Abstract
Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework.
Highlights
Intellectual disability (ID, formerly mental retardation) is characterized by significant limitations in intellectual functioning and in adaptive behavior, including conceptual, social, and practical skills, that originates before the age of 18 [1]
We conducted a limited literature review related to six aspects of sexual health care of women with intellectual disabilities (ID), including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting
After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework
Summary
Intellectual disability (ID, formerly mental retardation) is characterized by significant limitations in intellectual functioning (generally measured as IQ of 70–75 or less) and in adaptive behavior, including conceptual, social, and practical skills, that originates before the age of 18 [1]. In order to address these gaps, we conducted a limited review of the literature related to the sexual health care of women with intellectual disabilities. Our literature review was conducted using PubMed and Google Scholar, and search terms included combinations of the following: intellectual disability, mental retardation, International Journal of Family Medicine developmental disability AND sexual health, primary care, reproductive health, women’s health, sex education, sexual health education, sexual abuse, sexuality, cervical cancer, cytology, sexually transmitted infection, sexually transmitted disease, pregnancy, prenatal, parent, parenting, and mothers. An important limitation of this paper relates to the lack of evidence and clinical guidelines for best practice; for each topic area we have noted which recommendations are evidence-based and which are theoretical- or postulatedbased on empirical experience. Though recommendations are intended for use by individual primary care providers (i.e., family physicians, internists, nurse practitioners, etc.) who work in community settings, they may be applicable to practitioners in other settings, such as institutional environments and care teams
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