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Case of a Girl with Special Needs Seeking Menstrual Management

Abstract

Disabilities are common in children and adolescents with >5% of children and adolescents affected by a physical or intellectual disability. The onset and progression through puberty may be challenging for girls with mental and physical disabilities and their families and caregivers. Gynecologic care may be underutilized in adolescents with disabilities, but pediatricians and pediatric and adolescent gynecologists should use a nonjudgmental approach, incorporating anticipatory guidance regarding pubertal changes and options for menstrual regulation, confidential care with the adolescent, and attention to parental concerns. Menstrual regulation can be useful to reduce symptoms of dysmenorrhea, reduce irregular menstrual bleeding, and decrease the frequency or amount of menstrual breeding. Options for menstrual regulation include combined hormonal contraceptives (available in pill, patch, and vaginal rings), progesterone-only contraceptives (including pills, injectables, implants, and IUDs), NSAIDs, and, as a last resort, surgical intervention. The ability to give consent for consensual sexual activity should be assessed in patients with disabilities. Adolescents with disabilities are at higher risk for sexual abuse and should receive sexual abuse prevention education at an appropriate level for their intellectual abilities.

Keywords

Intellectual disability Puberty Adolescent development Sexual maturation Menstrual cycle Menstruation Contraception 

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Suggested Educational Reading, References, and Policies

  1. Altshuler AL, Hillard PJA. Menstrual suppression for adolescents. Curr Opin Obstet Gynecol. 2014;26:323–31.CrossRefGoogle Scholar
  2. Committee Opinion No. 668: Menstrual manipulation for adolescents with physical and developmental disabilities. Obstet Gynecol. 2016;128:e20–25.Google Scholar
  3. Quint EH, O’Brien RF, COMMITTEE ON ADOLESCENCE & North American Society for Pediatric and Adolescent Gynecology. Menstrual management for adolescents with disabilities. Pediatrics. 2016;138. pii: e20160295.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Cleveland Clinic Lerner College of Medicine at CaseClevelandUSA
  2. 2.Center for Adolescent MedicineCleveland Clinic Children’s HospitalClevelandUSA

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