SURGICAL sterilisation of mentally handicapped patients used to be a common practice in Singapore more than 20 years ago.

But six gynaecologists The New Paper on Sunday spoke to said such cases are rare these days. This is because of the availability of other non-permanent and less drastic measures that can be performed on these patients to prevent pregnancy and regulate menstrual flow.

They include administering injectible contraceptives like Depo-Provera and inserting an intrauterine device
in mentally handicapped girls.

Surgically speaking, women can undergo tubal ligation, where her fallopian tubes are clipped to prevent pregnancy. However, she will still menstruate in this instance.

Men can undergo vasectomy, where tubes which connect the testicles to the prostate are cut and closed, to sterilise them.

Every year, KK Women’s and Children’s Hospital (KKH) sees about two to three parents of intellectually disabled children – more often Down Syndrome children – requesting for birth-control measures for their child.

“Most of these parents are not as concerned about unwanted pregnancies as they are about managing the menstrual flow and maintaining personal hygiene for their child,” said Dr Anette Jacobsen, chairman of KKH’s division of surgery.

Dr Jacobsen said that KKH also discourages performing sterilisation surgery.

However, Dr Christopher Chen, a gynaecologist at Gleneagles Hospital, said that sometimes, in very rare and extreme cases, a hysterectomy – which is the removal of the uterus – is performed on a mentally handicapped girl to prevent her from menstruating completely.
 
This is done in the event that she is incapable of changing her sanitary pads herself.

Speaking of a hysterectomy which he performed on a mentally handicapped 18-year-old girl in the 1990s, he said: “This was a very extreme case where the girl’s parents were at a total loss as every time she had her menses, it became very unhygienic and unbearable for the girl’s mother.

“She couldn’t be around people and became anti-social.”

Dr Chen, who has been practising medicine for more than 20 years, added: “But I performed the hysterectomy after her case was thoroughly assessed by a psychiatrist.

“Gynaecologists cannot go ahead and perform surgery on such patients before the child and his parents are seen by a psychiatrist.”

Gynaecologists said while parents may think sterilising their mentally handicapped child is more convenient for them, ethically speaking it is much more complicated.

Dr Maurine Tsakok, gynaecologist at Camden Medical Centre, said: “Sterilising their kids just makes it more convenient for parents and it doesn’t in anyway help to prevent sexual abuse.”

Dr Tsakok, who has been practising for over 40 years, added that it would be better for parents to keep a close watch on their child to protect them.

Dr Ong Theng Kiat, a gynaecologist at Gleneagles Medical Centre who has been practising for 35 years, said that sterilising the mentally handicapped could be a “double-edged sword”.

It may encourage abuse because the perpetrator knows the victim can’t get pregnant, he said.