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[Gynecology. A specialty in action].

In the last decade gynecology has developed from an organ-oriented branch of medicine to a system-oriented specialty serving the physiology and pathology underlying human reproduction. Changes in a specialty are determined by methods which take longer in research and development (e.g. treatment of chronic diseases cancer) or shorter (e.g. diagnosis of reproductive disorders). Basic and applied research have led to progress in practical gynecology: methods in reproduction and ovulation induction related to endocrinology; invitro fertilization and embryo transfer; new treatment possibilities in sterility. The pill in birth control made a reliable separation between reproduction and sexuality possible but advances in birth control methods have brought along their own problems and the realization that no single ideal risk-free and acceptable-to-all method exists today. Achievements in obstetrics have resulted in lower maternal and infant mortality and decreased infant morbidity: better prenatal care and hormone monitoring; prenatal diagnosis and fetal monitoring; neonatal intensive care units with improved survival chances for premature infants. New research in human behavior promotes mother-infant bonding as seen in the promotion of rooming-in care breastfeeding alternate birthing methods and home deliveries. Gynecologic oncology progress has resulted in early diagnosis of cervical cancer and a higher cure rate. Close cooperation between clinician and histopathologist and individually-planned treatment have contributed to this. At the same time problems remain or new problems become manifest: e.g. the risk of over- or undertreatment with a resulting loss in quality of life; ovarian cancer has still a 70% mortality rate; the rate of cesarean sections has increased by 15-20%. These and other problems remain to be considered.