Department of Clinical Research, Federico Gomez Children's Hospital, Mexico City, Mexico.
Congenital Heart Disease Department, Centro Medico Nacional Siglo XXI, Mexican Institute of Social Security, Cardiology Hospital, Mexico City, Mexico.
Front Public Health. 2021 Nov 18;9:746399. doi: 10.3389/fpubh.2021.746399. eCollection 2021.
Non-therapeutic hysterectomy has been performed to this day in Mexican women with intellectual disabilities (IDs), but the rationale for performing the procedure has been rarely submitted to clinical ethics committees. The objectives of the present research were to determine the frequency of hysterectomy and the clinical and epidemiologic characteristics that associated to the indication of hysterectomy in girls and young females with IDs and to analyse the emerging ethical issues related to the procedure. A medical chart review was conducted to identify female patients aged ≤ 25 years who had IDs based on anatomical pathologies and hospital records and underwent hysterectomy between January 2014 and December 2019 in nine high-concentration hospitals in Mexico City. Data were collected using a questionnaire developed and validated through a pilot study and analysed using the Statistical Package for the Social Sciences (SPSS) 21.0 software. Information of 234 female patients with or without ID who were ≤ 25 years of age was reported by the departments of anatomical pathology and paediatrics. Of the patients, 184 (79%) were excluded because the information reported was found to be erroneous or incomplete during the medical records review. Most of the 50 emales included in the study had moderate ID ( = 23, 46%) followed by those with severe ID ( = 17, 34%). The mean age at hysterectomy was 15 ± 2.9 years. Prophylactic-total abdominal hysterectomy was the most frequently performed ( = 42, 84%). A concurrence was observed between the parental and medical reasons justifying hysterectomy. The most frequent reasons were fertility control (parents vs. physicians: 46 vs. 42%), management of menstrual hygiene (28 vs. 30%) and risk of sexual abuse (6 vs. 6%). This study showed that performing non-therapeutic hysterectomy is subject to the clinical judgement of physicians according to their perception of the patient's quality of life. Therefore, the ethical quality of the decision to perform the procedure in girls and young females resides in the ethical value of its consequences.
非治疗性子宫切除术至今仍在墨西哥患有智力障碍（ID）的女性中施行，但施行该手术的理由很少提交临床伦理委员会审议。本研究的目的是确定行子宫切除术的频率，以及与 ID 女孩和年轻女性行子宫切除术指征相关的临床和流行病学特征，并分析与该手术相关的新兴伦理问题。对 2014 年 1 月至 2019 年 12 月期间，9 家墨西哥城高浓度医院的基于解剖病理学和医院记录，年龄≤25 岁的 ID 女性患者的病历进行了回顾性研究。使用自行设计的问卷收集数据，通过预试验进行验证，并使用社会科学统计软件包（SPSS）21.0 进行分析。解剖病理学和儿科学系报告了 234 名患有或不患有 ID 且年龄≤25 岁的女性患者的信息。在这些患者中，184 名（79%）因在病历审查过程中发现报告信息有误或不完整而被排除。在所纳入的 50 名女性中，大多数为中度 ID（=23，46%），其次为重度 ID（=17，34%）。行子宫切除术的平均年龄为 15±2.9 岁。预防性全子宫切除术是最常施行的术式（=42，84%）。父母和医生的理由相符，以证明子宫切除术的合理性。最常见的原因是生育控制（父母：46% vs. 医生：42%）、月经卫生管理（28% vs. 30%）和性虐待风险（6% vs. 6%）。本研究表明，非治疗性子宫切除术是根据医生对患者生活质量的看法进行临床判断的。因此，对女孩和年轻女性施行该手术的决定的伦理质量取决于该手术后果的伦理价值。
