UAB Synopsis, Vol. 27, No. 40, October 27, 2008

The UAB Reproductive Health Clinic for Women with Disabilities offers specialized gynecological care to disabled women. The clinic began in 1988 to serve women with physical disabilities who often encounter physical, attitudinal, and informational barriers to health care.

“Our clinic is successful because we have eliminated many of the obstacles these patients face,” says Department of Physical Medicine and Rehabilitation Chair Amie B. Jackson, MD.

“A problem as simple as moving from a wheelchair to an exam table is one of the major obstacles these women must overcome,” she says.

A Special Exam Chair
UAB’s clinic has a special obstetric and gynecology chair that is wheelchair height and reclines into an examination table. Clinicians are trained to use alternative positioning to perform gynecologic examinations. Patients’ disabilities range from severe spasticity to problems with flaccidity. Both conditions make it difficult to use a traditional examination table.

Uncommon problems accompany certain disabilities, Dr. Jackson says. “People with quadriplegia complicated by autonomic dysreflexia sometimes find the gynecological examination very painful or uncomfortable. The ways their bodies feel and react are no longer under their conscious control, and they respond atypically. In addition, autonomic dysfunction can lead to extremely high blood pressure, headache, stroke, and death.

“These situations can become medical emergencies if the doctor doesn’t know what’s causing the problem and does not take measures to correct it,” she says. Disabled women can experience a range of conditions from chronic pain to mental changes associated with stroke or head injuries, urological difficulties, and unusual musculoskeletal and joint problems.

Attitudinal Barriers
Many women with disabilities report attitudinal barriers from health care providers who assume the women are asexual and therefore fail to offer preventive health care such as contraceptive counseling or screening for sexually transmitted diseases.

Dr. Jackson also provides sexual counseling for women with disabilities. “Many of these women lack knowledge about their conditions. I counsel them about the sexual adjustment problems their disability can cause and make sure they have a clear understanding of birth control,” she says. “Disabled women require care from clinicians who understand their reproductive health and disability.”