Singh Shrestha Prakriti, Ishak Angela, Maskey Upasana, Neupane Purushottam, Sarwar Sarosh, Desai Shreeya, Naffa Faris, Maria Cuevas Lou Claudia, Diaz-Miret Miguel
Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA.
University of Health Science, Punjab Medical College, Lahore, Pakistan.
J Family Reprod Health. 2022 Mar;16(1):9-15. doi: 10.18502/jfrh.v16i1.8589.
Our review aims to focus on identifying challenges faced by intellectually disabled women (IDW) in receiving gynecological and reproductive care and also highlights evidence based strategies to overcome those challenges. We conducted a literature review discussing challenges faced by IDW in obtaining healthcare services by thorough search on various electronic databases (PubMed, Google Scholar, and Scopus) starting from 2000 to 28 August 2021 excluding all non-english articles, reviews, editorials and letters to editor. The keywords used for search were "reproductive care", "gynecologic care", "intellectual disability", "mental handicap", and "mental retardation". The existing literature review showed that IDW have difficulty maintaining menstrual hygiene and lack knowledge regarding contraception use and sexual health resulting in violations of their reproductive rights. Sexually transmitted diseases and cervical cancer are common among IDW due to their vulnerability to sexual abuse. Nulliparity in IDW increases their suspectibility to even breast cancer. Moreover, they face problems with sexually transmitted infection (STI) and cancer screening due to physical barriers for assessment, low socio-economic status, physician-patient communication issues and deficit in skilled providers. Short acting sedatives such as ketamine or midazolam can be used to overcome challenges faced with gynecological and obstetric examination. Finally forced sterilization and institutionalization has been a habitual practice as menstrual hygiene and pregnancy in IDW raise concerns on psychosocial challenges along with associated obstetric complications. Reproductive and sexual health education including contraception use can be provided by using evidence based strategies involving use of pictures, animations and models by adequately trained healthcare providers including midwives. Further research involving IDW is needed to allow state-wise laws and policies to be created to mitigate the challenges and improve health outcomes in this population.
我们的综述旨在聚焦于识别智障女性在接受妇科和生殖保健时所面临的挑战，并强调基于证据的应对这些挑战的策略。我们进行了一项文献综述，通过对2000年至2021年8月28日期间的各种电子数据库（PubMed、谷歌学术和Scopus）进行全面检索，讨论智障女性在获得医疗服务方面所面临的挑战，排除所有非英文文章、综述、社论和给编辑的信件。用于检索的关键词有“生殖保健”“妇科保健”“智力残疾”“精神障碍”和“智力发育迟缓”。现有文献综述表明，智障女性在保持经期卫生方面存在困难，缺乏关于避孕使用和性健康的知识，导致其生殖权利受到侵犯。由于她们易遭受性虐待，性传播疾病和宫颈癌在智障女性中很常见。智障女性未生育会增加她们患乳腺癌的易感性。此外，由于评估存在身体障碍、社会经济地位低、医患沟通问题以及缺乏熟练的医疗服务提供者，她们在性传播感染（STI）和癌症筛查方面面临问题。可以使用氯胺酮或咪达唑仑等短效镇静剂来克服妇科和产科检查中面临的挑战。最后，强制绝育和收容机构化一直是一种惯常做法，因为智障女性的经期卫生和怀孕引发了对心理社会挑战以及相关产科并发症的担忧。可以由包括助产士在内的经过充分培训的医疗服务提供者，通过使用基于证据的策略，包括使用图片、动画和模型，来提供包括避孕使用在内的生殖和性健康教育。需要开展涉及智障女性的进一步研究，以便制定各州的法律和政策，以减轻这些挑战并改善这一人群的健康状况。
