The American Board of Obstetrics and Gynecology recently issued a new directive to U.S. OB-GYNs: Treat men, and risk losing the board’s certification. The board now prohibits the treatment of male patients, with a few exceptions: Doctors can care for men if they’re engaged in “active government service” or if the treatment is the course of the “evaluation of fertility,” the “expedited partner treatment of sexually transmitted diseases,” or a “newborn circumcision,” for example. The exceptions allow OB-GYNs to provide preventative and emergency care but bar men from returning to the gynecologist for further care when those routine checkups reveal a deeper problem.
As the New York Times reported this weekend, a group of gynecologists are specifically concerned that the board’s rule will prevent them from treating HPV-related anal cancers in men. Boston Medical Center gynecologist Dr. Elizabeth Stier, for example, treated 110 men for the disease last year and is participating in a multimillion-dollar clinical trial aimed at improving that treatment. As the Times puts it, some of the “best qualified, most highly skilled doctors” working on HPV-related cancers are gynecologists, who have extensive expertise treating HPV-related diseases in women.
The board reasons that gynecologists are specially trained “in the medical and surgical care of the female reproductive system and associated disorders.” But gynecologists are well-positioned to treat both men and women because they’re more likely to have experience with the “associated disorder” at work here. When it comes to HPV-related anal cancers, men and women are operating with similar equipment. The anoscopy procedure doctors use to identify anal cancers is identical regardless of gender. And the people most invested in treating it (and courting the funding to do so) are largely gynecologists.
Gynecologists have also proven essential in the treatment of marginalized communities for a range of sexually related diseases, regardless of the patient’s gender. While the board makes an exception for men in the “management of transgender conditions,” it doesn’t make clear if it’s OK to treat trans patients for more general medical problems (and it doesn’t specify what “male” means in the context of a trans person). Clinics like Planned Parenthood, which often bills on a sliding scale, have made historic gains in making sexual health care more accessible to low-income women and men. As Stier explained to the Times, the procedures she performs “are embarrassing and uncomfortable for patients, and it takes time for a doctor to gain their trust. Many of her patients are poor, from minority groups and infected with H.I.V. Some live in shelters, some have histories of drug use. And anal disorders add more stigma.” The board’s directive puts up an additional barrier for men like them to follow up on necessary treatments after they’re diagnosed through routine “partner” evaluations.
This isn’t the first gender issue to hit the field of gynecology. Though the specialty, like most medical specialties, is still majority male, women are flooding America’s OB-GYN residencies; some male doctors even say they're attracting fewer patients because of a growing preference for female practitioners. Meanwhile, the board making decisions for those doctors' patients remains overwhelmingly male. And its recent decision is out of touch with the skills and interests of the practitioners shaping the field today. Gynecology is changing, in more ways than one. This new crisis may force the field to reconsider what it means to be an OB-GYN—and who's allowed to benefit from the doctors' expertise.