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Sarah is 33 years old and has a one day history of lower abdominal pain and vomiting. She has also noticed increased urinary frequency but no dysuria. Her last menstrual period was around 8 weeks ago. Past medical history includes recurrent urinary tract infections. Urinary pregnancy test is positive and urine dipstick unremarkable. Observations are stable and abdominal examination reveals pelvic tenderness.

Based on the likely diagnosis, which one of the following factors would not be a risk factor for this?

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