Teaching principles of gynaecology to other specialists

This issue contains two separate Case Reports (Mukhopadhyay and Solomonz 2008; Garg and Gray 2008) on catamenial pneumothorax, i.e. pneumothorax concurring with menstruation. With more than 80 years of clinical experience between us, Harry Gordon and I have never seen such a case, but many of the Case Reports we publish are uncommon and, hence the curiosity associated with them. What is of importance in both cases was the failure of the non-gynaecologists to recognise their cyclical patterns and associations with menstruation.

Both sets of authors mention the association of catamenial pneumothorax with endometriosis, the delays in making the diagnosis, the ineffectiveness of surgical management, and the reluctance of respiratory, chest, or thoracic physicians and surgeons to consider the entity.

There is a danger as specialty training becomes more focused and condensed, and clinical experience of medical students in gynaecology is shortened, that our UK students, graduates, trainee doctors and specialists will underestimate the importance of taking a menstrual history when women present with a surgical, medical or even psychiatric emergency. The risk is not only that an early pregnancy or its complications may go unrecognised, but menstrual pattern variations in symptoms – pain, mood, endocrine functions and skin changes will not be noted. As gynaecologists, we need to reiterate these lessons to our non-gynaecology colleagues, and to at least enquire the date of the last menstrual period.