Chapter 549 Gynecologic Care for Girls with Special Needs
Abuse
The risk for sexual abuse in teens with disabilities is difficult to estimate. Studies show that teens with physical disabilities are just as sexually active as their nondisabled counterparts but that more of their activity is nonvoluntary. Screening for abuse is mandatory. Abuse prevention education can include the No! Go! Tell! model. For teens with limited verbal capacity or developmental delay, abuse may be very hard to detect. The care provider needs to be vigilant in looking for signs on physical exam, such as unexplained bruises or scratches, or changes in behavior that may be indications of sexual abuse in those adolescents (Chapters 37.1 and 113).
Pelvic Examination
A pelvic exam is rarely indicated in teens who are not sexually active, unless they have vulvar issues such as discharge, irregular bleeding, suspicion for abuse, or foreign body and an external inspection can be performed. A speculum exam is not performed, and if the vagina or cervix needs to be visualized, an exam under anesthesia by a gynecologist should be considered. Testing for STIs can be accomplished by urine testing or vaginal swabs (Chapter 114).
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.
