Valdez-Martínez Edith, Márquez-González Horacio, Bedolla Miguel
Unidad de Investigación Médica en Epidemiología Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Servicio de Investigación Clínica, Hospital Infantil de México "Federico Gómez", Ciudad de México, México.
Gac Med Mex. 2024 Apr 8;160(2):179-186. doi: 10.24875/GMM.M24000879.
Non-therapeutic hysterectomy in girls and adolescents with intellectual disability (ID) is an acceptable practice, even when there is a lack of prescriptive ethical reason.
To determine the magnitude of the practice of hysterectomy in girls and adolescents with ID, and explore the emic factors associated with this procedure.
Multicenter, intersectoral study with a mixed methods design.
The quantitative results showed that 50 of 234 reported hysterectomies corresponded to females with ID. Average age at the time of surgery was 15 ± 2.9 years. Prophylactic abdominal hysterectomy was the most common procedure, and the justifications for it were "fertility control", "menstrual hygiene management", and "risk of sexual abuse". A qualitative analysis of 15 focus groups revealed that parents' main concern was how to manage their daughters' index disease and reproductive health; they perceived menstruation positively; they expressed their fear of dying and leaving them without support, and emphasized fertility control; none of them approved hysterectomy.
The bodies that define health policies need to create a new philosophy that avoids the reductionist approach of current biomedical model, which separates (in the health-disease process) our interdependence with other humans.
对患有智力障碍（ID）的女童和青少年实施非治疗性子宫切除术是一种可接受的做法，即便缺乏明确的伦理依据。
确定对患有ID的女童和青少年实施子宫切除术的情况，并探究与该手术相关的本土因素。
采用混合方法设计的多中心、跨部门研究。
定量研究结果显示，在报告的234例子宫切除术中，有50例是针对患有ID的女性。手术时的平均年龄为15±2.9岁。预防性腹式子宫切除术是最常见的手术方式，其理由是“生育控制”“月经卫生管理”和“性虐待风险”。对15个焦点小组的定性分析表明，父母主要关心的是如何处理女儿的疾病和生殖健康问题；他们对月经持积极态度；他们表达了对死亡以及女儿无人照料的恐惧，并强调生育控制；他们中无人赞成子宫切除术。
制定卫生政策的机构需要创造一种新的理念，避免采用当前生物医学模式的还原论方法，这种方法在（健康 - 疾病过程中）将我们与他人的相互依存关系割裂开来。
