The Role of the Gynecologic Exam
In this issue of the “Reviews and Reports”, Dr. Shobin discusses the risk/benefit analysis that should be applied to the decision of whether annual PAP and pelvic exams are appropriate for all individuals with intellectual disabilities. This is a difficult topic as contending issues of discomfort and trauma of the exam must be balanced against general population recommendations and personalized care and, frequently, an unreliable sexual history. The most difficult patient with whom one would want this dialogue is often the patient who has the most severe cognitive deficit and doesn’t understand the benefits but clearly perceives the invasion and discomfort. In the past, these issues have been used as excuses to not perform a necessary exam, but this is clearly not optimal medical care. Using the recommendations of the American College of Obstetrics and Gynecology and assessing for risk factors is a good place to start. Dr. Shobin provides an experienced clinician’s perspective on this difficult task and distinguishes the approach based on whether the exam is for cancer screening or is problem-oriented.
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