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Individuals learn appropriate touching behaviors for each circle of intimacy, and are cautioned that "sometimes a friend may want to be closer to you than you want. Like typical young people, then, students with Down syndrome need early sex education accompanied by open discussion Because of significant variations within this population in cognitive levels, learning styles, living arrangements, and health problems, they require an individualized approach to sex education Van Dyke et al, There are no studies of dating patterns or related social behaviors in Down syndrome.
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Dating is a normal part of adolescent social development Fegan et al, l The social skills needed for dating can be taught as part of a life-skills based curriculum Fegan et al, l Such preparation is best provided before the actual dating experience. Those who doubt that dating occurs in the Down syndrome population should read the chapters on "Girls and Sex" and "Marriage and Children" in the book Count Us In: Growing Up with Down Syndrome. Written by two young men with Down syndrome, Count Us In provides eloquent proof that adolescents with Down syndrome have typical teenage concerns:.
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It's premature but it's okay Few papers have described marriage in the Down syndrome population. Studies of marriage in the mentally disabled population by Edgerton ; and by Koller et al have shown that individuals with cognitive deficits who married had only mild mental disabilities. The most troubled marriages were those in which both partners were mentally disabled Koller et al, Of 38 married individuals with Down syndrome including 35 female subjects, all had spouses without Down syndrome Edwards, In this study, couples lived in an environment that was closely and consistently supported and in some cases supervised by other family members or advocates Edwards, In general, adults with Down syndrome under-use the health care system Elkins et al, l Women with Down syndrome demonstrate significantly lower usage of gynecological and reproductive services than women in the general population Elkins et al, While it is recommended that all females with Down syndrome have a baseline pelvic examination and pap smear between 17 and 20 years of age, this recommendation is infrequently followed Rogers and Coleman, To address this problem, some care providers have developed special clinics for adults with Down syndrome Doty, Men with Down syndrome need to learn testicular self-examination as their cognitive level permits; likewise, women need to learn breast self-examination and the necessity for regular gynecological care Elkins et al, ; Doty, Contraception is often a major concern of parents of individuals with Down syndrome Van Dyke et al, Parents may be uncomfortable discussing sexual and reproductive issues with a physician Van Dyke et al, Health care providers and professionals need to initiate structured, nonjudgmental discussion of contraception and to provide clear information tailored to patient developmental levels Grant, Methods of contraception in males and females with Down syndrome are outlined in Table 2.
As in the general population, the only nonsurgical method available to males is the condom. Because barrier methods require application at the time of each coitus, they may not be practical for individuals with Down syndrome who may need supervision in using such devices Elkins, There are a number of contraceptive methods for females including condoms, spermicidal foams and gels, diaphragm, sponges, cervical cap, IUD, oral contraceptives, Norplant, and Depo-Provera.
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No form of contraception is totally contraindicated for individuals with Down syndrome Schwab, Oral contraceptives are frequently used by females with Down syndrome. Contraindications for this therapy in Down syndrome are the same as in women in the general population; both absolute and relative contraindications are outlined in Table 3 Heaton, ; Laros, Medroxyprogesterone Depo-Provera and Norplant levonorgestrel implant are frequently used depot forms of contraception.
Norplant is a progestin-impregnated silastic implant that is usually inserted into upper arm subcutaneous tissue. It is usually effective for five years but may be removed sooner Laros, Reports of complications requiring removal - including irregular vaginal bleeding - have dampened some of the initial enthusiasm for Norplant.
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Surgical contraceptive procedures include laparoscopic tubal ligation and total abdominal hysterectomy. Both procedures require informed consent and involvement of the patient and parent.
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