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G YNECOLOGICAL G YNECOLOGICAL C ONSIDERATIONS IN T REATING IN T REATING W OMEN WITH W OMEN WITH P HYSICAL D ISABILITIES P HYSICAL D ISABILITIES Developed.

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Presentation on theme: "G YNECOLOGICAL G YNECOLOGICAL C ONSIDERATIONS IN T REATING IN T REATING W OMEN WITH W OMEN WITH P HYSICAL D ISABILITIES P HYSICAL D ISABILITIES Developed."— Presentation transcript:

1 G YNECOLOGICAL G YNECOLOGICAL C ONSIDERATIONS IN T REATING IN T REATING W OMEN WITH W OMEN WITH P HYSICAL D ISABILITIES P HYSICAL D ISABILITIES Developed by the Center for Research On Women with Disabilities, Baylor College of Medicine

2 Identify effects of physical disabilities on masking symptoms and creating special concerns in reproductive health. Describe factors that interfere with diagnosing STD’s in women with physical disabilities. Select special techniques for conducting pelvic examinations. List the requirements of the Americans with Disabilities Act (ADA) for medical facilities. Recognize the symptoms of physical and sexual abuse, and refer women appropriately. OBJECTIVES

3 Percentage of Women with Disabilities Compared to Overall Population U.S. Census, %

4 National Study of Women with Physical Disabilities FINDINGS 94% sexually active Equal rates of STDs 31% denied services Significantly less likely to receive exams Barriers significantly discouraging 62% abused

5 CASE STUDY Day 1 HISTORY: 24-year-old; Complete T2 SCI; Intermittent catheterization; Previous UTIs & Yeast infections EXAM: Discharge; Frequent leg spasms. TREATMENT: OTC miconazole

6 COMPLAINTS: Fever; Headache; Sweating EXAM: 160/95; 70 bpm; Bruises; Firm, tender abdomen; Elevated WBC; Few bacteria DIAGNOSIS: Urinary Tract Infection TREATMENT: Oral cotrimoxazole Day 11 CASE STUDY

7 COMPLAINTS: Fever; Headache; Sweating; Nausea; Flushing; Cold feet EXAM: 210/105; Bowel sounds absent; Firm abdomen; WBC 21K w/97% segs; Staphylococcus epi, E. Coli exam (EXAM STOPPED) DIAGNOSIS: Urosepsis TREATMENT: Klebsiella; BP elevates w/bimanual Nitroprusside drip; ceftazidime Day 15-ICU CASE STUDY

8 TREATMENT: Ampicillin; Clindamycin; Exploratory laparotomy drainage DIAGNOSIS: Acute salpingitis and tubo- ovarian abscess; Cultures grow chlamydia NOTE: Day 18 fever resolves, BP returns to 100/70 mmHg Day CASE STUDY

9 STDs in women w/SCI Factors Interfering with Diagnosis: Common symptoms absent or undetected Findings attributed to more common causes Nonspecific signs and symptoms unrecognized Delay in seeking medical attention

10 Lesion Stimulus AUTONOMIC DYSREFLEXIA

11 Symptoms Severe hypertension Pallor Piloerection Sweating AUTONOMIC DYSREFLEXIA

12 Management Education / Prevention Gentle use of speculum Local anesthetic AUTONOMIC DYSREFLEXIA

13 Treatment Remove stimulus Gentle use of speculum Local anesthetic Stop exam Reposition patient Loosen clothing Check bladder / rectum Administer short acting antihypertensive AUTONOMIC DYSREFLEXIA

14 History —menstrual and sexual Examination  Breast— i nspection and palpation  Pelvic—speculum, bimanual  Rectal Screening tests as appropriate  Mammogram  Pap Test  Vaginitis & STD’s  Fecal occult blood  Bone density Contraceptive counseling THE GYNECOLOGICAL EXAM

15 PATIENT TRANSFERS

16 EXAM POSITIONS

17

18 CONTRACEPTION General  Data scarce  Effects of hormones on disabilities Oral contraceptives  Thrombotic predisposition  Effect on coagulation markers  Benefits

19 CONTRACEPTION Depo-provera and norplant  Irregular bleeding  Decreased bone mass Barrier methods  Inconvenient  UTI IUDs  Pelvic inflammatory disease

20 MENSTRUAL MANAGEMENT Manual dexterity Transfer techniques Pharmaceutical intervention

21 DISABILITY & MENOPAUSE Premature osteoporosis

22 Decreased tissue turgot & strength Loss of skin elasticity Reduced blood supply to skin & soft tissue Vasomotor instability OTHER ISSUES

23 High prevalence among women with disabilities Longer periods of time More difficulty resolving abusive situations More likely abuse in medical settings Excuses for signs of abuse ABUSE

24 Clues from Medical History Inconsistent description Time delay Accident-prone history Suicide attempts or depression Repeated psychosomatic complaints (Adapted from Salber PR, Taliaferro, E, 1995) ABUSE

25 Clues from Medical History (cont.) Alcoholism and/or drug abuse Injuries during pregnancy Poor nutrition Other pregnancy-related problems Post-traumatic stress syndrome Disability-related abuse ABUSE

26 What To Do For Abused Patient Talk about abuse Assess degree of danger Help develop safety plan Document the incident Plan for follow-up Provide resource information HOW TO HELP

27 ADA - Examples of Disabilities Orthopedic, visual, speech and hearing impairments Cerebral palsy Epilepsy Muscular dystrophy Multiple sclerosis Cancer Heart disease Diabetes Mental retardation Psychiatric disability Specific learning disabilities Tuberculosis Past history of drug addiction and/or alcoholism

28 Guaranteed services Equal services Integrated setting Facility evaluation Accessibility modifications Administrative or eligibility criteria Practices, policies, and procedures Providers’ costs ADA REQUIREMENTS

29 IDEAL PHYSICIAN’S OFFICE Hallways and exam room able to accommodate wheelchair Adjustable-height, extra-wide padded exam table Platform scale Staff trained to assist with dressing and to be sensitive to disability issues

30 GOOD EXAMPLES

31 ADJUSTABLE HEIGHT EXAM TABLE

32 PLATFORM SCALE

33 HOPES & DREAMS

34 This CME Presentation was developed by the Center for Research on Women with Disabilities Margaret A. Nosek, PhD, Executive Director Department of Physical Medicine and Rehabilitation Baylor College of Medicine Houston, Texas With funding from the Paralyzed Veterans Association, Education and Training Foundation and the National Institute on Disability and Rehabilitation Research


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