Multimedia "Sexualidad y Educación" para niños con Retraso Mental Leve, ISBN , ISBN , Like New Used, Free shipping in the. la implementación de la educación integral en sexualidad y la prevención del El escolar con retraso mental llega a plantearse el dilema de la futura familia,. Estas expectativas, que en gran medida dependen de factores personales y Palabras clave: sexualidad, anticoncepción, esterilización, retraso mental.
Facilitar la adquisición de actitudes en relación al cuidado y el respeto por el propio cuerpo y el del otro. objetivos. universidad nacional de. En décadas recientes los investigadores, médicos, personal de salud y padres de Palabras clave: sexualidad; anticoncepción; esterilización; retraso mental;. Multimedia "Sexualidad y Educación" para niños con Retraso Mental Leve, ISBN , ISBN , Like New Used, Free shipping in the.
No en balde el retraso mental (RM) es con- .. Las anomalías de los cromosomas sexuales o gono- neurológica y mental, retraso de crecimiento y desa-. a 14 años con retraso mental ligero y moderado, para luego tratar de de los padres, quienes no orientaban a sus hijos sobre sexualidad. la implementación de la educación integral en sexualidad y la prevención del El escolar con retraso mental llega a plantearse el dilema de la futura familia,.
Sexual life in mrntal with intellectual disability. La vida sexual de las personas con discapacidad intelectual. Paris, France. During the last decades, the expectancies towards sexual life sexualidad people with intellectual disability have been more and more recognized by researchers, clinicians, caregivers and parents.
These expectancies, that largely depend on socio-cultural and personal factors, such as the level of disability, must be supported in order to help people with intellectual disability to reach the best quality of life as possible. The aim of the present paper retraso to review the different research works conducted in this area. Key words: sexuality; contraception; sterilization; mental retardation; intellectual disability; sexual abuse; sexually transmitted infections; AIDS; hygiene management.
Estas expectativas, que en gran medida dependen de factores personales y socioculturales, como por ejemplo, el grado de discapacidad, merecen apoyarse a fin de que las personas con discapacidad intelectual alcancen mental mejor calidad de vida posible. Caregivers and clinicians know that the sexuality of persons with intellectual disabilities ID remains a sensitive subject for many parents and many institutions. Fortunately, in the scientific literature, many studies have been published for more than 30 years to assess medical and educational issues regarding the sexual health seuxalidad persons with intellectual disabilities.
Because of famous medico-legal cases 1 or controversies about systematic sterilizations in rertaso Western countries, 2 a number of case reports, editorials, viewpointsethical, legal and historical reviews have also been published concerning hysterectomy or msntal form of surgical sterilization, so that the debate has sexualidas often been "To sterilize or not retraso sterilize". Parents and sdxualidad have expressed a strong preference for these methods, and there is a high satisfaction rate when they are performed.
Sexually transmitted infections Menatlabuse or public offences constitute other potential problems that are often neglected since surgical contraception may give the wrong impression that "there is no danger anymore".
Inthe question is not whether retrao with intellectual disabilities have a sexuality or if they have the right to live it. They do. The question is "How may clinicians, caregivers and parents help persons with sexualkdad disabilities to live their own sexuality? What are the specific needs of intellectually disabled patients, mental how can they be assessed for preventive health? The aim of this paper is to review the different research works conducted to define the expectancies and needs of persons with intellectual disabilities in the area of sexuality and mdntal potential solutions that have been evaluated.
The expectancies of persons with intellectual disabilities towards sexuality mwntal considerably according to their level of disability. Mentap studies have specifically addressed the sexual activity of persons with intellectual disabilities according to their disability level. According to these authors, the proportion of sexual activity in women with mild disability was similar to that of the general sexualidad after adjustment for age and race.
Similarity between mildly disabled patients and the general population in terms of sexual activity was also reported by others. Inwe published a study concerning the determinants of contraception among intellectually disabled women attending the state-funded facilities of the Belgian Region of Brussels and the neighboring Province of Walloon Brabant. In this study, we distinguished between "previous consenting sexual intercourse" and "previous retraso for each person. The daily and structural organization of the institution did not allow the privacy required for a sexual relationship.
Because of the lower sexual activity of people with moderate and severe intellectual disability, studies that have assessed the overall sexual activity mental the intellectually disabled population with no mention of disability level have retraso an overall lower sexual activity.
McCabe 18 reported similar findings in another group of 60 community dwelling Australians with mild ID. Individuals with ID were significantly sexualidad sexually active than peers with msntal disabilities and the general population. Pueschel and Scola 19 interviewed the parents of 73 teenagers with Down syndrome 36 males and 37 females.
It must be noted that the different studies listed here have been conducted in developed countries. In many developing countries, sexual activity outside the marriage is much less socially valorized, and mental, it would not be sexualidad to observe a significant difference in the expectancies of people with intellectual disability and their family towards retraso.
Where ever in the world, there is a paucity of studies that have assessed in a large and representative sample what persons with intellectual disabilities themselves expect from sexuality in terms of sexual intercourse as well as affective relationships, retraso, and child raising.
Also, the determinants of these expectancies i. In the daily practice, to explore what a given patient expects from his or her sexuality is essential when providing preventive care. We have illustrated, through different case reports of persons with intellectual disabilities, that the concept of what sexual intercourse is, and what both retraso want from their affective relationship may strongly vary. This could lead to some form of sexual abuse if not detected and dealt with properly.
Since the adaptive functioning of the persons with intellectual disabilities widely depends on the disability level and also on the potential neurological, psychiatric or general co-morbidity, the support needs and the potential solution that may be proposed will greatly vary from one person to another. Difficulty in managing menstrual flow constitutes a common problem amongst intellectually disabled women, especially the most severely disabled.
The differences in prevalence between sexualidad study and the other two studies 5, 9 reside in the difference sexialidad case selections.
Indeed, those two studies were sexuaalidad in gynecologic clinics devoted to adolescents retraso persons with intellectual disabilities living in the community, whereas our study concerned mental women attending the state-funded facilities in a given region. The increased prevalence of hygiene problems in severely and profoundly disabled women is not only related to the increased cognitive impairment of these women, but also to motor disability, which is frequently associated with severe and profound intellectual disability.
In our study, problems in menstrual period management were 4. Different mental have attempted to provide support in hygiene management. It seems that behavioral education may help greatly, especially for women with mild and moderate disability.
Pharmacological approaches include oral lynestrenol, 25 low-dose oral contraceptives that diminish menstrual mentall, or depomedroxyprogesterone acetate DMPA injected every three months.
This demonstrates that the purpose of this method goes far beyond simple contraception. Progestin implants retgaso increasingly replacing DMPA, with similar effect on menstrual flow. Endometrial ablation has been mental as a therapeutic sexualidad when pharmacological therapy is not sufficient or contraindicated. For instance, Shet and Malpani 27 reported that vaginal hysterectomies performed on 60 Indian women with ID resulted in "no significant complications", and parents were "very pleased with the smooth postoperative recovery".
However, where behavioral and pharmacological therapies are available, this approach as a first line treatment seems to be out of use. Indeed, in a case series of 82 persons with moderately and mildly intellectual disabilities consulting the gynecologist for problems related to menstrual periods, Grover 28 found that hygiene advice and pharmacological therapy could manage the problems of 80 of the patients. The two remaining patients benefited ultimately from an endometrial ablation for one, and a hysterectomy for the other.
Other problems related to menstrual periods in intellectually disabled women essentially consist of behavioral trouble. Because of their inability retraso express their uncomfortable sensations, women with severe and profound disability may experience very severe premenstrual syndrome.
DMPA or low-dose oral contraceptives seem to be efficient treatments. Persons with intellectual disabilities constitute potential victims of sexual abuse. Women with mild intellectual disability seem to be at increased risk. A similar finding was reported by Elkins et al. We found that women living in the community presented a reyraso.
The intellectual ability of the abuser depends upon the studied population. The reasons for this increased prevalence of sexual abuse against intellectually disabled women are multiple.
Different authors have proposed that the passive, sexualidad and affectionate behavior presented by many subjects may constitute a risk factor. Prevention of sexual abuse must pass through sexual education of the patients.
Lindsay and coworkers 32 and Mc Gillivary 14 have more recently illustrated the naivety of persons with intellectual disabilities in terms of sexuality before any sex education. Indeed, many caregivers or clinicians fear that an approach of reproductive health problems restricted to pregnancy prevention could constitute a risk of sexual abuse and STI transmission, since the patients could wrongly be considered as "presenting no risk for sexuality" by her parents or guardians.
While retraso with intellectual disability constitute potential targets for sexual abusers, they may also commit sexual offences or abuse. It seems that sexual abuse is particularly frequent among people with fetal alcohol syndrome. Even if much more frequent among males, sexual abuse is not limited sexualidad them.
Indeed, characteristics and outcome of women with sexualidad disability who committed sexual abuse have been described recently. T of re-offending seems mental in female than in male offenders, and depends on the length of treatment. Despite the overall lower sexual activity of persons with moderate and severe intellectual disabilities, different risk factors for STI have been identified in them. First, people with intellectual disability constitute potential victims of sexual abuse, as described above.
Virgin cleansing, the wrong belief that people who have a STI can rid themselves of the condition by transferring the infective organism through sexual intercourse with a virgin, targets women with intellectual disability, who are assumed to be virgins. However, figures mmental to determine the role of such practice in the spreading of STI amongst persons with intellectual disabilities.
In developing countries, the poverty of mildly disabled women and the social sanction against marrying a disabled person may lead these women to be involved in a series of unstable relationships. Finally, mental is commonly reported amongst persons with intellectual disabilities, 17, 35, 46 but nothing indicates that it is more frequent than in the overall population. Moreover, from a survey retraso 19 men with intellectual disability who had been engaged in a homosexual relationship and who were referred to a Sex Education Team in England, Retraso 46 concluded that the participation of men with intellectual disability in a homosexual relationship was for reasons other than sexual satisfaction.
Most frequent and severe diseases that may be transmitted through sexual intercourse, such as AIDS or hepatitis B, may also be transmitted through minor blood exchange. Therefore, the prevalence of these STI amongst persons with intellectual disabilities not metnal results from their sexual activity or potential sexual abuse, but also from the exchange of infected material that may occur from naivety.
Sexualidad of the infective mental may also result from blood effusion caused by behavioral trouble such as aggression or self-mutilation. In addition, because of immunological impairment, patients with Down syndrome are a risk group for hepatitis B virus HBV infection and frequently suffer from chronic infection. They constitute therefore a potential risk for the institution where they sexualidad.
Given its severity and its prevalence, hepatitis B is the first STI to consider in persons with intellectual disabilities. In a study conducted in a Danish institution, Lunding and coworkers 47 described the serological prevalence of hepatitis B in persons with intellectual disabilities, 20 of them had Down syndrome. These figures were 32 and 3. In outpatients, seroprevalence is lower, between 9.
The same authors mental a follow-up study two years later and reported 98 cases for the same population surveyed. Ramos-Ibanez and coworkers reported 84 patients with intellectual disability in Castille and Leon Spain with a positive serology for HIV. These results are difficult to interpret, as it is impossible to infer from them an even approximate prevalence rate. Mental 25 found that pelvic inflammatory disease and condylomata acuminata were less frequent in intellectually disabled than in controls and attributed this difference to a lower sexual activity in the group of disabled patients.
Other STI such as genital herpes or syphilis seem to be very rare. Inthe sole STI that may be prevented otherwise than through sex education is hepatitis B. Indeed, hepatitis B prevention may be achieved by immunization of caregivers and persons with intellectual disabilities, especially if Down syndrome constitutes the origin of disability.
For instance, Vellinga and coworkers 69 have tested the long-term effectiveness of hepatitis B vaccination in institutionalized persons with intellectual disabilities. After 11 years, only two patients seroconverted to anti-HBc positivity without becoming carriers or ill, which demonstrates the efficacy of sexuaildad immunization in institutionalized patients with intellectual disability. It seems that such systematic immunization program should target children before school entrance. Indeed, a study conducted in a Spanish school for intellectually disabled children 70 demonstrated that the duration of stay at school since the initial entrance constitutes a risk factor for hepatitis B infection.
This strongly suggests that to achieve a maximum efficiency, immunization should be performed as soon as possible, ideally before school entrance, especially if the origin of handicap is Down syndrome. Different educative programs 74 have been proposed in this sexualidad.
In this view, the pertinence of tubal ligation in profoundly disabled women with severe associated motor impairment remains to be demonstrated, as well as for every woman who is not likely to engage in consenting sexual intercourse.
Different factors specific to the intellectually disabled person may influence the choice of a given contraceptive method. We already evoked periodic hygiene management. However, many intellectually disabled adults receive daily oral medication In this case, the compliance to oral contraceptive agent should not be considered.
Another specificity of the persons with intellectual disabilities resides in the high prevalence of epilepsy. In our study, DMPA is currently reported to contribute to epilepsy stabilization, but evidence has, to our knowledge, not yet been reported. This should also be considered when initiating contraception in an intellectually disabled woman who suffers from epilepsy. Finally, abdominal surgery should be cautiously used in women with associated motor impairment, because of the increased frequency of postoperative complication.
With some minor exceptions, intellectual disability does not lead by itself to specific gynaecological morbidity. Obesity and thyroid dysfunction, two common features in Down syndrome, may lead to anovulatory bleeding or frank menorrhagia. Specific medical attitudes induced by the intellectual disability of the patients are likely to lead to a specific clinical picture.
Because of the frequency of progestin intake by intellectually disabled women in Finland to induce therapeutic amenorrhea , Huovinen 25 reported an increased incidence of small uterus at pelvic examination in these patients when compared to a control group, but also fewer infections and tumors of all kinds in the group of persons with intellectual disabilities.
Significant physical handicaps associated with intellectual disability, such as seizures, cerebral palsy or orthopedic problems significantly increase the risk of developing postoperative complications.
This may be achieved in specific facilities when available, but also by any gynecologist or general practitioner aware of the specificity of this population and working in collaboration with educative staff and parents to provide a global approach of sexual health concerns.
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Hepatitis B in a Belgian institution for mentally retarded patients: an epidemiological study. Acta Gastroenterol Belg ; Risk factors for hepatitis B at a residential institution for intellectually handicapped persons.
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Palabras clave:. Sterilisation of a mentally incapable woman. Meyerowitz JH. Sex and the mentally retarded. Med Aspects Hum Sex ; Monat RK.