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Abstract
Providing routine gynecologic care to patients with mental retardation can be a very
difficult task. A program was developed at the University of Michigan to facilitate
routine gynecologic examinations of patients with mental retardation so that evaluations
could be made without excess physical force or unnecessary inducement of fear. Special
techniques allowing for gynecologic examination of mentally retarded women are described.
Early experience using intravenous or intramuscular Valium and chloral hydrate was
unsuccessful for completion of gynecologic exams without force. As a result, it was
necessary to perform eight pelvic examinations under general anesthesia. After instituting
a protocol using oral ketamine and midazolam, excellent outpatient sedation was achieved
and only 4 of 25 patients subsequently referred for an examination required general
anesthesia. The medications were well tolerated and without significant side effects,
allowing for discharge home within 60 minutes of achieving effective sedation. A satisfactory
gynecologic exam can be accomplished in the vast majority of mentally retarded women
while avoiding unnecessary physical and emotional trauma and the need for general
anesthesia.
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References
- Issues in fertility control for mentally retarded adolescents: Sexual activity, sexual abuse, and contraception.Pediatrics. 1984; 73: 445
- Pelvic examination of the adolescent.Female Patient. 1986; 11: 51
- The adolescent's first pelvic exam.Con-temp Ob-Gyn Special Issue—The Active Woman. 1986; 28: 76
- Sources of anxiety about pelvic examinations among adolescent girls.J Adolesc Health Care. 1984; 5: 105
- The sexual adolescent who is retarded.J Pediatric Psych. 1977; 2: 104
- Edward's Sexual Assessment Scale.Ednick Communications. 1984;
- Oral ketamine and oral midazolam for sedation of mentally handicapped patients.in: Presented at the American Academy of Pediatrics Annual Meeting (Abstract). 1986
Article info
Footnotes
*.This paper was presented in part at the Second Annual Meeting of the North American Society for Pediatric and Adolescent Gynecology held in Cleveland, OH, September 1987.
Identification
Copyright
© 1988 Springer-Verlag New York Inc. Published by Elsevier Inc. All rights reserved.
