For many women with intellectual disabilities, pelvic exams can be frightening and potentially uncomfortable. If the situation permits, focus the first visit on history and relationship building alone. The following may be helpful to reduce both the patient’s and the provider’s anxiety about the pelvic examination:

• Get to know your patient before attempting a pelvic exam.
• Educate the patient and caregivers about the exam.
• Don’t assume that a pelvic exam will be any more difficult or uncomfortable for a person with a disability than for anyone else. You don’t know until you try.
• Women with disabilities, including those with intellectual disabilities, can and do have sex.
• Use anatomy models with visual demonstration before the visit.
• Allow extra time (this is a must!).
• Encourage your patient to bring a supportive person to the appointment.
• If needed, locate the cervix manually.
• The anatomy of women with disabilities is often normal. However, it may be helpful to have several different pediatric and adult sized speculums available.
• Pelvic exams can be done in a variety of positions. You may need assistants to hold a flashlight or help the patient maintain a comfortable position.
• Use a soothing voice, deep breathing, visualization and praise.
• Consider pelvic ultrasound if bimanual exam is not possible.
• Consider using a short acting benzodiazepine for pre‐sedation before a pelvic exam for women who have anxiety, spasticity or agitation. Consider a test dose at home prior to the visit. Ask the caregiver to carefully document the patient’s reaction, as well as the peak action of the medication.
• Consider doing the exam under conscious sedation or general anesthesia especially if the patient has a scheduled surgical or dental procedure under anesthesia. Other exams, such as echocardiograms, labs, EKG, hearing tests, etc., can be coordinated at the same time.