Addressing sexual and reproductive health in adolescents and young adults with intellectual and developmental disabilities.

PURPOSE OF REVIEW: This review provides support for promoting the sexual health of adolescents and young adults with developmental disabilities, and particularly those with intellectual disabilities. It offers guidance for pediatricians on incorporating counseling on sexuality and reproductive healthcare, socially appropriate behavior, and sexual abuse prevention for adolescents and young adults with developmental disabilities into healthcare visits. Additionally, it provides resources for developmentally appropriate sexuality education in the home and community to allow access to the comprehensive sexual and reproductive healthcare patients deserve. RECENT FINDINGS: Adolescents and young adults with developmental disabilities often do not receive developmentally appropriate sexual health education, and this is associated with poor sexual health outcomes and increased rates of sexual abuse in this population. SUMMARY: Pediatricians should discuss sexual health with all patients, including adolescents and young adults with developmental disabilities. They are well suited to provide sexual health education and inform families about appropriate sexual health resources.

Women with cerebral palsy: A qualitative study about their experiences with sexual and reproductive health education and services.

PURPOSE: To explore the recalled experiences of women with CP regarding sexual health education and services they received. METHODS: Semi-structured interviews and focus groups were conducted at four academic tertiary hospitals with 33 adult women with CP. Templates were used to ask about four key content domains: appointment planning (including planning for a gynecologic exam), accessibility of services, experiences with providers, and recommendations for improvement. Sessions were transcribed verbatim and analyzed to generate a coding dictionary. Blinded coding was carried out for each transcript, with duplicate coding used to confirm identified themes. Iterative analysis was used to identify and consolidate coding and key themes. RESULTS: Similar barriers were discussed at the four sites, including lack of accessible exam tables, hospital staff unfamiliar with physical disabilities, and assumptions that women with CP are not sexually active. Many described the sexual education they received as brief, omitted, or mistimed. Self-advocacy was crucial, and recommended strategies ranged from pre-gynecologic exam medication to visit checklists. CONCLUSION: Reproductive health education for young women with CP is frequently inadequate. Medical professionals lack relevant knowledge and awareness; medical facilities lack necessary infrastructure. Recommendations for improvements are made.

New strategies for cervical cancer screening in adolescents.

PURPOSE OF REVIEW: This paper reviews the epidemiology and natural history of human papillomavirus (HPV) infection in young women, the development of new technologies for cervical cytology screening, proper cervical cytology sampling technique, the new Bethesda system for reporting cervical cytology findings, and several recent professional society guidelines for cervical cytology screening and management of cytologic abnormalities in adolescents. RECENT FINDINGS: Natural history studies of HPV infection in healthy young women show that infection is quite prevalent, but is generally transient. New and sensitive technologies such as HPV DNA testing and liquid-based cytology are more likely to detect cytologic abnormalities in young women who are at low risk for actual invasive cervical disease. This sensitivity potentially places adolescents at risk for increased anxiety, testing, and intervention. The multi-center ASCUS-LSIL Triage Study has shown that HPV DNA testing can be used safely to minimize intervention in many cases. SUMMARY: HPV infection is common in young women, but rarely progresses to invasive cervical disease. Providers need to inform themselves about new professional society guidelines that suggest delaying initiation of cervical cancer screening to within 3 years of onset of sexual activity. Given the idiosyncrasies of this population, the authors counsel using clinical discretion when applying these guidelines to individual teenagers. In light of the extremely low likelihood of invasive disease in this age group, providers must separate the provision of contraceptive services and sexually transmitted disease screening from requirements for cervical cancer screening.