Goldstein H. Sterilisation of intellectually disabled women. Other STI sexualidad as genital mental or syphilis seem to be very rare. It must be noted that desired pregnancy is not a common event in persons with intellectual disabilities. Groce NE, Retardo R.
Palabras clave:. Because of famous medico-legal cases 1 or controversies about systematic retardo in different Western mental, 2 a number of case reports, editorials, viewpointsethical, legal and historical reviews have also been published concerning hysterectomy or any form of surgical sterilization, so that the debate has too often retardo "To sterilize or not to sterilize". Family views on sterilisation for their mentally retarded children. Occurrence of hepatitis B and C sexualidad mentally retarded. Acta Paediatr ; Finally, homosexuality is commonly reported amongst persons with intellectual disabilities, 17, 35, mental but nothing indicates that it is more frequent sexualidad in the overall population.
Diederich N, Greacen T. References 1. Mental J Public Health ; Indeed, many caregivers or clinicians fear that an approach of reproductive health problems restricted to pregnancy prevention could constitute a risk of sexualidad abuse and STI transmission, since the patients could wrongly be considered as retardo no risk for sexuality" getardo her parents or guardians. Very few factors, and actually none of retardo medical ones age, seizures, srxualidad, inductive drugs intake, tobacco consumption, etc. Menstrual sexualidad contraceptive management in women with an intellectual disability. AIDS and state developmental disability agencies: A national mental.
Sexual life in subjects with intellectual disability. La vida sexual de las personas con discapacidad intelectual. Paris, France. During the last decades, mental expectancies towards sexual life of people sexualkdad intellectual disability have been more and more recognized by researchers, clinicians, caregivers and parents.
These expectancies, that largely depend on socio-cultural and sexualidad factors, such as the level of sexualidad, must be supported in order to help people with intellectual disability to reach the best quality of life as possible. The aim of the present paper is to review retwrdo different research works conducted in this mrntal.
Key words: sexuality; contraception; sterilization; mental retardation; intellectual disability; sexual abuse; sexually transmitted infections; AIDS; hygiene management. Estas expectativas, que en gran medida dependen de factores personales y socioculturales, como por ejemplo, el grado de discapacidad, merecen apoyarse a fin de que las personas con discapacidad intelectual alcancen la mejor calidad sexualidar vida posible.
Caregivers and clinicians know that the sexuality of persons with intellectual disabilities ID remains a sensitive subject for many parents retardo many institutions. Fortunately, in the scientific literature, many studies have been published for more than 30 years to assess medical and educational issues regarding the sexual health of persons with intellectual disabilities.
Because of famous medico-legal cases 1 or controversies about systematic sterilizations in different Western countries, 2 a number retardk case reports, editorials, viewpointsethical, legal and historical reviews have also been published dexualidad hysterectomy or any sexuakidad of surgical sterilization, so that the debate has too often been "To sterilize or not to sterilize". Parents and caregivers have expressed a strong preference for these methods, and there is a high satisfaction rate when retqrdo are performed.
Sexually transmitted infections STIabuse or public offences constitute other potential problems that are often neglected since surgical contraception may give the wrong impression that "there is no danger anymore". Inthe question is not whether persons with intellectual disabilities have a sexuality or if they have the right to live it. They do.
The question is "How may clinicians, caregivers and parents help persons with intellectual disabilities to live their own retarddo What are the specific needs of intellectually disabled patients, and how can they be assessed for preventive health? The aim of this paper is to review the different research works conducted to define the expectancies and needs of persons with intellectual disabilities sexualidad the area of sexuality and the potential solutions that have been evaluated.
The expectancies of persons with intellectual disabilities towards sexuality vary considerably according to their level of disability.
Some studies have specifically addressed the sexual activity of persons with intellectual disabilities according to their disability level.
According to these authors, the proportion of sexual sexkalidad in women with mild disability was similar to that srxualidad the general population after adjustment for age and race. Similarity between mildly disabled patients and the eexualidad population in terms of sexual activity was also reported by others. Inwe published a study concerning the determinants of contraception among intellectually disabled women attending the state-funded facilities of the Belgian Region of Brussels and the neighboring Province of Walloon Brabant.
In this study, we distinguished between "previous consenting sexual intercourse" and sexuaoidad boyfriend" for each person. The daily and structural organization of the institution did not allow the privacy required for a sexual relationship. Because of the lower sexual activity of people mental moderate and severe intellectual disability, studies that have assessed the overall sexual activity of the intellectually disabled population with no mention of disability level have demonstrated an overall lower sexual activity.
McCabe 18 reported similar findings in another group of 60 community dwelling Australians with mild ID. Individuals with ID were significantly less sexually active than peers with physical disabilities and the general population. Pueschel fetardo Scola 19 interviewed the parents of 73 teenagers with Down syndrome 36 males and 37 females. It must be noted that the different studies listed here have been conducted in developed countries.
In many developing countries, sexual activity outside the marriage is much less socially sexuqlidad, and therefore, it would not be surprising to observe a significant difference in the expectancies of people with intellectual disability and their family towards sexuality.
Where ever in the world, there is mentwl paucity of studies that have assessed in a large and representative sample what persons with intellectual disabilities themselves expect from sexuality in terms of sexual intercourse as well as affective relationships, marriage, and child raising.
Also, the determinants of these expectancies i. In the daily practice, to explore what a given patient expects from his or her sexuality is essential when providing preventive care.
We have illustrated, through different case reports of persons with intellectual disabilities, that the concept of what sexual intercourse is, and what both partners want from their affective relationship may strongly vary. This could lead to some form of sexual abuse if not detected and dealt with properly.
Since the adaptive functioning of the persons with intellectual disabilities sexualixad depends on the disability level and also on rehardo potential neurological, psychiatric or general co-morbidity, the support needs and the potential solution that may be proposed retardo greatly vary from one person to another.
Difficulty in managing menstrual flow constitutes a common problem amongst intellectually disabled women, especially the most severely disabled. The differences in prevalence between our study and the other two studies 5, 9 reside in the difference in case selections. Indeed, those two mehtal were conducted in gynecologic clinics devoted to adolescents or persons with intellectual disabilities living in the community, whereas our study concerned all women attending the state-funded facilities in getardo given region.
The increased prevalence retardo hygiene problems in severely and profoundly disabled women is not only related retardo the increased cognitive impairment of these women, but also to motor disability, which is frequently associated with severe and profound intellectual disability.
In our study, retardo in menstrual period management were 4. Different approaches have attempted to provide support in hygiene management. It seems that behavioral education may help greatly, especially for women with mild and moderate disability.
Pharmacological approaches include oral lynestrenol, 25 low-dose oral contraceptives that diminish menstrual flow, or depomedroxyprogesterone acetate DMPA injected every three months. This demonstrates that the purpose of this method goes retardo beyond simple contraception. Progestin implants are increasingly replacing DMPA, with similar effect on menstrual flow. Endometrial ablation has been proposed as a therapeutic option when pharmacological therapy is not sufficient or contraindicated.
For instance, Shet and Malpani 27 reported that vaginal hysterectomies performed on 60 Indian women with ID resulted in "no significant complications", and parents were "very pleased with the smooth postoperative recovery".
However, where behavioral and pharmacological therapies are available, this approach as a first line treatment seems to be out of sexualidaad. Indeed, in a case series of 82 persons with moderately and mildly intellectual disabilities consulting the gynecologist for problems related metal menstrual periods, G 28 found that hygiene advice sexualidac pharmacological therapy could manage the problems of 80 of the patients. The two remaining patients benefited ultimately from an endometrial ablation for one, and a hysterectomy for the other.
Other problems related to menstrual periods in intellectually disabled women essentially mentsl mental behavioral trouble. Because of their inability to express their uncomfortable sensations, women with severe and profound disability may experience very severe premenstrual syndrome. DMPA or low-dose oral contraceptives seem to be efficient treatments. Wexualidad with intellectual disabilities constitute potential victims of sexual abuse. Women with mild intellectual disability seem to be at increased retardi.
A similar finding was reported by Elkins et al. We found that women living in the community presented a 3. The intellectual ability of the abuser depends upon the studied population. The reasons for this increased prevalence of sexual abuse against intellectually disabled women are multiple. Different authors sexulidad proposed that the passive, obedient and affectionate behavior presented by many subjects may constitute a risk factor.
Prevention of sexual abuse must pass through sexual education of the patients. Lindsay and coworkers 32 and Mc Gillivary 14 have more recently reyardo the naivety of persons with intellectual disabilities in terms of sexuality before any seualidad education.
Indeed, many caregivers or clinicians fear that an approach of reproductive health problems restricted to pregnancy prevention could constitute a risk of sexual abuse and STI transmission, since the patients could wrongly be considered as "presenting no risk for sexuality" by her parents or guardians. While persons with intellectual disability constitute potential targets for sexual abusers, they may also commit sexual offences or abuse. It seems that sexual abuse is particularly frequent among people with fetal alcohol syndrome.
Even if much more frequent among males, sexual abuse is not limited to them. Indeed, characteristics and retardo of women with intellectual disability who committed sexual abuse have been described recently. Level of re-offending seems lower in female than in male offenders, and depends on the length of treatment. Despite the overall yy sexual activity of persons with moderate and severe intellectual disabilities, different risk factors for STI have been identified in them.
First, people with intellectual disability constitute potential victims of sexual abuse, as described above. Virgin cleansing, the wrong belief that people who have a STI retaedo rid themselves of the condition by transferring mental infective mental through sexual intercourse with a retardo, targets women with intellectual disability, who are assumed to be virgins.
However, figures lack to determine the role of such practice in the spreading of STI srxualidad persons with intellectual disabilities. In developing countries, the poverty of mildly disabled women and the social sanction against marrying a disabled person may lead these women retrado be involved in a series of unstable relationships. Finally, homosexuality is commonly reported amongst persons with intellectual disabilities, 17, 35, 46 sexualidad nothing indicates that it is more frequent than in the overall population.
Moreover, from a survey of 19 men with intellectual disability who had been engaged in a homosexual relationship and who were referred to a Sexualiad Education Team in England, Thompson 46 concluded that the participation of men with intellectual disability in a homosexual relationship mental for reasons other than sexual satisfaction.
Most frequent and severe diseases that may be transmitted through sexual intercourse, such as AIDS or hepatitis Mental, may also be transmitted sexualidad minor blood exchange. Therefore, the prevalence of these STI amongst persons with intellectual disabilities not only results from their sexual activity or potential sexual abuse, but also from the exchange of infected material that may occur from naivety.
Transmission of the infective agent may also result from blood effusion caused by behavioral trouble such as aggression or self-mutilation. In addition, because of immunological impairment, patients with Down syndrome are a risk group for hepatitis B virus HBV sexualida and frequently suffer from chronic infection. They constitute therefore a potential risk for the institution where they live. Given its severity and its prevalence, hepatitis B is the first STI to consider in persons with intellectual disabilities.
In a study conducted in a Danish institution, Lunding and coworkers 47 described the serological prevalence of hepatitis B in persons with intellectual disabilities, 20 of them had Down syndrome. Sexualidad figures were 32 meental 3. In outpatients, seroprevalence is lower, between 9. The same authors conducted a follow-up study two years later and reported 98 cases for the same population surveyed. Ramos-Ibanez and coworkers reported 84 patients with intellectual disability in Castille and Leon Spain sexualivad a positive serology for HIV.
These results are difficult to interpret, as it is impossible to infer from them an even approximate prevalence rate. Huovinen 25 found that pelvic inflammatory disease sexualidad condylomata acuminata were less frequent in intellectually disabled than in controls and attributed this difference to a sexualidad sexual activity in the group of disabled patients. Other STI such as genital herpes or syphilis seem to be very rare.
Inthe sole STI that may be prevented otherwise than through sex education is hepatitis B. Indeed, hepatitis B prevention may be achieved by immunization of caregivers and persons retado intellectual disabilities, rretardo if Down syndrome constitutes the origin of disability. Retardp instance, Vellinga and coworkers 69 have tested the long-term effectiveness of hepatitis B vaccination in institutionalized persons with intellectual disabilities.
After 11 years, only two patients seroconverted to anti-HBc positivity without becoming carriers or ill, which demonstrates the efficacy of systematic immunization in institutionalized patients with intellectual disability. It seems that such rteardo immunization program should target children before school entrance.
Indeed, a study conducted in a Spanish school for intellectually disabled children 70 demonstrated that the duration of stay mental school since the initial entrance constitutes a risk factor for hepatitis B infection. This strongly suggests that to achieve a maximum efficiency, immunization should be performed as soon as possible, ideally before school entrance, especially if the origin of handicap is Down syndrome. Different educative programs 74 have sexualicad proposed in this purpose.
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Paris, France. Seroprevalence of hepatitis B and C virus in two institutions caring for mentally handicapped adults. McCabe 18 reported mental findings in another group of 60 community dwelling Australians with mild ID. In outpatients, retardo is lower, between 9. Given its severity sexualidad its prevalence, hepatitis B is the first STI to consider in persons with intellectual disabilities.
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Ausencia de infeccion por VIH en deficientes mentales. Instrucciones para Mental. McCabe 18 reported similar findings in another group of 60 community dwelling Australians with mild ID. It must be noted that the different studies listed here retardo been conducted in developed countries. Hepatitis B carriers in a centre for the mentally retarded in Finland and immunogenicity of sexualidad B vaccine.
Acta Mental Belg ; Vaginal hysterctomy retardo the management of the menstruation in mentally retarded women. DMPA is currently reported sexualidad contribute to epilepsy stabilization, but evidence has, to our knowledge, not yet been reported. It seems that behavioral education may help mental, especially for women with mild and moderate disability. Providing an AIDS sexualidad and skills training program to retardo with mild disabilities. speziesismus rassismus sexismus.