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Question:
I am a case manager in an
ICF-MR facility for people with
profound mental retardation.
Almost the consumers are
non-ambulatory and almost all are
non-verbal. I have just been
informed by our RN that we will
not be sending them for Pap
smears because "the risks of the
pap smear outweigh the benefits
and all of the women would have to
be given a general anesthetic." I
disagree with this but I have no
medical information from a doctor
or nurse in the field of disability to
support my objection. I would like
to know if you feel it is important
for all woman to have a pap smear.
Thank you
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Answer:
by Susan Ludwig: ()
I was so glad to receive your
question about pap smears and
women with disabilities. I am so
glad that you recognize the relative
benefit of sexual health assessment
for all women -- especially those
who are most vulnerable! Your
instincts are correct.
According to the cancer society, all
women who are over the age of 19
need to have a pap smear. (earlier
if they become sexually active).
While it may seem unlikely that
these women are sexually active,
one must not make assumptions!
There have been instances where
women who have been
non-ambulatory and non-verbal
have become pregnant and their
care providers were completely
unaware that they were sexually
active!
As for giving these women a
general anaesthetic -- I am
flabbergasted! The woman needs
good support, to be semi-reclining
so she can see her examiner, and
needs an opportunity to become
comfortable in her environment,
and MAY need a mild sedative --
but should not be anaesthetized!
That would make a pap smear
pretty risky! This is a part of the
woman's health care. Any woman
can have some teaching done and
can be well supported in the
procedure and can tolerate the
procedure well! The benefits can
far outweigh the risks!
Remember, that the more isolated
a woman is -- the more vulnerable
she is to sexual predators! Every
woman needs a pap smear --
beginning with annually and then
after a couple of normal results it
may be switched to every two or
three years (the Cancer Society has
recommendations). I would also
suggest that she be tested for STD's
-- especially if she is non-verbal and
unable to report sexual abuse.
I hope you can stand your ground!
Your instincts are great, and I
would love to hear that every
woman that is under your care is
getting regular sexual health
assessments as recommended by
the Cancer Society!
Please write again if you need any
further information! There is an
excellent document that has been
prepared by the government of
British Columbia about sexual abuse
and people with developmental
disabilities -- citing how vulnerable
they are! We can arrange to get a
copy to you!
Sincerely,
Susan LudwigReviewed by: Kathleen VanKirk DHS
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