Successful Routine Cervical Cancer Screening Facilitated by Pelvic Floor Physical Therapy for a Woman With Developmental Disability and a History of Trauma: Case Report

Abstract

Background: Women with intellectual and developmental disabilities (I/DD) are not getting routine cervical cancer screens at the recommended frequency, limiting opportunities for early detection and treatment of cervical cancer. Pelvic floor physical therapy plans of care can be used to successfully address this health care disparity. Case Description: This is the case of a patient who had diagnoses of developmental delay, oppositional defiant disorder, attention-deficit disorder, unilateral hearing loss, and a history of trauma. The patient was referred by her primary care physician after a halted first pelvic examination due to tension of the patient's pelvic floor and her overall discomfort and dissociation from the session. Clinical findings revealed pelvic floor tension. Interventions were employed over the course of 18 sessions. Outcomes: Sessions focused on education, positioning, relaxation, and graded vaginal dilator insertion while keeping the patient engaged to prevent dissociation. The patient showed minimal clinically important differences on the Patient-Specific Functional Scale, met the short- and long-term goals including undergoing a pain-free pelvic examination, and had a significantly decreased pelvic floor resting tone. Discussion: For patients with I/DD, pelvic floor physical therapy can be a valuable tool to help them undergo a successful and pain-free routine cervical cancer screen. It may take longer than typical plans of care, but the outcomes justify the length of the intervention. Practices that promote self-determination are a key to success. Informed consent was obtained and signed by the patient's medical guardian. Video Abstract: Supplemental Digital Content available at: http://links.lww.com/JWHPT/A128