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Background Menstruation has been shown to be problematic for many women with intellectual disabilities. There has been a greater focus on menstrual suppression or elimination than on help and training to manage menstrual care successfully. Method A cross-sectional questionnaire survey was conducted in England to investigate the help and training currently given to women with intellectual disabilities. Results Twenty-nine percent of the women had never been given the opportunity to learn how to manage their own menstrual care. Where someone had tried to teach the woman, this was most often her mother. Carers were giving considerable amounts of assistance with menstrual care, although some of the women with more profound disabilities were able to manage menstrual care independently.Conclusions The authors argue that all women with intellectual disabilities should have the chance to manage or assist with their own menstrual care, backed by a strategic approach to menstrual education and support.

Background Menstruation appears to be problematic for women with learning disabilities, yet there has been little quantitative research on their experiences, or comparisons with other groups of women. This paper considers the nature and extent of menstrual problems experienced by women with learning disabilities. Methods The data reported here come from a cross-sectional postal questionnaire survey conducted with carers of 452 women, aged 14-55 years, who had learning disabilities.Results Women with learning disabilities appear to be as likely to experience menstrual problems as other women. However, such problems may be experienced differently and more negatively and may not always be recognized appropriately. Conclusions More attention needs to be given to menstrual problems experienced by women with learning disabilities, both in research and in practice. It is particularly important that women with learning disabilities be supported to play a central role in recognizing and defining the problems they experience.

Developments in genetics have huge implications for disabled people (including people with learning difficulties) and their families. On the positive side, there is the potential for greater understanding of -and ultimately, perhaps, treatments forserious conditions like cystic fibrosis and sickle cell anaemia, but there are also concerns about the negative implications, including the potential for discrimination in insurance, employment and even life itself. Yet, the voices of those most affected by these developments -people with learning difficulties and their families, and disabled people generally -have been conspicuously absent from these debates. The present article describes two workshops that explained the use of prenatal testing and genetic information to inform choices in pregnancy to people with learning difficulties, and then explored the issues with them and the contribution subsequently made by these people to a national conference on this subject. Methods for explaining the complex issues involved in an accessible way and exploring them in a supportive environment are described along with the views of people with learning difficulties on these issues.

M e n s t ru ation is not simply a biologi c a l p h e n o m e n o n ; being experienced only by wo m e n , it is an important marker of femaleness and the way menstru ation is understood reflects the way women are situated in social stru c t u r e . C u l t u r e s h ave different ways of responding to menstru at i o n , and often ' t a b o o s ' . L aws (1990) uses the term ' m e n s t rual etiquette' for the white, largely secular culture which dominates in Bri t a i n , a l l ow i n g recognition of the particular responses and u n w ritten rules that exist in relation to m e n s t ru at i o n . Social rules of this nature express and reinforce the distinctions between people of different social stat u s , in this case between men and wo m e n . L aws (1990) argues that the dominant feature of menstrual etiquette in white B ritish culture is that menstru ation should remain h i d d e n , especially from men. Special European issue of The Tizard Learning Disability Review Ava i l able in June 2001The Tizard Learning Disability Review is published in association with the Tizard Centre at the University of Kent at Canterbur y. Special issues focusing on the organisation, planning and development of learning disability services across Europe will be being published in June 2001 and early 2002.These will provide case studies, accounts of innovation and cross-national perspectives on a range of issues and themes related to learning disability services in Europe.