The decision of sterilization for special needs girls
Parents of girls with special needs may be fought with concerns and fears about the hardships associated with her monthly menstrual encounters.
Special situations such as –
- Extreme (sometimes self-inflicting) behaviour changes
- Physical inability to manage menstrual self-care
- Cognitive difficulties that make the child completely dependent on the care giver
to name a few, often push parents over the edge to consider an alternate course of action to improve their child’s, and their quality of life. When met with such situations, parents must seek advice and consolation by interacting with parents in their support network and get medical advice from an experienced gynaecologist.
The two main hormones produced by a woman’s ovaries predominate in the upkeep of her sexual development. These hormones also interact with other faculties in the body and function to regulate them. For example, the two female sex hormones are essential for the healthy functioning of a woman’s bone and heart function too. Hence, removal of a woman’s ovaries will impact not just her sexual development, but also have a drastic effect on other essential body systems. Should parents consider opting to sterilize their child in her best interest, removal of the ovaries would prove to do more harm than good to the girl’s body. However, removal of the uterus, termed medically as hysterectomy would be a relatively suitable alternate, with the hormonal disruption being less impactful than when the ovaries are removed. In India, hysterectomy is recommended only after 2 years after the onset of menarche, i.e. the first occurrence of menstruation.
Disclaimer: Since the procedure is performed under general anaesthesia, associated complications maybe experienced.
Given that puberty is every girl’s right to experience, parents must let the process of menstruation happen to the extent that is manageble before thinking about sterilization. It is, only under very rare circumstances will a doctor counsel parents over making this important medical decision. Some situations include –
- The severity of the disability, which may render the girl bed-ridden at all times
- If the girl suffers from excessive bleeding that is not manageable
- The socio-economic condition of the family
- The primary caregiver is much older in age in addition to having age-related health issues, which would make it difficult to provide necessary care to the child.
A preferable alternative to hysterectomy can be the insertion of a hormonal intra-uterine device (IUD) which can be replaced every 5 years. This also needs to be inserted with local anaesthesia under the guidance of a good gynaecologist.