Arielle is a 41 yr old female presenting to her family doctors office with concerns of irregular menstrual cycles and painful intercourse. Arielle states she has noticed increased episodes of spotting in between her menstrual cycles over the past 8 months. Arielle has also noticed increased vaginal discharge and abdominal cramping at times with associated swelling of her legs. Arielle thought her lower leg symptoms were a result of her long work hours and standing for long periods of time. Arielle immigrated to Canada from the United States 15 years ago. She works as a daycare attendant and a waitress on the weekends to support her parents who reside with her and her partner. Arielle did not have regular access to healthcare as a teenager while living in Florida with her parents who immigrated to the US from Mexico shortly after Arielle was born. Arielle did not receive any vaccinations as a child or as a teenager. Arielle was sexually active at the age of 14 with multiple partners before her husband. She has been in a monogamous relationship for the past 6 years. Arielle reports she has given birth to 3 children which she gave up for adoption and underwent 2 pregnancy terminations prior to meeting her husband. Her husband does not know about any of the previous pregnancies or procedures she underwent prior to meeting him.