Simplify the following rational expression. 
Definitions:
Lithotomy Position
A medical positioning of a patient where they lie on their back with legs elevated and supported in stirrups, commonly used during childbirth and gynecological surgery.
External Genitalia
The reproductive organs located outside of the body, which differ between sexes and play roles in sexual reproduction and urination.
American Woman
Refers to a female citizen or resident of the United States of America.
Physical Assessment
A systematic examination of the body performed by a healthcare professional to evaluate overall health and detect possible diseases or conditions.
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