How has the diagnosis of gynaecological diseases changed over the last 10 years?
The change has been spectacular! There is no doubt that diagnostic imaging has played a very important role in the diagnosis of uterine diseases. In the past, we made a surgical diagnosis, which meant the patient had to undergo surgery. Now, through imaging, with an ultrasound scan for example, we can greatly refine this diagnosis and treat the disease more quickly. In this aspect, there has been an authentic revolution.
For gynaecologists, ultrasound equipment is like a phonendoscope for internists. Indeed, a few weeks ago, the Service bought several small portable ultrasound machines that fit in a gown pocket. If we have a good diagnosis earlier, we can start the treatment more quickly and avoid the long-term consequences of the disease for patients.
We live in a patriarchal society and we have had a very masculine vision of the world.
Have you ever stated insistently that periods shouldn’t be painful?
If you stop and think about it, it’s quite logical. How can a physiological process like having a period be painful? How can it be that it incapacitates you? It doesn’t make sense from a biological point of view. We live in a patriarchal society and we have had a very masculine vision of the world. Women have been in a position of inferiority and we have taken this to be normal. We have assumed that women have to be incapacitated when they have their period, and that is not right. Periods should not be painful! In recent years, the situation has changed a lot; women have stood up and said enough is enough!
Why does a disease like endometriosis take so long to diagnose?
We still need to get our message across better: period pain should not be normalized. Luckily, more and more tools are available: social networks, media, and scientific societies that allow us to reach more and more women, and we need to know how to use them. The key is to work with women and patients. We need to insist on the fact that what is happening to them is not normal, that what they are experiencing has a name, and that what they are experiencing can be treated, and that we can improve their quality of life. Women are spearheading this movement and we need to celebrate that.
Do you think women are used to living with pain?
Chronic pain is one of the main serious problems affecting public health, and two out of every three people who suffer from it are women. Pain is a major cause of disability and loss of quality of life. However, we must not forget that bleeding and anaemia, for example, are very common among women. Moreover, this situation, especially in women, can lead to a lack of social opportunities, inequalities and exclusion, which have not yet been sufficiently evaluated. As gynaecologists, we want to focus on women's quality of life: global, social, sexual, etc. The aim is to ensure women can live well: our objective is to give our patients a good quality of life.
Uterine transplantation was a major challenge in tackling gynaecological problems. How do you see the future of gynaecology in the short term?
In October 2020, we carried out the first uterus transplant in Spain at the Hospital Clínic, in collaboration with the Urology Service. The uterus transplant sparked an ethical debate that was necessary. Technology is enabling us do things that were unthinkable in the past, and we have to know how to take advantage of them.
Technology is moving faster than us and we need time to hold the necessary in-depth debates that will allow us to progress whilst striking the right balance. For example: there is still a long way to go in gene therapy and genetic modification, but we must think carefully about what they involve.
Soon, we shall see major advances in diagnostic imaging and in the genomic and metabolic diagnoses of these diseases. We shall discover the aetiology of uterine fibroids, of endometriosis, and even be able to prevent the disease in many cases.
In the field of surgery, there will be new techniques with the fusion of magnetic resonance or ultrasound images and real-time laparoscopic images that we shall obtain in the operating theatre.
Will there be changes in gynaecological surgery too?
Yes, of course. In the field of surgery, there will be new techniques with the fusion of magnetic resonance or ultrasound images and real-time laparoscopic images that we shall obtain in the operating theatre. This fusion of images should enable us to better guide surgery. I am convinced that before entering the operating theatre, and thanks to artificial intelligence, we will be able to practise and predict how the operation will go. All this will allow us to reduce the risks for patients. This will happen in 8 to 10 years' time. Note that I’m not saying 25 years! In the near future this will be a reality, I’m sure.
You were recently appointed president of the Society of Endometriosis and Uterine Disorders (SEUD) at the 7th annual congress held in Sweden. Where did the need to create an international society specializing in this type of disease come from?
This society’s scope of action is global. It is a meeting point for gynaecology professionals from Europe, Asia, Africa, America, etc. The Society works to contribute its vision of how medical care for uterine diseases should be provided across the globe.
The meeting at which we decided to promote an international gynaecology society was held in Barcelona in 2014, and one year later we established it legally. We 4 professionals who promoted the creation of the Society all felt that our branch of gynaecology was very much neglected by other medical societies in general. There was no scientific society that addressed a group of diseases that are very common in women and have a major impact on their quality of life. These are diseases, most of which are benign, that affect them greatly physically, psychologically and even economically.
None of these diseases is purely medical or purely surgical. We created the society with these women in mind, and in order to provide a comprehensive and holistic vision.
What will the priorities be for this three-year term?
At the society, we want to attach more weight to research and adopt a very scientific approach in our day-to-day practice in order to broaden our knowledge. We also want to stimulate interest in these diseases and support young professionals, creating grants to promote the talent of young researchers. We have also created a journal, the Journal of Endometriosis and Pelvic Pain Disorders, in order to bring together and promote knowledge about these diseases.
During the three years that I will be president of the Society, I would like to strengthen its structure, recover the activity that the pandemic forced us to stop, expand its presence in South America, and reinforce its presence in Europe and Asia.
There have always been more men than women in your profession. Do you think that will continue?
At the Hospital Clínic Gynaecology Service, the ratio is approximately 50-50. In my age group, there are more men than women, admittedly, but we can see that this trend is changing. At university, more women are studying to be gynaecologists than before. The male gynaecologist is an endangered species.