CERVICAL CYTOLOGY IN WOMEN WITH MENTAL-RETARDATION

Objective: To examine our experience with performing pelvic examinatio n and obtaining cervical cytology in women with mental retardation. Me thods: From November 1985 to October 1992, 658 women were seen in our clinic for women with mental disabilities. A standardized clinic visit form was completed for each woman. Of these records, 574 were availab le for analysis. All charts were reviewed for data on the level of ret ardation, incidence of sedation, success in performing pelvic examinat ion and Papanicolaou smear, technique used for cervical smear, and pat hology results of the cervical cytology. Results: Of the 574 women, 28 9 (50%) had severe, 69 (12%) moderate, and 31 (5%) mild retardation. I n 185 (32%), the exact level of retardation was not established. Durin g the study period, 1235 pelvic examinations were analyzed. Within thi s group, 845 examinations could be completed initially, 177 required t he use of sedation (14%), and 213 (17%) examinations could not be comp leted. Of the 845 examinations, 706 cervical smears were available for analysis. Of these, only 243 (34%) contained endocervical cells. Two abnormal cytology results were found (0.3%). Of the 177 examinations d one with sedation, 44 women (25%) still could not be examined. Cytolog y specimen results were obtained in 124 of the examinations, and 40 (3 2%) of these specimens contained endocervical cells. No cytologic abno rmalities were present. In a cervical smear technique comparison, endo cervical cells were present in 58% of 161 standard speculum examinatio ns and in 18% of 93 cotton-swab tests (P < .001). Conclusion: Cytology specimens can be obtained without sedation in most mentally retarded women. Only one-third of Papanicolaou smears contained endocervical ce lls from examinations with sedation as well as those without. The cott on-swab technique has a significantly lower endocervical cell collecti on rate than the standard speculum technique. The incidence of abnorma lities on cytologic examination appears to be low compared with other populations of women. Whether this is due to suboptimal smears, lower prevalence of human papillomavirus, or a combination of both remains t o be resolved. Copyright (C) 1997 by The American College of Obstetric ians and Gynecologists.