Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework.

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Sexual and Reproductive Health Care for Women with Intellectual Disabilities: A Primary Care Perspective

Background Attitudes to the sexual expression of adults with an intellectual disability (ID) are one reflection of the inclusiveness of a community. Our capacity to measure attitudes towards this important aspect of adult life is limited by the lack of an appropriate instrument. The aim of this study was to continue the development of a recently published questionnaire and to establish normative data. 

Method The Attitudes to Sexuality Questionnaire (Individuals with an Intellectual Disability) (ASQ-ID: Cuskelly & Bryde, 2004) was modified slightly and questions about hypothesised stereotypical views of sexuality were added. A community sample of 261 adults completed this modified questionnaire, as well as a shorter version of the questionnaire about attitudes to sexual expression in typically developing adults. 

Results Factor analysis revealed one general factor associated with sexual rights, plus three other factors related to parenting, non-reproductive sexual behaviour, and self-control. There were few differences in attitudes towards male and female sexuality, and attitudes were only slightly less positive for individuals with an ID than for those without a disability. Views about parenting by people with an ID were more cautious than for other aspects of sexuality. 

Conclusions The present study established the factor structure of an instrument for measuring attitudes towards the sexual expression of adults with an ID and provided normative data. Community attitudes towards the sexual rights of adults with an ID are generally quite positive.

Attitudes to Sexuality Questionnaire (Individuals with an Intellectual Disability): Scale development and community norms

The impact of sexual abuse among those with an intellectual disability is an area in need of further research. The current article provides an in-depth narrative review of the sexual abuse literature relevant to individuals with an intellectual disability. The 29 articles included in this study focused on (a) the prevalence of sexual abuse, (b) the risk factors associated with this population, and (c) the psychological impact of abuse. The findings confirmed that children and adults with an intellectual disability are at a higher risk of sexual abuse than nondisabled peers. Research regarding risk factors is equivocal, with a range of possible factors indicated. Similarly, evidence suggests that there is no single diagnostic trajectory when dealing with the sequelae of sexual abuse among those with an intellectual disability. The article concludes by discussing recommendations for future research and development of policy around this area.

Prevalence and psychological sequelae of sexual abuse among individuals with an intellectual disability: A review of the recent literature.

What difficulties are experienced by caregivers in relation to the sexuality of people with intellectual disabilities? A qualitative meta-synthesis.

Objective Our objectives were to describe the general fertility rate (GFR) and age-specific fertility rates (ASFRs) of women with intellectual and developmental disabilities (IDD) and the social and health characteristics of those with a singleton live birth, and to compare these to women without IDD. Methods In this population-based retrospective cohort study using linked Ontario health and social services administrative data, we identified 18- to 49-year-old women with IDD (N = 21 181) and without IDD (N = 990 776). The GFR and ASFRs (2009) were calculated for both groups and compared using rate ratios (RR) and 95% confidence intervals (CI). Among women with a singleton live birth (N = 423 with, N=42 439 without IDD), social and health characteristics were compared using Pearson's Chi square tests. Results The GFR in women with IDD (20.3 per 1000) was lower than that in women without IDD (43.4 per 1000) (RR 0.47; 95% CI 0.43 to 0.51). ASFRs in 18- to 24-year-olds were similar in both groups. Among women with a singleton live birth, those with IDD were younger and had higher rates of poverty, epilepsy, obesity, and mental health issues. They also had high rates of medication use during pregnancy. Conclusion In the largest study of fertility in women with IDD to date, we found that ASFRs are similar in young women with and without IDD. Women with IDD with a singleton live birth experience significant social and health disparities during pregnancy. These findings suggest the need to develop services to support the reproductive health of this vulnerable group.

https://www.jogc.com/article/S1701-2163(15)00005-5/pdf

Pregnancy in Women With Intellectual and Developmental Disabilities.

Purpose of reviewThe current review attempts to summarize the current status of our knowledge and clinical practice in the complex and challenging area of relationships and sexuality for people with an intellectual disability.Recent findingsAlthough there has been an ideological shift within service

Relationships, sexuality and decision-making capacity in people with an intellectual disability.

The COVID-19 pandemic and the resulting restrictions placed upon society have had a profound impact on both physical and mental health, particularly for young people.The current study assesses the impact of COVID-19 on student mental health.Four hundred and thirty four first year Undergraduate students completed a battery of self-report questionnaires (PHQ-P, GAD-7 and SAS-SV) to assess for depression, anxiety and mobile phone addiction respectively with data being collected over a 2 year period. The data from each year was compared (216 and 218 students respectively).A MANOVA revealed that COVID-19 had a significant impact on self-reported levels of depression, anxiety and smartphone addiction-which all significantly increased from the 2020 to the 2021 group. The percentage of students who had a score which warranted a classification of clinical depression increased from 30 to 44%, and for anxiety increased from 22 to 27%-those students who showed a comorbidity across the two rose from 12 to 21%. Smartphone addiction levels rose from 39 to 50%. Correlational analysis showed a significant relationship between Smartphone usage and depression and anxiety.This research suggests that COVID-19 has had a major impact upon student mental health, and smartphone addiction. The importance of identifying predictive factors of depression and anxiety is emphasised, and suggestions for intervention are discussed. 

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Austin A. Bayley

Papers

Relationships, sexuality and decision-making capacity in people with an intellectual disability.

Effects of the COVID-19 lockdown on mental health in a UK student sample