Sexuality and contraceptive options in young people with cognitive disability: a comparative study
ESC Congress Library. Nunes F. May 28, 2014; 50487; A-071
Dr. Filipa Nunes
Dr. Filipa Nunes
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Objectives: characterize and evaluate the multiple components of a specific gynecology appointment for patients with cognitive disability and compare the reason for medical appointment, sexual activity and contraceptive methods (their complications and compliance) with young people without cognitive impairment. This study can contribute to improve the reproductive health of this population.

Method:  A retrospective case-control study was conducted by consulting the medical information of patients aged ≤ 20 years old: 201 patients with cognitive disability (group A) and 206 patients without cognitive impairment (group B). The statistical analysis was performed with IBM SPSS statistics 20.0.

Results: In group A, there was a mild cognitive impairment in 29.4%, moderate in 38.8% and severe in 31.8%. The mean age was 14.1 years in group A and 16.0 in group B (p<0.001). The need for contraception was one of the reasons for appointment in 47.3% in group A and 33.0% in group B (p=0.003). In group A, 4.7% were sexually active and 60.2% in group B (p<0.001). Contraception was prescribed in 79.6% of the cases in group A and 80.1% in group B (p=0.901). There was a significant statistical difference between the contraceptive method in both groups (p=0.007).  In group A, 82.5% used oral estroprogestative (EP), 10.6% subcutaneous progestative (P), 6.3% transdermal EP and 0.6% tubal ligation.  In group B, 91.5% used oral EP, 5.5% subcutaneous P, 1.8% vaginal EP, 0.6% transdermal EP and 0.6% intrauterine device. There was a poor compliance with the contraceptive method in 5.0% in group A and 6.1% in group B (p=0.704), and a 10.9% complication rate in A vs. 12.2% in B (p=0.755). There were no registered pregnancies in group A and 4.9% in group B (p=0.002).

Conclusions: According to these results, one can conclude that in the group of the patients with cognitive disability, despite an earlier age on the first appointment and a lower rate of sexual activity, the need for contraception has a prominent position and contraception was prescribed in 79.6% of the cases. In both groups, the most common contraceptive method was oral EP. However, within the cognitively impaired patients, there is a larger percentage of non-user-dependent methods. Given all this particular features, it is of paramount importance to offer a specific medical appointment for young patients with disability.

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