Do any of us really enjoy visiting a gynecologist?

If you are an OB/GYN, here are 6 things you need to know:

1.  You will have patients on the autism spectrum.

People with disabilities may vary in challenges and characteristics, but we all still participate in the basic stages of human development: physical and sexual. Basically, it means people with disabilities (including autism) are capable of developing sexual desires, act on sexual needs, become sexually active, and getting pregnant.  It also means people with disabilities can develop menstrual issues, fertility issues, STDs/STIs, menopause, cervical cancer, ovarian cancer, and genital-related infections.  So individuals with disabilities need to be attentive to their physical and sexual health just as much as other people do.

Most medical professionals are aware of this. But once in a while I’ll run into a medical professional who isn’t as knowlegable about the sexuality component in people with developmental disabilities.

When it comes to discussing birth control options and STD protection, it’s important that you remain considerate of any concerns your patient expresses in particular methods.  Sensory issues play a significant role in autism, and different people on the spectrum will vary in their tolerances in utilizing the available methods.  For instance, condoms are extremely difficult to use for some people with ASD due to the texture, feel, and odor of the material (latex, synthetic, or lambskin).  You will also want to document any known allergic reactions (latex, oils, lubricant ingredients, hormone, spermicide, etc.).  Once you are aware of the sensory issues and known allergies your patient has, it will be easier for you to make recommendations based on their needs.

Unless there is a specific unrelated fertility issue, people on the autism spectrum have the capability to become pregnant and bear children. Although not everyone will be able to develop the skills required in parenting and raising a family, there are plenty of us who have that capability to raise a family if we so choose.  Therefore, if a patient expresses desire to become pregnant and go though pregnancy, it is important you respond to their desires with respect and dignity.

2. Accommodations are essential. Period.

In the United States, the American with Disabilities Act states the requirements of public accommodations for individuals with disabilities (as pointed out in the ADA Title III).  Although these requirements apply to people with any type of disability, the document focuses more on accommodations for people with mobility disabilities.  As a result, medical professionals in the health care industry may not even be aware that people with ASDs and developmental disabilities require accommodations, too.  So the concept of having to make accommodations for patients with ASD might be new to an OB/GYN, since an OB/GYN do not typically cover disability and sexuality in their licencing requirements.  People with developmental disabilities may not require structural accommodations (such as ramps, elevators and wider entryways).  But these people still need accommodations.  Lighting, temperature, paint color on the walls, sound level, sound frequency, and furniture textures inside a clinic can strongly affect an autistic person.

Re-vamping your entire clinic or office space may rack up some costs and effort.  But you can see this as benefiting all of your patients… allowing them to take in the relaxing effects of ASD-friendly accommodations.  It will be sure to entice most anyone who walks into your clinic, and that’s well-worth the money (and the growth of your business).

You can… 

• Place a tropical fish tank in the waiting room.

• Use light fixtures with incandescent light bulbs instead of fluorescent tube bulbs.  A number of individuals (myself included) consider fluorescent lights to be a visual and auditory violation, which can increase anxiety.

• Have music playing at a low volume in the background.

• Monitor the thermostat to an average temperature range of comfort (not too cold or too hot). Be sure to ask your patient if the temperature setting is comfortable for them.

• Lower the ringer volume level of office telephones, or place the phones on vibration mode.

• Provide a weighted blanket or throw if the patient is sensitive to colder temperatures (which office environments often are). Weighted blankets also really help with providing applied pressure that autistic individuals often use for sensory input or reducing stress levels.

• Have pillows available if the patient expresses discomfort on the exam table.

Prior to the first appointment

If you make major aesthetic changes to your clinic in between their introductory visit and the date of the appointment, let your patient know in advance so they will know what to expect when they walk in.

When the time comes to schedule an appointment, allow a longer time frame than typical appointment times.  If a typical appointment lasts an hour, schedule for an hour and a half (two hours if necessary).  People with ASD often need additional time to process the information that you provide them, responses to your questions, and preparing for the procedures or exams being given.  Some people may also need additional time to exchange communication with you, your nurses and your staff (via an accompanying interpreter or alternative communication device).

On date of appointment, before the exam or procedure

Before any procedure or exam, establish a “code” word or non-verbal indicator that your patient can use at any point that they want to stop or take a break.  This will provide reassurance to your patient that they are in a safe place and still gives your patient a sense of self-control.  People with ASD need to establish self-control in order to feel safe.  And in order for any visit with an OB/GYN to work, the patient needs to feel safe.

During the exam or procedure

OB/GYNs usually do a good job with alerting patients the steps of a procedure they may be performing.  It’s especially crucial you communicate with your ASD patient every step you are about to take in a given exam.  An example you may give to a female patient during a pap test: “We will now be inserting an instrument called a speculum to open up the vagina.  This instrument is made of metal (or plastic), and you may feel the muscles in that area stretching.  This is being done so it will be easier for me to be able to see if your cervix, ovaries, uterus and vagina look normal.  Now you will feel a slight pinch.  This should not hurt. I am simply using a cotton swab to collect cells so we can test them in the lab to make sure your cells are healthy.”

After the exam or procedure

If test results are not available on the day of the appointment, you will want to provide clear written step-by-step instructions on how your patient can obtain their results.  You will also want to let your patient know of any possible side effects, discomfort or sensations that may be felt inside the body following an exam or procedure (as explained earlier).

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