Gynaecological issues in adolescents with disability

Menstruation and contraception is a concern for families who have a daughter with a significant disability, either physical or developmental. Accessing information regarding options may be difficult. Maternal experiences of menses further impact on the anxiety. The onset of menses is a reminder that their daughter is at risk of sexual abuse and pregnancy. It may highlight the fact that they are at their limits of coping – without the addition of yet another problem, of managing menses. Parental and carer concern is about the practicalities of how the adolescent will manage menstruation – both the hygiene aspects of menses and also the potential pain. Additionally, information is required about the possible need for contraception and the role and importance of reproductive hormones for preventing cardiac disease and osteoporosis. Recognition that a number of other medical problems may be related to reproductive hormones – such as cyclic seizure, behavioural difficulties and osteoporosis – is important as this gives an alternative avenue for intervention. The focus of this paper will be on the gynaecological aspects of young women with significant disabilities, rather than those with mild disabilities.