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Vulvar Intraepithelial Neoplasia and Cancer often macular and pink to red in color.3 Hyperpigmented lesions are present in 10% to 15% of patients.14 Patients who are identi ed with symptoms or lesions should undergo an extensive vulvar examination. Evaluation of the vulva following the application of 4% acetic acid followed by inspection with a coloposcope or a handheld magnifying glass must be performed in identi ed patients. Because of the upper keratinized layer of epidermis, the acetic acid should be in contact with vulvar skin for several minutes, rather than the shorter contact times required for cervical or vaginal mucous membranes. The keratinized layer also most often obscures underlying vascular changes, with dysplastic lesions most often appearing as dense acetowhite lesions on the vulvar skin. The use of toluidine blue to identify lesions has also been described. The technique applies a 1% aqueous solution of toluidine blue to the entire vulva. The area is allowed to dry for several minutes and then washed with a 1% to 2% acetic acid solution. Areas of increased nuclear activity stain blue. Many nd this technique limited due to the high false-positive rate associated with areas of infection, non-neoplastic ulceration, or excoriation. The increased nuclear activity of these areas results in a high uptake of toluidine blue. False negatives are also noted in hyperkeratotic lesions, as little dye is absorbed.

STEP 7: ENCOURAGE DEVELOPMENT OF ALTERNATIVE RESPONSES TO BOTH PAST INJURIES AND CURRENT STRESSORS As above, it can be helpful to provide some explicit psychoeducation about how emotional reactivity works how a current crisis precipitated by illness can seem much bigger if it happens to touch on a sore point an area of particular vulnerability or sensitivity; and conversely, how the

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g Tribe, 1971) A more fundamental critique has been offered by Cohen (1977) who questions the applicability of conventional probability theory to trial disputes, indicating that Bayesian probability is inconsistent with the rules of proof in legal trials Cohen goes on to argue that inductive probability rather than mathematical probability ts the forensic context much better The issue of whether probability theory should and does underpin the reasoning and decision-making of lay fact- nders ( juries), magistrates and judges has been visited by psychologists Psychology s answer to the issue is to say that even although the context in which legal fact- nding is conducted is quite different from fact- nding in less institutionalised settings, none the less, at base, it is always humans who are reasoning about facts, inferring the probabilities, and making the decisions under conditions of uncertainty.

Jacobs, J L (1992) Religious ritual and mental health In J Schumacher (Ed), Religion and mental health (pp 291 299) New York: Oxford University Press Jung, C G (1954) Marriage as a psychological relationship (R F C Hull Trans) Collected works (Vol 17, Bollingen Series 20) Princeton, NJ: Princeton University Press Jung, C G (1958) Psychology and religion: West and East (R F C Hull Trans) Collected works (Vol 2, Bollingen Series 30) New York: Pantheon Books Jung, C G (1963) Mysterium coniunctionis (R F C Hull, Trans) In Collected works (Vol 14, Bollingen Series 20) Princeton, NJ: Princeton University Press Kaslow, F, & Robinson, J A (1996) Long-term satisfying marriages: Perceptions contributing factors American Journal of Family Therapy, 24(2), 153 170 Kok, C J, & Leskela, J (1996) Solution-focused therapy in a psychiatric hospital Journal of Marital and Family Therapy, 22, 397 406.

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