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Sexual Health, Gynecologic Care for Sexual and Gender Minorities

Mary, a 32-year-old, G0P0, female who identifies as lesbian, presents with c/o vaginal discharge
that has a strong fishy odor. She has tried douching and over-the-counter remedies with no relief.
She shares that she and her girlfriend use sex toys. She denies having sex with anyone else, but
she says her girlfriend is bisexual and possibly has been with someone else. She says she has
only had one pelvic exam when she was 20 years old, with a male physician, and she felt as
though she had been raped. During the examination, he was rough and she could tell he did not
like the fact that she identified as lesbian. She has not been seen since. She denies any health
issues in her past, has never been pregnant, has never had sex with males, and has never had an
STI, or at least she believes she has not. She also shares that she is very nervous but knew she
had to come in.

  1. Prior to your exam, how will you address her fear?
  2. What other historical information will you obtain?
    On exam, her height is 5′ 8″, weight 165lbs, BP 118/76, breast exam negative, pelvic exam
    reveals thin homogenous, frothy green discharge pooling in the posterior fornix. Negative
    cervical motion tenderness, negative adnexal tenderness, and her uterus is normal size, shape,
    and contour with no tenderness on palpation. Her cervix is normal but bleeds easily with
    manipulation.
  3. What are your differential diagnoses? What is your final diagnosis?
  4. What additional tests will you order and why?
  5. Based on your final diagnosis, what is your treatment plan?
  6. What educational issues do you want to discuss with this patient.

Sample Solution

nanoparticle size using different organic solvents and he found that in all cases, increasing polymer concentration in organic phase resulted in increasing mean size [149],and D. Quintanar-Guerrero et al., 1999 [215] who used emulsion-diffusion method to prepare Eudragit E nanoparticles using Eudragit E/ethyl acetate/PVAL system and cellulose acetate phthalate (CAP) nanoparticles using cellulose acetate phthalate/2-butanone/Poloxamer 407 system and in two systems it was found that there is a switch between micro and nanoparticles depending on polymer concentration in internal organic phase where, as polymer concentration increased, size of produced particles significantly increased [215]. On the other hand, these results are disagreeing with those reported in Ahmed, I.S., et al.,2014 [216] who prepared poly-Ɛ- caprolactone nanoparticles by solvent displacement method and investigated the effect of polymer concentration on particle size. It was found that increasing polymer concentration from (0.5 to 0.8% w/v) at surfactant concentration (0.5% w/v) resulted in increasing particle size while, at the same surfactant concentration and increasing polymer concentration to (1% w/v) particle size decreased. Also, increasing polymer concentration from (0.5 to 0.8% w/v) at surfactant concentration (1% w/v) resulted in decreasing particle size while, at the same surfactant concentration and polymer concentration was increased to (1% w/v) particle size increased. These results were attributed to that at low polymer concentration and high surfactant concentration, the solubility of polymer in acetone/water mixture might have increased due to the solubilizing effect of the surfactant leading to slower rate of polymer precipitation and formation of larger particles. While at higher polymer concentration the effect of surfactant on solubility was less marked leading to higher precipitation rate and the formation of smaller particles [216]. The higher polymer concentration might also results in increasing viscosity of the organic phase, which might decrease the diffusion rate and might lower the rate of Ostwald ripening for the more viscous solutions so smaller particles were produced [217]. Eudragit S100 nanoparticles were smaller than those of HPMC phthalate HP55 while maintaining the same formulation conditions; this may be due to that polymer molecular weight that influences nanoparticle size as the higher polymer molecular weight, the smaller the nanoparticles [218].According to this, molecular weight of Eudragit S100 (150000 g/mole) [128] is greater than molecular weight of HPMC p
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