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Clinical implication: clinicians should treat vaginal symptoms in patients taking semaglutide as real and addressable , but approach causality cautiously: prioritise common diagnoses (genitourinary syndrome of menopause, infections, dermatologic vulvar disease, STIs, irritant/contact dermatitis, pelvic floor disorders), identify important confounders (notably SGLT2 inhibitors, antibiotics, hormonal therapies), manage symptoms and underlying conditions, and report suspected adverse reactions when there is a reasonable temporal relationship and alternative causes are less likely
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