6 Things an OB/GYN Needs to Know When Taking Care of a Patient with ASD

4. Visual or data-based communication and resources are helpful… VERY helpful.

People with ASD often rely on visuals and data for learning and processing information.  This includes processing sexuality education and the various procedures that take place on an OB/GYN’s office.  Provide your patient with brochures, links, and other resources you may have in your fingertips of the procedure or exam your patient would be coming in for.  Do this during their initial introduction visit, prior to the first scheduled office visit.

When discussing birth control options with your patient, provide brochures and descriptions with precise drawings, photos, diagrams and comparison charts for your patient to take home and process to make their decision making easier.  For instance, with pap tests, you can present material that falls something along the lines of this example or this example.

Here are a few other examples to help you get a better idea of what you can present to your patient:

Birth Control Tool (contains a customizable comparison table) | Association of Reproductive Health Professionals

STD Brochures – The Facts (contains downloadible PDF files) | Centers for Disease Control

Pelvic ultrasounds | Web MD (see page 3 of that article for drawing diagrams of the various ultrasound procedures)

5. Maintaining a professional persona will ensure less anxiety. Keep your personal emotions to yourself.

Over the years, I have visited several OB/GYN offices… most which were not pleasant, but still well-handled.  But one particular visit with an OB/GYN turned out to be an especially distressing experience.  This particular doctor (and the clinic) broke a number of accommodation rules.  Her tone of voice lacked a sense of calm, and she raised her voice when expressing surprise or disagreement.  She interrupted me several times during our consultation. Her facial expressions were hauntingly dramatic.  And the worse part of that experience is when she pulled out the ‘God Card’ — stating that “you cannot trust a man (even when you’re in a solid committed relationship) to go out and cheat on you and possibly give you an STD… but once you’re legally married, a condom is no longer necessary and it’s up to him and God.”

Oh, really?  And a partner is not as likely to cheat when you’re married as when you’re not married?  Bullshit.  (I wish I had responded all that to my doctor had I processed my thoughts fast enough.)

Obviously, I have no plans to return to that particular clinic.  One’s personal views and religious beliefs are to be fully respected.  But it is beyond inappropriate to bring that into any professional relationship, including a doctor’s office visit.

So please keep in mind…

  • Facial expressions can still be defined (happiness, concern, etc.) but try not to be too dramatic in your facial expressions.  The complexity of dynamic facial expressions often distracts a person with ASD, and may prove intimidating to your patient.
  • Be aware of your tone of voice. People with ASD respond best with a tone of voice which is calm, professional, and not overly fluctuating.
  • Take caution on using humor or “small talk” with your patient,  as this often will bring more discomfort and escalate their anxiety level. When in doubt, it’s best to avoid it altogether.
  • If a patient shares information which brings you concern (i.e. your patient is sexually active and does not use protection, your patient has experienced sexual trauma, or you patient is not following all the steps for efficient prenatal care), handle it professionally.  It is perfectly appropriate to address your concerns and safety recommendations based on facts (i.e. unprotected sex increases the risk of contracting STDs, STIs and unwanted pregnancy).  But avoid imposing these concerns based on your personal beliefs.

Keep your personal emotions to yourself, and the interaction between you and your patient will flow more smoothly.

6. Treat your patient with ASD like you would your other patients. Treat fairly.

Just as your other patients have a right to be informed and make their own choices, autistic individuals also have that right.

The American with Disabilities Act prohibits discrimination against access to medical services on the basis of disability.  So it’s important to provide your ASD patient with the same amount of access to medical care as you would your other patients.  Allow your patient to fill out the same paperwork (including health history). Converse with your patient without withholding information (even if you assume it might be irrelevant).  Provide your patient with the same range of choices in birth control methods. Provide them with sufficient sexuality information they may request. And most importantly, allow your patient to make their own decisions.  Just as your other patients have a right to be informed and make their own choices, autistic individuals also have that right.

For additional insight on this topic, I highly recommend checking these out:

Sex & the Spectrum: Autism and Gynaecological Health by Nominatissima

Interactive site for clinicians serving women with disabilities (contains a recorded slideshow program:“Reproductive Health for Women with Disabilities”,  which focuses on both physical and developmental)

Gynecologic Care of Women with Developmental Disabilities and Other Special Needs

Fellow self-advocates:  please feel free to share thoughts in the comments on
what you would like OB/GYNs to know about caring for patients on the autism spectrum.

Image credits: The Doctr, Jeffrey Beall, Vagabond Shutterbug, Raychel MendezAnn64

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5 Comments

  1. Laura
    Posted September 26, 2011 at 8:23 PM | Permalink

    Seeing the OBGYN is my biggest concern for when I start having sex. I have bookmarked this post to show to my doctor when this happens. The only comment I have is in regard to the weighted blankets – I have an aversion to specifically weighted accessories due to a negative experience with weighted vests during childhood OT sessions, and would prefer simply having a heavy quilt around, or bringing my own sweatshirt like I do to movie theaters, on the rare occasion I go.

  2. katie
    Posted September 26, 2011 at 9:21 PM | Permalink

    God, the small talk. That’s the absolute worst part. Like I want to talk about my school or my job or my last fucking vacation while you’re sticking things up me. Small talk is bad enough in everyday life but at the dentist, or getting your blood drawn or getting a pelvic exam is the absolute worst time! I’m trying to go off in my own little world and you keep dragging me back here to tell you about any movies I’ve seem lately? But typically I feel to vulnerable to say “I don’t like small talk” while she’s doing it, and I always forget before hand.

  3. Posted September 27, 2011 at 12:27 AM | Permalink

    This needs to go out to every gynecology practice & should be required reading for all aspiring gynecologists.

  4. Posted February 27, 2015 at 8:06 AM | Permalink

    I really like your tip on establishing a safe word between the doctor and the patient. This way I know that whatever happens, I’m in control, and I will feel a lot more comfortable and safe. I’ll have to talk to my doctor and see if we can establish a safe word together.

  5. Liz
    Posted January 14, 2016 at 1:35 PM | Permalink

    Right before I went under to have an abnormal growth removed from my uterus I was clarifying what I would eat afterwards (I have dietary restrictions and cannot eat hospital food) and the surgeon patted me on the leg and said to not worry, just trust her and the other people, they know what they are doing. My anxiety went through the roof. I want reasoning and communication, this is not faith healing.
    Last year I had a surgery done on my hand in Costa Rica. The medical system is totally different there. At every step they explained everything with total bluntness, including risks. When we schedule the surgery, the surgeon said while showing me on his hand, “I will cut from here to here and detach two ligaments and a vein, remove the tumor, then sew it back up. You will have a nerve block put in your arm here that will totally numb your arm for 24 hours. My fee is $2,000 and the hospital will charge you around $1,000, 20% of these come back.” I totally relaxed and was so much happier. Getting information in detail out of medical people here is like pulling teeth. When I talked to the anesthesiologist he told me he wanted to give me a benzo to help me relax, I asked if I could have something else, and he said, “Of course, whatever you want and no sedative is fine.” Because I have trouble being still we settled on low dose propofol and I was totally aware, but still. I can’t even imagine being treated like that here. Stimming is not a good thing during hand surgery.
    I have no intention of getting medical care in the US again if I can avoid it, I would rather hop on a plane. The Gynecologist visit was like he had just read your essay. As soon as I told him that the more I know the more I relax, he gave me every detail ahead of time. The office was quiet and calm. This was private care paid for with cash and with my high deductible my out of pocket was lower than getting care here.

    I feel like medical care in the USA is oriented toward a totally different kind of person. It treated like religion and any questioning is discouraged.

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