Gynecologic Care for Girls with Special Needs

Published on 27/03/2015 by admin

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Last modified 27/03/2015

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Chapter 549 Gynecologic Care for Girls with Special Needs

Adolescence is a challenging time for all children and their families, but especially for teens with special needs; the hormonal changes occurring and the start of menstrual cycles can profoundly affect the lives of teens and their families. In addition there may be concerns about sexual activity, safety and abuse, and unplanned pregnancies.

Menstruation

Irregular menstruation is common in teenagers, especially the first 5 years after menarche, due to immaturity of the hypothalamic-pituitary-ovarian (HPO) axis and subsequent anovulation (Chapter 110). Several conditions in teens with disabilities are associated with an even higher risk of irregular cycles. Teens with Down syndrome have a higher incidence of thyroid disease. There is a higher incidence of reproductive issues, including PCOS in teens with epilepsy and on certain antiepileptic drugs (AEDs) (Chapter 546). Antipsychotic medication can cause hyperprolactinemia, which can affect menstruation.

The main issue with menstrual cycles, whether they are regular, irregular or heavy, is the impact of menstruation on the patient’s life and her normal activities. The history should focus on this aspect, and menstrual calendars may be helpful to document the cycles, behavior, and the impact of treatments. Most adolescents who self-toilet can learn to use menstrual hygiene products appropriately.

The evaluation for abnormal bleeding is the same as for all teens. Areas requiring particular attention for the child with special needs are the possible need for menstrual suppression for hygiene or cyclical behavioral issues, like crying, tantrums, or withdrawal, and a request for birth control, especially coming from a caregiver and not from the teen, which requires an evaluation of the teen’s ability to consent and evaluate the safety of her environment.

Treatment

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