Proctogyneacological conditions are those involving the anal canal, anal sphincter muscles, rectum, rectovaginal septum, as well as the female reproductive tract. They may be due to sagging of the pelvic floor and the rectovaginal septum (rectal, vaginal or uterine prolapse, enterocele and rectocele), perinatal or other type of injury, including sphincter damage, rectovaginal fistulas, endometriosis with anal sphincter and rectovaginal septum involvement, proctological inflammatory diseases in pregnancy, as well as radiation-induced rectal damage after gynaecological cancer treatment. There are no uniform guidelines defining which specialist should treat patients on the borderline of these two specialties. The treatment approach, as well as the role of gynaecologist and proctologist differ in each of these conditions. Personal experience in performing specific, often technically complex surgical procedures, is undoubtedly crucial.

In this paper, we discuss the most common clinical situations that may require a cooperation between a gynaecologist and a proctologist. We also attempted to systematise indications for surgeries performed by these two specialists, bearing in mind that this is a significant simplification of the problem and that operator’s experience in performing a given procedure is the main decisive factor, whereas speciality (gynaecology or surgery) is of secondary importance.

These are:

– peripartum anal sphincter damage often coexisting with vaginal ectasia,

– rectovaginal fistula (postpartum, radiation-induced or other),

– conditions associated with sagging of the pelvic floor and the rectovaginal septum (rectal, vaginal or uterine prolapse, enterocele and rectocele),

– endometriosis,

– proctological conditions in pregnancy and the perinatal period.

Much depends on the experience of a particular doctor in the treatment of the above diseases, hence the scope of competence may vary.

Perineal tear occurs in 2-6% of patients having vaginal delivery (1). Less than 0.5% of all births are complicated by grade III and IV perineal tear (2), with only a small proportion of patients reporting symptoms of incontinence. It may be therefore concluded that these injuries are properly managed on an emergency basis in most cases. In the case of third-degree tear, i.e. damage involving the anal sphincter, but with preserved rectal wall continuity, emergency suturing of the anal sphincter is most often performed by a gynaecologist-obstetrician. For medical and legal reasons, this should be the most experienced doctor in the team on duty or a less experienced doctor assisted by the duty chief. In the case of fourth-degree perineal tear, which is a very serious complication involving damage to the rectal wall, it is advisable that the surgery is performed by a surgeon if possible. If the injury was missed during labour (occult defect accounting for 3% to up to 35% of cases in literature reports) (3) or wound dehiscence occurred, repair should be delayed by 4-6 months until inflammation in the adjacent tissues resolves. In such cases, the procedure should be preceded by diagnosis in a reference colorectal centre (imaging and functional diagnosis). Elective sphincter repair should be performed by a proctological surgeon experienced in this type of surgeries. If the procedure is combined with posterior vaginal wall repair, multidisciplinary surgeries (performed by a surgeon and a gynaecologist), often combined with levatorplasty, are the best approach. This type of surgery may be performed by an experienced coloproctologist (fig. 1, 2).