Primary Care for Women with Intellectual Disabilities

Article Figures & Data

Table 1.

Search Strategy and Selection of Articles Reviewed

Search Terms: “Mental Retardation” OR “Intellectual Disability” AND	Number of Articles Identified	Basic Science or Case Reports	Other^*	Final Number Reviewed	Final Number Used
“Contraception” OR “Contraception behavior” OR “Menstrual disorders” OR “Amenorrhea”	65	6^†	46	13	11
“Pap Smear” OR “Cervical Cancer” OR “Gynecological Exam”	14	5	5	4	8^‡
“Mammography” OR “Breast disease” OR “Breast neoplasm”	21	11	5	5	7^§
“Osteoporosis” OR “Bone density” OR “Bone densitometry”	127	44	67	16	13^‖

* Other reasons for exclusion include: population included other forms of cognitive disability (eg, dementia); population included men or children; syndrome-specific (except for Down syndrome); not in English/not translated.
† In this category only, articles published before 1985 were eliminated, as contraceptive recommendations and options for the general population have changed substantively since that time.
‡ Includes 4 articles from nursing journals which describe techniques for the gynecological exam in women with intellectual disabilities. These were identified from the bibliography of ref. 8.
§ Includes 3 additional articles from ref. 8.
‖ Includes 1 additional article from ref. 8.

Table 2.

Summary of Clinical Guidelines and Resources

Topic	Clinical Guidelines	Available Resources	SORT
Menstrual disorders	Therapeutic amenorrhea may be indicated; stepwise management and least invasive options recommended	Consensus statement on menstrual and contraceptive management¹³	C
Cervical cancer screening	Interval for screening should be individualized to patient; consider sedation, relaxation techniques		B
Contraception	Can be influenced by residential setting and individual needs; caution regarding antiepileptic drugs^*	Consensus statement¹³ and issue of Contraception Report²⁶	C
Breast cancer screening	Follow established guidelines for mammography		C
Osteoporosis	High prevalence in women with ID; early and more frequent screening	13 references; see refs. 50 and 52	A

* Antiepileptic drugs can be (1) more likely to interact with oral contraceptives and (2) more likely to have teratogenic effects that would prompt initiation of contraception.
SORT, strength of recommendation taxonomy; ID, intellectual disability.