OB/GYNs Will Not Lose Board Certification for Treating Some Men

Obstetrician-Gynecologists (OB/GYNs) are experts in medical and surgical care of the female reproductive system and associated disorders. The specialized field of medicine was created to treat problems of the female reproductive tract, and is overseen by the American Board of Obstetrics and Gynecology (ABOG), one of 24 medical specialty boards approved by the American Board of Medical Specialties to grant board certification to physicians. OB/GYN is the only gender-specific medical specialty recognized in the United States.

Although it may seem illogical, OB/GYNs do not solely treat women. Despite the differences in male and female reproductive systems, humans of all sexes share many physical features and experience many medical issues in identical ways. Many OB/GYNs provide fertility and family-planning services to men, perform genetic counseling and testing for couples, and treat men for sexually-transmitted infections. As doctors, they provide treatment to all patients regardless of sex in emergency situations, during active government service, and while administering immunizations. OB/GYNs have also found ways to use their expertise in female reproductive systems to treat analogous medical conditions in men. For example, the leading cause of cervical cancer in women is human papillomavirus (HPV), a sexually transmitted infection (STI); HPV is also the leading cause of anal cancer in women and men. Techniques pioneered by OB/GYNs to treat HPV infection and cervical cancer may prevent anal cancer from HPV, which is expected to cause 880 deaths in the United States in 2013.

OB/GYN Certification

Board certification is a voluntary process that demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice. Board certified OB/GYNs demonstrate their expertise by passing written and oral examinations created and administered by ABOG. Maintaining board certification requires OB/GYNs to actively keep pace with the latest advances in the specialty and demonstrate best practices for patient safety, communications, and ethics.

On September 12, 2013, ABOG updated its definition of an ABOG-certified OB/GYN. The new definition prohibited ABOG-certified OB/GYNs from caring for male patients in most circumstances. ABOG restricts OB/GYNs to taking care of women patients because the specialty of obstetrics and gynecology was specifically designed to treat problems of the female reproductive tract. Along with the updated definition, ABOG posted a Frequently Asked Questions page, which specifies that OB/GYNs are not permitted to perform vasectomies. They are further prohibited from performing procedures that are identical in patients of both sexes on male patients, even if their training included such procedures. Examples of procedures that OB/GYNs may not perform on male patients include hernia repair and appendectomy. OB/GYNs are permitted to perform newborn circumcisions. When ABOG changed its definition on September 12, it also excluded OB/GYNs from performing male anoscopies, an examination of the anal canal that is part of screening for anal cancer.  Failure to practice consistently with the ABOG definition may result in loss of certification.

Anal Cancer Prevention Study

The explicit prohibition against performing anoscopies on male patients made headlines for causing problems for a major clinical trial aimed at preventing anal cancer. The trial, which received $5.6 million in funding from the National Cancer Institute and the Office of AIDS Research at the National Institutes of Health, plans to use highly-trained physicians to conduct high-resolution anoscopies on 5,000 patients of both sexes. The doctors will look for abnormal anal canal growths using a high-resolution magnifier; although cancers usually require surgery, doctors can burn off precancers in hopes of preventing cancer. The study is attempting to apply techniques that have been successful in preventing cervical cancer to anal cancer.

Due to their experience in treating women with HPV and cervical cancer, OB/GYNs are some of the best-qualified physicians to conduct anoscopies for the study. Along with OB/GYNs who treat men at high risk for anal cancer, the clinical trial’s director has asked ABOG to reconsider its position on male anoscopies. ABOG initially refused, stating that it has seen no compelling reason to change its certification requirements. Many of the physicians who are trained in providing high-resolution anoscopies are OB/GYNs who would have no longer been able to treat men, either in daily practice oras part of the clinical trial. The problems caused OB/GYNs to fault ABOG’s “absolute” and “dogmatic” new definition. Although ABOG’s director of evaluation stated that there are plenty of other doctors available to provide the HPV-related procedures that some gynecologists have been performing on men, OB/GYNs planning on participating in the anal cancer study were concerned about “significant setbacks” for what they call a “very vulnerable patient population.”

ABOG Reversal

On November 26, 2013, ABOG again revised its definition of a board-certified OB/GYN. The updated definition allows OB/GYNs to treat male patients for “evaluation and management of sexually transmitted infections.” As it reconsidered treatment of men, ABOG determined that gynecologists had a long tradition of treating STIs in both men and women. Further, ABOG recognized that HPV and problems related to the virus, including anal cancer, fell into that category; it did not want to interfere with the anal cancer prevention study, and determined that its previous decision was disturbing existing doctor-patient relationships. The express prohibition against performing male anoscopies was removed from ABOG’s FAQ page.  OB/GYNs applauded the decision, which allows them to continue treating their male patients for HPV-related anal cancer and to perform high-resolution anoscopies in the clinical trial.