who might have had vasectomy training as part of a family planning curriculum can be an important provider of vasectomy services in under-served areas.

In fact, the authors of the article in Annals of Internal Medicine do discuss that the ABOG appeared to be insensitive not just to “men,” but also to intersexuality and transsexuality in more global terms. This is particularly concerning, as such segments of society often seek out the care of gynecologic endocrinologists. Another concern involved the medicolegal quandary that many practicing members found themselves in as a result of the ABOG position—and punishment—associated with the treatment of men by gynecologists: Should a doctor “dump” a patient to avoid being thrown out of the ABOG?

Heard in a gynecologist’s office last week: “Now, slide your bottom toward me, and move your sack to the left.”

Those are the words of another boundary torn asunder: Gynecologists may now treat men.