Cervical cytology in women with mental retardation

To examine our experience with performing pelvic examination and obtaining cervical cytology in women with mental retardation.

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 available for analysis. All charts were reviewed for data on the level of retardation, incidence of sedation, success in performing pelvic examination and Papanicolaou smear, technique used for cervical smear, and pathology results of the cervical cytology.

Of the 574 women, 289 (50%) had severe, 69 (12%) moderate, and 31 (5%) mild retardation. In 185 (32%), the exact level of retardation was not established. During the study period, 1235 pelvic examinations were analyzed. Within this group, 845 examinations could be completed initially, 177 required the use of sedation (14%), and 213 (17%) examinations could not be completed. 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 done with sedation, 44 women (25%) still could not be examined. Cytology specimen results were obtained in 124 of the examinations, and 40 (32%) of these specimens contained endocervical cells. No cytologic abnormalities were present. In a cervical smear technique comparison, endocervical cells were present in 58% of 161 standard speculum examinations and in 18% of 93 cotton-swab tests (P < .001).

Cytology specimens can be obtained without sedation in most mentally retarded women. Only one-third of Papanicolaou smears contained endocervical cells from examinations with sedation as well as those without. The cotton-swab technique has a significantly lower endocervical cell collection rate than the standard speculum technique. The incidence of abnormalities 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 to be resolved.