Reconstructive and Reproductive Surgery in Gynecology – Enables the reader more readily to understand pathogenesis
During the last four decades, we have witnessed rapid and significant innovations in various scientific and technological fields that have changed the practice of medicine including our own specialty. In parallel fashion, there have been important demographic and social changes that affect both the world in which we live and the nature of our medical practice.
In the short span of 30 years from 1987 to 2017, the world population has increased from 5 billion to over 7 billion, a growth rate that shows no signs of relenting and a circumstance that challenges both the resources and the environmental conditions of our planet and its inhabitants. This population growth occurred despite the simultaneous decline in the birth rate of industrialized nations.
Together with the continuous prolongation of mean life expectancy, this reduced population growth is significantly increasing both the absolute and relative numbers of elderly individuals in the developed world, a dramatic change with important social, economic, and political consequences.
The environmental “new normal” will be characterized by a population of women who will live increasingly longer, prolong their stay in the workforce, and likely continue to delay childbearing to the later reproductive years, and even beyond. These trends, in themselves, have important repercussions for medical practice in general, and our specialty in particular. Women will require medical care during a much longer postmenopausal life span. They will increasingly seek anti-aging treatment, more often undergo cosmetic surgery, and more frequently require reconstructive procedures for various conditions such as stress incontinence and genital prolapse. Indeed, there are already many gynecologists who include cosmetic surgery as part of their practice.
Women who enter and stay in workforce typically delay childbearing—a circumstance that contributes to trends evident today. The total fertility rate (estimated number of births over a woman’s lifetime) in the United States is about 1.84 births per 1,000 women, which is below the rate of 2.1 births per 1,000 women necessary for a generation to exactly replace itself. The average age of the proportion of U.S. women who had their first child when they were over 30 years of age increased from 5% in 1975 to 22% in 1995, reaching 30.3% by 2015.1