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Tsuda S, Takada S. Assessing the effectiveness of a comprehensive menstrual health education program for preadolescent girls with intellectual disability and high support needs in Japan. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:93-103. [PMID: 36189770 DOI: 10.1177/17446295221130423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The menarche age in girls with intellectual disability and high support needs (HSN) is approximately the same as in girls with typical development. However, there is no clear teaching procedure for menstrual hygiene management (MHM) skills before menarche. This study examined whether a menstrual education program that focuses on visual support affects the MHM skills of girls with intellectual disability/HSN. The study comprised 11 preadolescent girls with intellectual disability/HSN in their pre-menarche age. They were asked to change napkins on a doll three times: before, immediately following, and one month after attending the program. Fifteen MHM items were measured. The participants' scores were significantly higher after attending the program. There was no significant difference in the mean scores for each of the 15 items among the levels of intellectual disability. The program that utilized visual materials was effective, and the effect was not influenced by age or intellectual level.
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Affiliation(s)
- Satoko Tsuda
- College of Life and Health Sciences, Chubu University, Kasugai-shi, Aichi, Japan
| | - Satoshi Takada
- Graduate school of Health Sciences, Kobe University, Kobe-City, Hyogo, Japan
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Pepe G, Coco R, Corica D, Di Rosa G, Bossowski F, Skorupska M, Aversa T, Stagi S, Wasniewska M. Prevalence of Endocrinopathies in a Cohort of Patients with Rett Syndrome: A Two-Center Observational Study. Genes (Basel) 2024; 15:287. [PMID: 38540345 PMCID: PMC10970698 DOI: 10.3390/genes15030287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/09/2024] Open
Abstract
Systematic data on endocrinopathies in Rett syndrome (RTT) patients remain limited and inconclusive. The aim of this retrospective observational two-center study was to assess the prevalence of endocrinopathies in a pediatric population of RTT patients. A total of 51 Caucasian patients (47 girls, 4 boys) with a genetically confirmed diagnosis of RTT were enrolled (mean age 9.65 ± 5.9 years). The patients were referred from the Rett Center of two Italian Hospitals for endocrinological evaluation. All the study population underwent clinical and auxological assessments and hormonal workups. MeCP2 mutations were detected in 38 cases (74.5%), CDKL5 deletions in 11 (21.6%), and FOXG1 mutations in 2 (3.9%). Overall, 40 patients were treated with anti-seizure medications. The most frequent endocrinological finding was short stature (47%), followed by menstrual cycle abnormalities (46.2%), weight disorders (45.1%), low bone mineral density (19.6%), hyperprolactinemia (13.7%) and thyroid disorders (9.8%). In the entire study population, endocrinopathies were significantly more frequent in patients with MeCP2 mutations (p = 0.0005), and epilepsy was more frequent in CDKL5 deletions (p = 0.02). In conclusion, our data highlighted that endocrinopathies are not rare in RTT, especially in patients with MeCP2 deletions. Therefore, in the context of a multidisciplinary approach, endocrinological evaluation should be recommended for RTT patients.
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Affiliation(s)
- Giorgia Pepe
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
| | - Roberto Coco
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
| | - Domenico Corica
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
| | - Gabriella Di Rosa
- Child Neuropsychiatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98128 Messina, Italy;
| | - Filip Bossowski
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
| | - Magdalena Skorupska
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
| | - Tommaso Aversa
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, 50139 Florence, Italy;
- Meyer Children Hospital IRCCS, 50139 Florence, Italy
| | - Malgorzata Wasniewska
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (G.P.); (R.C.); (D.C.); (F.B.); (M.S.); (T.A.)
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Sharma R, Kumar A, Suri V, Kaur S, Singh AJ. An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India. Int J Gynaecol Obstet 2023; 163:818-824. [PMID: 37345270 DOI: 10.1002/ijgo.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/14/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services. METHODS This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes. RESULTS Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear. CONCLUSION Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.
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Affiliation(s)
- Ruchi Sharma
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Amar Jeet Singh
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Buyers EM, Hutchens KJ, Kaizer A, Scott SM, Huguelet PS, Holton C, Alaniz VI. Caregiver goals and satisfaction for menstrual suppression in adolescent females with developmental disabilities: A prospective cohort study. Disabil Health J 2023; 16:101484. [PMID: 37344273 DOI: 10.1016/j.dhjo.2023.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Adolescents with developmental disabilities and their caregivers often seek menstrual management. Caregivers frequently serve as medical decision-makers, and little is known about caregiver goals for menstrual management and satisfaction over time. OBJECTIVE Assess caregiver reasons for initiating menstrual management in adolescents with disabilities and satisfaction over 12 months. METHODS Prospective cohort study of caregivers of adolescents with developmental disabilities seeking menstrual management at a pediatric and adolescent gynecology clinic. Data derive from caregiver surveys and adolescents' electronic medical records. RESULTS Ninety-two caregiver-adolescent pairs enrolled. The mean age of adolescents was 14.4 (±2.6). The most common method started was levonorgestrel intrauterine device (LNG-IUD; 52, 56.5%), followed by oral norethindrone acetate (21, 22.8%). Caregivers cited hygiene concerns (84.8%), behavioral problems (52.2%), and heavy/excessive bleeding (48.9%) as reasons for initiating menstrual suppression. Caregivers who identified hygiene or heavy/excessive bleeding as the most important reason for management were more likely to select LNG-IUD (p = 0.009). Caregivers who cited behavioral/mood or seizure concerns as the most important reason were more likely to choose other methods (p < 0.05). At 12 months, caregiver satisfaction with all methods was high (66.2-86.9 on a 100-point scale). For every additional day of bleeding, satisfaction decreased by 3.7 points (95% CI: 2.3-5.0). CONCLUSIONS Caregiver satisfaction with all methods is high; however, it negatively correlates with days of bleeding. Caregiver reasons for menstrual suppression influence the method chosen. Management may reflect both patient and caregiver priorities; research is needed to better understand shared decision-making models that promote reproductive autonomy in adolescents with a developmental disability.
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Affiliation(s)
- Eliza M Buyers
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO, USA
| | - Kendra J Hutchens
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO, USA
| | - Alex Kaizer
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Stephen M Scott
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO, USA
| | - Patricia S Huguelet
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO, USA
| | - Carri Holton
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO, USA
| | - Veronica I Alaniz
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO, USA.
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Hensel DJ, Misseri R, Wiener JS, Roth JD, Whittam BM, Cain MP, Szymanski KM. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022; 19:1766-1777. [PMID: 36216747 DOI: 10.1016/j.jsxm.2022.08.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic. AIM Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB. MAIN OUTCOME MEASURES Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use. METHODS Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome. RESULTS The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors. CLINICAL IMPLICATIONS Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care. STRENGTHS & LIMITATIONS Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. CONCLUSION Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.
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Affiliation(s)
- Devon J Hensel
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - John S Wiener
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Benjamin M Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Karthikayini S, Arun S. Challenges Faced by Primary Caretakers of Adolescent Girls with Intellectual Disability during their Menstrual Cycle in Puducherry: A Mixed Method Study. Indian J Community Med 2021; 46:416-420. [PMID: 34759478 PMCID: PMC8575223 DOI: 10.4103/ijcm.ijcm_433_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Adolescents with Intellectually Disability (ID) compared to their normal peers face greater challenges at menarche due to their caregiver dependence for their day-to-day personal care activities. Objective: The objective of the study was to know the sociodemographic characteristics of adolescent girls with ID and to explore the challenges faced by their primary caretakers during their menstrual cycle in Puducherry. Subjects and Methods: The study was conducted among primary caretaker of adolescent girls with ID from December 2018 to May 2019. The study adopted quantitative method to capture sociodemographic details among 73 primary caretakers of adolescent with ID who attained menarche and In-Depth Interview (IDI) was conducted to explore the challenges faced by primary caretakers. The caretakers of adolescents were selected using purposive sampling and conventional content analysis was followed for data analysis. Results: We discovered that 80.9% of adolescent with ID were not able to manage their menstruation of their own. Primary caretakers who were interviewed were mostly mother's 67.1%. Due to caretaker's dependency, 94.5% of the adolescent with ID were not going to school during their menstrual cycle. Conclusions: Majority of the caretakers faced problems such as rejection of sanitary napkins and inability to recognize about the start of period by their adolescents with ID.
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Affiliation(s)
- S Karthikayini
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth (Deemed to be University) Puducherry, India
| | - S Arun
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth (Deemed to be University) Puducherry, India
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Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: ACOG Committee Opinion, Number 817. Obstet Gynecol 2021; 137:e7-e15. [PMID: 33399429 DOI: 10.1097/aog.0000000000004209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT Obstetrician-gynecologists frequently are consulted either before the initiation of cancer treatment to request menstrual suppression or during an episode of severe heavy bleeding to stop bleeding emergently. Adolescents presenting emergently with severe uterine bleeding usually require only medical management; surgical management rarely is required. Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management. When used continuously, combined hormonal contraceptives are effective for producing amenorrhea, although complete amenorrhea cannot be guaranteed. The risk of venous thromboembolism in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the risk-benefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.
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Power R, Wiley K, Muhit M, Heanoy E, Karim T, Badawi N, Khandaker G. 'Flower of the body': menstrual experiences and needs of young adolescent women with cerebral palsy in Bangladesh, and their mothers providing menstrual support. BMC WOMENS HEALTH 2020; 20:160. [PMID: 32738885 PMCID: PMC7395369 DOI: 10.1186/s12905-020-01032-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Abstract
Background This study offers voice to young adolescent women with cerebral palsy (CP) in Bangladesh as they describe their menstrual experiences and needs, and their mothers providing menstrual support. Method Semi-structured focus groups with adolescents with CP, and separately their mother. Data was analysed using a material discursive framework and drawing on feminist disability theory. Participants were recruited from the Bangladesh CP Register (BCPR); a population-based surveillance of children and adolescents with CP in rural Bangladesh. Results Participants were 45 women including 12 female adolescents with CP and 33 female caregivers. Participants reported a wide range of experiences and needs; menarche acted as a gateway to menstrual information although for some a discourse of silence prevailed due to exclusion from peer and familial networks. Menstruation was discursively constructed as a sign of ‘female maturation’ marked by an expectation of ‘independence’, required for acceptance into socially valued adult roles, and was positioned alongside increased vulnerability to sexual abuse. Young adolescent women with CP were expected to ‘quietly endure’ the material aspects of menstruation although unmanaged pain and distress were described. Mothers reported an imperative for meeting their adolescent’s menstrual needs however this role was discursively positioned as ‘painful’, ‘irritating’ and ‘shameful’, in part due to an absence of affordable, functional menstrual resources. Conclusion The findings of the present study provide motivation for disability services in Bangladesh to account for the menstrual needs of young adolescent women with CP within service delivery through strategies such as providing menstrual education and by embedding value in constructs such as ‘interdependence’. Moreover, interventions focused on alleviating menstrual pain among young adolescent women with CP as well as those targeted to alleviate distress among mothers providing menstrual care are required. Finally, policy responses are required to ensure that ‘inclusive development’ considers the needs of menstruating women with disability.
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Affiliation(s)
- R Power
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead, NSW, 2145, Australia. .,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.
| | - K Wiley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - M Muhit
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh
| | - E Heanoy
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh
| | - T Karim
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, NSW, Australia
| | - N Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, NSW, Australia
| | - G Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
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Kırbaş ZÖ, Kaşko Arıcı Y. Training female adolescent students with intellectual disabilities about genital hygiene skills using peer training. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:332-341. [PMID: 35615253 PMCID: PMC9126564 DOI: 10.1080/20473869.2020.1774224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 06/15/2023]
Abstract
PURPOSE The study aimed to evaluate the effects of peer training of female adolescent students diagnosed with intellectual disabilities and started menses, about genital hygiene and menstrual care skills on a baby doll. METHODS This study was planned as a non-control group research design including pre-test, post-test and follow-up stages. It was conducted in special educational institutions. The population consisted of 68 female students between 10-18 years old. Calculation of sample size was not performed, and 65 students were included in the study. The data were collected using Socio-Demographic Form, Genital Cleansing Skill Form (GCSF), Pad Replacement Skill Analysis Form (PRSAF), and Teacher/Parent Opinion and Feedback Form. The statistical analysis of the study data was performed using Mc-Nemar test, Mann-Whitney U test, Kruskal-Wallis test and Friedman test followed by Dunn-Bonferroni post-hoc test. RESULTS In all follow-up periods, GCSF and PRSAF scores compared by Mann-Whitney U and Kruskal-Wallis tests did not change based upon demographic characteristics (p > 0.05). Friedman test showed that GCSF and PRSAF scores showed significant differences between the follow-up periods (p < 0.001). According to Dunn-Bonferroni post-hoc test, there was no statistically significant difference between 2nd and 3rd follow-up scores with respect to both GCSF and PRSAF (p > 0.05). However, 2nd and 3rd follow-up scores were found to be significantly higher than 1st follow-up score (p < 0.05). CONCLUSION The study demonstrated that menstrual care skills of female adolescent students with intellectual disabilities improved after training and peer training was found to be effective. Peer training can be useful when used as continuing training to help individuals achieving a higher criterion of mastery.
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Affiliation(s)
- Zila Özlem Kırbaş
- Department of Health Care Services, Ikizce Vocational High School, Ordu University, Ordu, Turkey
| | - Yeliz Kaşko Arıcı
- Faculty of Medicine, Department of Biostatistics and Medical Information, Ordu University, Ordu, Turkey
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Powell RM, Parish SL, Mitra M, Rosenthal E. Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:131-157. [PMID: 31808223 PMCID: PMC9016753 DOI: 10.1111/jir.12706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/10/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID. METHOD We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country. RESULTS The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation. CONCLUSIONS Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.
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Affiliation(s)
- R M Powell
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - S L Parish
- The College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - M Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - E Rosenthal
- School Psychology, College of Education, Lehigh University Bethlehem, Pennsylvania
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Verlenden JV, Bertolli J, Warner L. Contraceptive Practices and Reproductive Health Considerations for Adolescent and Adult Women with Intellectual and Developmental Disabilities: A Review of the Literature. SEXUALITY AND DISABILITY 2019; 37:541-557. [PMID: 33005065 PMCID: PMC7527256 DOI: 10.1007/s11195-019-09600-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whereas progress has been made on increasing access to comprehensive healthcare for individuals with intellectual and developmental disabilities (I/DD), disparities continue in health outcomes, including those related to the reproductive health of adolescent and adult women with I/DD. This review summarizes reproductive care considerations for adolescent and adult women with I/DD and current practices regarding the delivery of contraceptive services to these women. Forty-seven (47) articles based on research conducted in the US between 1999 and 2019 were selected for inclusion in the review. Primary themes discussed include (1) common reproductive health concerns for adolescent and adult women with I/DD, other than pregnancy prevention; (2) contraceptive methods and disability-related concerns; (3) informed consent and reproductive decision-making; and (4) provider knowledge and education. The management of menses and hormonal dysregulation were identified as concerns that providers encounter among patients with I/DD and their families. Disability-related concerns with regard to use of contraception in general and considerations regarding certain methods in particular include challenges with prescription adherence, physical effects of hormonal therapies, drug interactions for individuals with additional health conditions, and legal and ethical concerns involved with decision-making and consent. The results of this review also suggest that focused efforts in partnership with health care providers may be needed to address barriers that adolescent and adult women with I/DD face when trying to obtain quality reproductive health services and contraceptive guidance.
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Affiliation(s)
- Jorge V. Verlenden
- Morehouse School of Medicine, Satcher Health Leadership Institute, Atlanta, USA
- Atlanta, USA
| | - Jeanne Bertolli
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
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Solomon D, Pantalone DW, Faja S. Autism and Adult Sex Education: A Literature Review using the Information-Motivation-Behavioral Skills Framework. SEXUALITY AND DISABILITY 2019; 37:339-351. [PMID: 33311815 DOI: 10.1007/s11195-019-09591-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Adults on the autism spectrum report comparable levels of desire for sex and sexual satisfaction as adults who are not on the spectrum. However, there has been little empirical focus on the need for sexual and relationship-oriented education for youth on the spectrum as they transition to adulthood. In this review, we use the Information-Motivation-Behavioral Skills Model of sexual health behavior change as a lens through which to understand the experiences of adults on the autism spectrum. We present those insights infused with emerging data and best practices in the field. Overall, it appears clear from the extant literature that providers need to recognize the specific characteristics of autism when developing sexual education curricula. Specifically, the social communication and sensory profile of people on the autism spectrum appears to interact with access to information, motivation to engage in healthy sexual activities, and the development of skills needed to engage in healthy sexual behavior. Finally, the voice of adults on the spectrum is essential to guide the emerging understanding of healthy sexuality.
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Affiliation(s)
- Dasha Solomon
- Division of Developmental Medicine, Boston Children's Hospital, 02215.,Department of Pediatrics, Harvard Medical School, 02215
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, 02125.,The Fenway Institute, Fenway Health, 02215
| | - Susan Faja
- Division of Developmental Medicine, Boston Children's Hospital, 02215.,Department of Pediatrics, Harvard Medical School, 02215
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No. 313-Menstrual Suppression in Special Circumstances. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e7-e17. [DOI: 10.1016/j.jogc.2018.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kirkham YA, Ornstein MP, Aggarwal A, McQuillan S. N° 313 - Suppression menstruelle en présence de circonstances particulières. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e18-e29. [DOI: 10.1016/j.jogc.2018.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wandresen G, Sgarbi F, Nisihara R. Management of contraceptives and menstrual complaints in patients with Down syndrome. Gynecol Endocrinol 2019; 35:103-108. [PMID: 30324830 DOI: 10.1080/09513590.2018.1501017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Enhanced health care for patients with Down syndrome (DS) results in improved overall quality of life and longer life expectancy. The main gynecologic complaints of patients with DS and their caregivers relate to menstrual cycles, hygiene and reproductive issues. Certain aspects, such as age of menarche, menstrual cycles, internal genitalia, and hormone profile are similar to those observed in the general population. However, individuals with DS may have a higher incidence of other disorders related to menstruation, such as hypothyroidism, epilepsy and use of anticonvulsants. Contraceptive measures for individuals with DS can be used for both contraception and control of menstrual symptoms. The physician must be to make an individualized recommendation aimed at offering the most efficient and least invasive method with the fewest side effects. Among medical options are oral contraceptives, quarterly injectable medroxyprogesterone acetate, oral progesterone, a levonorgestrel-releasing intrauterine system, transdermal patch and vaginal rings. Surgical methods, including hysterectomy, endometrial ablation, or tubal ligation, are rarely considered because they raise ethical and legal questions. This article reviews the literature and basic guidelines to assist physicians who attend adolescent girls and women with DS to provide guidance on the appropriate management of the main gynecologic complaints of this population.
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Affiliation(s)
- Gustavo Wandresen
- a Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná , Curitiba , Brazil
| | - Fernanda Sgarbi
- b Medicine Department , Positivo University , Curitiba , Brazil
| | - Renato Nisihara
- a Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná , Curitiba , Brazil
- b Medicine Department , Positivo University , Curitiba , Brazil
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Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020348. [PMID: 29462872 PMCID: PMC5858417 DOI: 10.3390/ijerph15020348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 01/04/2023]
Abstract
Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method—about two times more frequently—among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13–2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method.
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Deeb A, Akle M, Al Zaabi A, Siwji Z, Attia S, Al Suwaidi H, Al Qahtani N, Ehtisham S. Maternal attitude towards delaying puberty in girls with and without a disability: a questionnaire-based study from the United Arab Emirates. BMJ Paediatr Open 2018; 2:e000306. [PMID: 30397668 PMCID: PMC6203014 DOI: 10.1136/bmjpo-2018-000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Parental anxiety about the impact of puberty/menses, particularly in girls with severe disability leads to seeking therapeutic pubertal suppression. We aim to explore maternal attitudes and reasons for seeking pubertal suppression. METHODS Mothers of girls receiving gonadotropin -releasing hormone analogue therapy in Mafraq hospital, Abu Dhabi were enrolled in the study. A semistructured interview was conducted to ascertain possible reasons for delaying puberty. The study group was divided into girls with a disability with central precocious puberty (CPP) or normal puberty and girls without a disability presenting with CPP. RESULTS 42 mother-daughter pairs were enrolled and divided into two groups; group A: 15 girls with CPP with no disability; group B: 27 girls with disability (10 had CPP (group B1) and 17 had normal pubertal timing (group B2)). Mothers in group A aimed to delay puberty, while in group B, 13 (48%) mothers desired to halt puberty and 7 (26%) requested permanent surgical intervention. Fear of short stature (15, 100%), inability to cope psychologically (10, 67%) and fear of peer rejection (9, 60%) were the main concerns in group A. In group B, mothers were concerned about menstrual hygiene management (25, 92.5%), fear of child abuse or unwanted pregnancy (15, 55%) and fear of inability to express pain/discomfort with menstruation (8, 30%). CONCLUSION Mothers of girls with a disability commonly seek medical help to delay/halt puberty due to concerns about menstrual hygiene. Short final height was the main concern for girls without a disability. Culture and religion play an important role in puberty management in girls with a disability.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Mariette Akle
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Abrar Al Zaabi
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Zohra Siwji
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Salima Attia
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Hana Al Suwaidi
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Nabras Al Qahtani
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Sarah Ehtisham
- Paediatric Department, Mediclinic City Hospital, Dubai, N/A, United Arab Emirates
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Chuah I, McRae A, Matthews K, Maguire AM, Steinbeck K. Menstrual management in developmentally delayed adolescent females. Aust N Z J Obstet Gynaecol 2017; 57:346-350. [DOI: 10.1111/ajo.12595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Irene Chuah
- Department of General Medicine; The Children's Hospital at Westmead; The Sydney Children's Hospital Network; Sydney New South Wales Australia
| | - Alexandra McRae
- Academic Department of Adolescent Medicine; The Children's Hospital at Westmead; The Sydney Children's Hospital Network; Sydney New South Wales Australia
| | - Kim Matthews
- Department of Adolescent Medicine; The Children's Hospital at Westmead; The Sydney Children's Hospital Network; Sydney New South Wales Australia
| | - Ann M. Maguire
- Institute of Endocrinology and Diabetes; The Children's Hospital at Westmead; The Sydney Children's Hospital Network; Sydney New South Wales Australia
- Discipline of Child and Adolescent Health; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Katharine Steinbeck
- Academic Department of Adolescent Medicine; The Children's Hospital at Westmead; The Sydney Children's Hospital Network; Sydney New South Wales Australia
- Discipline of Child and Adolescent Health; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
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Suppression menstruelle en présence de circonstances particulières. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S484-S495. [DOI: 10.1016/j.jogc.2016.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Committee Opinion No. 668: Menstrual Manipulation for Adolescents With Physical and Developmental Disabilities. Obstet Gynecol 2016; 128:e20-5. [DOI: 10.1097/aog.0000000000001585] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Altundağ S, Çalbayram NÇ. Teaching menstrual care skills to intellectually disabled female students. J Clin Nurs 2016; 25:1962-8. [PMID: 27104653 DOI: 10.1111/jocn.13215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to teach pad replacement skills to intellectually disabled adolescent female students during their menstruation periods by demonstrating on a dummy. BACKGROUND It may be difficult to make intellectually disabled adolescents achieve self-care during menstruation. In addition, there are difficulties experienced in explaining menstruation, such as physical changes and the practice of cleaning during this period. DESIGN The study used a 'One group pretest and post-test model'. METHOD The study was performed in a special educational institution. The population consisted of 77 female students in the high school section. Calculation of a sample size was not attempted, and 54 students with no attendance issues agreed to take part in the study and were included. RESULTS In this work, we found that pad replacement training significantly changed the scores of mentally disabled adolescents before and after training. Our training yielded positive results, and the population improved their skills at all stages of skill building. CONCLUSION Training adolescents with mental disabilities helped them gain hygiene habits. Performance of these trainings occurs at the beginning of menstrual hygiene education. RELEVANCE TO CLINICAL PRACTICE To achieve improved success in life, it is important that adolescents assume the responsibility of self-care and manage sustained care activity on their own.
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Affiliation(s)
- Sebahat Altundağ
- Pamukkale University Faculty of Health Sciences, Department of Pediatric Nursing, Denizli, Turkey
| | - Nazan Çakırer Çalbayram
- Ankara University, Faculty of Health Sciences, Department of Midwifery, Altındağ, Ankara, Turkey
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Abstract
OBJECTIVE To provide a Canadian consensus document for health care providers with recommendations for menstrual suppression in patients with physical and/or cognitive challenges or those who are undergoing cancer treatment in whom menstruation may have a deleterious effect on their health. OPTIONS This document reviews the options available for menstrual suppression, its specific indications, contraindications, and side effects, both immediate and long-term, and the investigations and monitoring necessary throughout suppression. OUTCOMES Clinicians will be better informed about the options and indications for menstrual suppression in patients with cognitive and/or physical disabilities and patients undergoing chemotherapy, radiation, or other treatments for cancer. EVIDENCE Published literature was retrieved through searches of Medline, EMBASE, OVID, and the Cochrane Library using appropriate controlled vocabulary and key words (heavy menstrual bleeding, menstrual suppression, chemotherapy/radiation, cognitive disability, physical disability, learning disability). Results were restricted to systematic reviews, randomized controlled trials, observation studies, and pilot studies. There were no language or date restrictions. Searches were updated on a regular basis and new material was incorporated into the guideline until September 2013. Grey (unpublished) literature was identified through searching websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS There is a need for specific guidelines on menstrual suppression in at-risk populations for health care providers. Recommendations 1. Menstrual suppression and therapeutic amenorrhea should be considered safe and viable options for women who need or want to have fewer or no menses. (II-2A) 2. Menstrual suppression should not be initiated in young women with developmental disabilities until after the onset of menses. (II-2B) 3. Combined hormonal or progesterone-only products can be used in an extended or continuous manner to obtain menstrual suppression. (I-A) 4. Gynaecologic consultation should be considered prior to the initiation of treatment in all premenopausal women at risk for abnormal uterine bleeding from chemotherapy. (II-1A) 5. Leuprolide acetate or combined hormonal contraception should be considered highly effective in preventing abnormal uterine bleeding when initiated prior to cancer treatment in premenopausal women at risk for thrombocytopenia. (II-2A).
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Neylon OM, Grover SR, Zacharin M. Exploring clinician confidence in the management of adolescent menstrual and reproductive health problems. Horm Res Paediatr 2014; 81:182-8. [PMID: 24503880 DOI: 10.1159/000356920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/11/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE A high incidence of menstrual problems is reported in adolescent girls, with significant attendant morbidity. The majority are likely to be seen and managed by doctors other than specialist gynaecologists. This study aimed to survey the practice of doctors other than gynaecologists, to establish their chosen therapeutic options and confidence levels and to explore knowledge, using clinically challenging scenarios. METHODS A questionnaire designed to fulfil the above aims was distributed to a wide range of clinicians across paediatric disciplines and primary care. RESULTS The questionnaire was returned by 306 clinicians. General practitioners and paediatric endocrinologists were more confident in management and were more likely to self-manage patients (p < 0.01). The oral contraceptive pill was the most frequently chosen first-line therapy by all clinicians, followed by transdermal oestrogen/progesterone, etonorgestrel implant, progesterone-only pills, levonorgestrel-intrauterine system and depot medroxyprogesterone acetate injections. General, community and subspecialist paediatricians were more likely to choose suboptimal management strategies for each of five clinical scenarios. CONCLUSIONS Low confidence levels, suboptimal therapy choices and high referral rates are common among general paediatricians, community paediatricians and subspecialists for adolescents with menstrual and reproductive health concerns. Targeted education for these clinician groups, towards optimizing management for these patients, would enhance care.
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Affiliation(s)
- Orla M Neylon
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Melbourne, Vic., Australia
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Menstrual and reproductive issues in adolescents with physical and developmental disabilities. Obstet Gynecol 2014; 124:367-375. [PMID: 25004333 DOI: 10.1097/aog.0000000000000387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most obstetrician-gynecologists will encounter adolescents with disabilities in their practice, because developmental and physical disabilities are common in young patients (8.4%). Reproductive health issues such as puberty, sexuality, and menstruation can be more complicated for teenagers with disabilities and their families as a result of concerns surrounding menstrual hygiene, abuse risk, vulnerability, changes in seizure pattern, and altered mood. Teenagers with disabilities have gynecologic health care needs similar to those of their peers as well as unique needs related to their physical and cognitive issues. The gynecologic health visit for a teenager with disabilities should include an evaluation of the teenager's reproductive knowledge as well as an assessment of her abuse and coercion risk and her ability to consent to sexual activity. The menstrual history is focused on the effects of menstrual cycles on her daily life. Diagnostic testing is not different from other adolescents. Hormonal treatment is often requested by the patient and her family to alleviate abnormal bleeding, cyclic mood changes, dysmenorrhea, or a combination of these, to assist with menstrual hygiene, and to provide contraception. Menstrual manipulation can be used to induce complete amenorrhea, regulate cycles, or decrease regular menstrual flow. However, treatment risks and side effects may have a different effect on the lives of these adolescents. The comfort level of health care providers to respond to the special concerns of adolescents with disabilities is low, and several barriers exist. This review addresses the complex issues of puberty, menstruation, sexuality, abuse, and safety highlighting the distinctive needs of this population. The options and decisions around menstrual manipulation are highlighted in detail.
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Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
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Zacharin M. Endocrine problems in children and adolescents who have disabilities. Horm Res Paediatr 2014; 80:221-8. [PMID: 24021568 DOI: 10.1159/000354305] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/11/2013] [Indexed: 11/19/2022] Open
Abstract
The consequences of disability span almost all aspects of life, for families and for an affected individual. Endocrine aspects of disability cover disorders of hypothalamic pituitary dysfunction, bone health, puberty, fertility, sexual function and contraceptive needs. Adequate endocrine assessment for a child with a disability requires extensive and sensitive history to address social issues, general nutrition, vitamin D status, specific hypothalamic pituitary problems, together with parental concerns regarding puberty and contraception. Bone health assessment includes history of minimal trauma fracture, need for intervention or fitness for surgery. Strategic interventions to improve outcome include management of puberty, vitamin D status, biomechanical stimulation with vibration and standing and possible consideration for bisphosphonate in special circumstances. Both early and late puberty cause major family concerns. The paediatrician must be aware of a range of management options to improve outcomes for the child and family.
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Affiliation(s)
- Margaret Zacharin
- Department of Endocrinology, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic., Australia
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27
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Kirkham YA, Allen L, Kives S, Caccia N, Spitzer RF, Ornstein MP. Trends in menstrual concerns and suppression in adolescents with developmental disabilities. J Adolesc Health 2013; 53:407-12. [PMID: 23763962 DOI: 10.1016/j.jadohealth.2013.04.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 04/22/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Demonstrate changes in methods of menstrual suppression in adolescents with developmental disabilities in a recent 5-year cohort compared with an historical cohort at the same hospital. METHODS Retrospective cohort study of patients with physical and cognitive challenges presenting for menstrual concerns at an Adolescent Gynecology Clinic between 2006 and 2011 compared with a previous published cohort (1998 to 2003). RESULTS Three hundred patients with developmental disabilities aged 7.3 to 18.5 years (mean 12.1 ± 1.6) were analyzed. Caregiver concerns included menstrual suppression, hygiene, caregiver burden, and menstrual symptoms. Ninety-five percent of patients had cognitive disabilities, 4.4% had only physical impairments. Thirty-two (31.7) percent of patients presented premenarchally. The most commonly selected initial method of suppression was extended or continuous oral contraceptive pill (OCP) (42.3%) followed by patch (20%), expectant management (14.9%), depot medroxyprogesterone acetate (DMPA) (11.6%), and levonorgestrel intrauterine system (LNG-IUS) (2.8%). Published data from 1998 to 2003 indicated a preference for DMPA in 59% and OCP in 17% of patients. The average number of methods to reach caregiver satisfaction was 1.5. Sixty-five percent of initial methods were continued. The most common reasons for discontinuation were breakthrough bleeding, decreased bone mineral density, or difficulties with patch adherence. Second-choice selections included OCP (42.5%), LNG-IUS inserted under general anesthesia (19.2%), DMPA (17.8%), and patch (13.7%). CONCLUSIONS Since identification of decreased bone mineral density with DMPA and emergence of new contraceptive options, use of extended OCP or patch has surpassed DMPA for menstrual suppression in our patient population. LNG-IUS is an accepted, successful second-line option in adolescents with developmental disabilities.
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Affiliation(s)
- Yolanda A Kirkham
- Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada.
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de Knegt NC, Pieper MJC, Lobbezoo F, Schuengel C, Evenhuis HM, Passchier J, Scherder EJA. Behavioral pain indicators in people with intellectual disabilities: a systematic review. THE JOURNAL OF PAIN 2013; 14:885-96. [PMID: 23830762 DOI: 10.1016/j.jpain.2013.04.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
UNLABELLED People with intellectual disabilities (IDs) have a higher risk of painful medical conditions. Partly because of the impaired ability to communicate about it, pain is often undertreated. To strengthen pain assessment in this population, we conducted a systematic review to identify behavioral pain indicators in people with IDs by using Embase, PubMed, PsycINFO, CINAHL, and Cochrane. Inclusion criteria were 1) scientific papers; 2) published in the last 20 years, that is, 1992 to 2012; 3) written in English, 4) using human subjects, 5) intellectual disabilities, 6) pain, 7) behavior, and 8) an association between observable behavior and pain experience. From 527 publications, 27 studies were included. Pain was acute in 14 studies, chronic in 2 studies, both acute and chronic in 2 studies, and unspecified in 9 studies. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Of the 14 categories with behavioral pain indicators, motor activity, facial activity, social-emotional indicators, and nonverbal vocal expression were the most frequently reported. Most of the behavioral pain indicators are reported in more than 1 study and form a possible clinical relevant set of indicators for pain in people with IDs. Determination of a behavioral pattern specific for pain, however, remains a challenge for future research. PERSPECTIVE This review focuses on categories of behavior indicators related to pain in people with IDs. The quality of evidence is critically discussed per category. This set of indicators could potentially help clinicians to recognize pain in this population, especially when unique individual pain responses are also identified.
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Affiliation(s)
- Nanda C de Knegt
- Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.
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Greenwood NW, Wilkinson J. Sexual and reproductive health care for women with intellectual disabilities: a primary care perspective. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:642472. [PMID: 24455249 PMCID: PMC3876698 DOI: 10.1155/2013/642472] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/19/2013] [Accepted: 10/03/2013] [Indexed: 05/22/2023]
Abstract
Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework.
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Affiliation(s)
- Nechama W. Greenwood
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- *Nechama W. Greenwood:
| | - Joanne Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA
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Gomez MT, Carlson GM, Van Dooren K. Practical Approaches to Supporting Young Women With Intellectual Disabilities and High Support Needs With Their Menstruation. Health Care Women Int 2012; 33:678-94. [DOI: 10.1080/07399332.2012.684812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sexuality, pre-conception counseling and urological management of pregnancy for young women with spina bifida. Eur J Obstet Gynecol Reprod Biol 2012; 163:129-33. [DOI: 10.1016/j.ejogrb.2012.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/21/2012] [Accepted: 04/02/2012] [Indexed: 11/23/2022]
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Hamilton A, Marshal MP, Sucato GS, Murray PJ. Rett syndrome and menstruation. J Pediatr Adolesc Gynecol 2012; 25:122-126. [PMID: 22206685 DOI: 10.1016/j.jpag.2011.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Describe the experience that girls with Rett syndrome have with menstruation including menstrual hygiene, dysmenorrhea, premenstrual syndrome (PMS), and attempts at treatment. DESIGN Anonymous web-based survey. SETTING Convenience sample recruited from Rett syndrome LISTSERV in July of 2009. PARTICIPANTS Mothers of girls with Rett syndrome between the ages of 10-25 who have had at least one menses. MAIN OUTCOME MEASURES Prevalence, frequency, and severity of dysmenorrhea and PMS; hygiene concerns; and treatments attempts and perceived effectiveness. RESULTS Dysmenorrhea and PMS are common problems among young women with Rett syndrome. Despite their frequency and severity they do not routinely limit activities. Multiple treatment attempts are common. Hormonal contraception is used mostly for menstrual cycle control with oral contraceptive pills the most commonly used method. CONCLUSIONS Young women with Rett syndrome have standard symptoms of dysmenorrhea and PMS as well as autism spectrum specific PMS symptoms. Hormonal contraception is commonly used for menstrual management.
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Affiliation(s)
- Amy Hamilton
- University Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael P Marshal
- Department of Psychiatry, University Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gina S Sucato
- Division of Adolescent Medicine, Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Pamela J Murray
- Division of Adolescent Medicine, Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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