Research Article| Volume 1, ISSUE 3, P195-198, 1988

A clinical observation of a program to accomplish pelvic exams in difficult-to-manage patients with mental retardation

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      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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