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    It is important comprar viagra professional to allow for the possibility of the full spectrum of behavior, to avoid judgments or assumptions about sexual identity, and to assure confidentiality. Some studies have found that gay and lesbian youths are at significant risk for suicidality (Moscicki et al. Health care practitioners can alleviate some of the stresses on lesbian teens by providing an environment in which they can expect nonjudgmental care. Proctor and Groze 1991). Gibson suggested that this comprar viagra professional risk represents three times the risk for heterosexuals.

    Inclusive and comprehensive information on risk-reduction guidelines should be offered to all young patients. The adolescent tasks of defining self, individuating from family, developing social skills, and finding one’s place within society are more complex for lesbians, who must struggle with issues of adolescence without the benefit Psychological Aspects of Lesbian Health Care 633 of supportive societal institutions, role models, and the rituals of passage and celebration available to their heterosexual peers (Kreiss and Patterson 1994). Homosexual adolescents are also at greater risk for homelessness and its attendant risks of exposure to violence, rape, drug and alcohol use, and sexually transmitted diseases, including HIV/AIDS. 1996.

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    T. Physical examination should include a complete routine pelvic examination as well as a microscopic examination of the vaginal secretions for the detection of Trichomonas, a search for the clue cells indicative of bacterial vaginosis, and a rough quantitation of yeast forms. Cultures for bacterial vaginosis are useful only on a research basis. Diagnosis and T reatment Vulvovaginal Symptoms Vulvovaginitis A complete evaluation of vulvovaginitis includes a careful history of sexually transmitted diseases, use of intrauterine devices, the medical risk factors described previously in this chapter, and a sexual history.

    But the microscopic test is not diagnostic, vaginalis cultures may be useful in the rare instance when symptoms appear to be typical of that disease. Because they are often positive in asymptomatic women and do not provide a quantitative measure, specific cultures for yeast are seldom of benefit.

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