Sexual Response In Women Research Articles

Effects of Aversive Classical Conditioning on Sexual Response in Women With Dyspareunia and Sexually Functional Controls

IntroductionIn dyspareunia—a somatically unexplained vulvovaginal pain associated with sexual intercourse—learned pain-related fear and inhibited sexual arousal are supposed to play a pivotal role. Based on research findings indicating that enhanced pain conditioning is involved in the etiology and maintenance of chronic pain, in the present study it was hypothesized that enhanced pain conditioning also might be involved in dyspareunia. AimTo test whether learned associations between pain and sex negatively affect sexual response; whether women with dyspareunia show stronger aversive learning; and whether psychological distress, pain-related anxiety, vigilance, catastrophizing, and sexual excitation and inhibition were associated with conditioning effects. MethodsWomen with dyspareunia (n = 36) and healthy controls (n = 35) completed a differential conditioning experiment, with one erotic picture (the CS+) paired with a painful unconditional stimulus and one erotic picture never paired with pain (the CS−). Main Outcome MeasuresGenital sexual response was measured by vaginal photoplethysmography, and ratings of affective value and sexual arousal in response to the CS+ and CS− were obtained. Psychological distress, pain cognitions, and sexual excitation and inhibition were assessed by validated questionnaires. ResultsThe two groups showed stronger negative affect and weaker subjective sexual arousal to the CS+ during the extinction phase, but, contrary to expectations, women with dyspareunia showed weaker differential responding. Controls showed more prominent lower genital response to the CS+ during acquisition than women with dyspareunia. In addition, women with dyspareunia showed stronger expectancy for the unconditional stimulus in response to the safe CS−. Higher levels of pain-related fear, pain catastrophizing, and sexual inhibition were associated with weaker differential conditioning effects. ConclusionsPairing of sex with pain negatively affects sexual response. The results indicate that a learned association of sex with pain and possibly deficient safety learning play a role in dyspareunia.Both S, Brauer M, Weijenborg P, Laan E. Effects of Aversive Classical Conditioning on Sexual Response in Women With Dyspareunia and Sexually Functional Controls. J Sex Med 2017;14:687–701.

The Specificity of Women's Sexual Response and Its Relationship with Sexual Orientations: A Review and Ten Hypotheses.

Category-specific sexual response describes a pattern wherein the individual shows significantly greater responses to preferred versus nonpreferred categories of sexual stimuli; this pattern is described as gender specific for sexual orientation to gender, or gender nonspecific if lacking response differentiation by gender cues. Research on the gender specificity of women's sexual response has consistently produced sexual orientation effects, such that androphilic women (sexually attracted to adult males) typically show gender-nonspecific patterns of genital response and gynephilic women (sexually attracted to adult females) show more gender-specific responses. As research on the category specificity of sexual response has grown, this pattern has also been observed for other measures of sexual response. In this review, I use the Incentive Motivation and Information Processing Models as complementary frameworks to organize the empirical literature examining the gender specificity of women's sexual response at each stage of sexual stimulus processing and response. Collectively, these data disconfirm models of sexual orientation that equate androphilic women's sexual attractions with their sexual responses to sexual stimuli. I then discuss 10 hypotheses that might explain variability in the specificity of sexual response among androphilic and gynephilic women, and conclude with recommendations for future research on the (non)specificity of sexual response.

Incidence and Prevalence of Sexual Dysfunction in Infertile Females

Introduction: The sexual response in women is complex. The association of infertility and sexual dysfunction is overlapping.Objective: To find the incidence and prevalence of female sexual dysfunction in infertile females and its correlation with infertility.Material and Methods:Total of 500 patients in the age group of 24-42 years participated in the prospective study. They were assigned fertile and infertile group. Female sexual dysfunction was assessed according to FSFI questionnaire. Patients with past history of any psychiatric illness, endocrinological disorder e.g. diabetes mellitus or on antihypertensive treatment were excluded. In our study 170 (63.67%) patients in the infertile group (n=267) had female sexual dysfunction as compared to108 (46.35%) in the fertile group (n=233), which is statistically significant (P 0.0001). Most common dysfunction observed was arousal (70%) in infertile patients. Common dysfunctions observed in fertile females were desire(40%) and orgasm(40%). FSD was significantly higher in infertile females of 31-37 years age group (P 0.002), while more common in fertile females of >42years age (P< 0.0001) . Higher female sexual dysfunction was observed in illiterate infertile females (P 0.039). Amongst the pathological factors endometriosis was the statistically significant factor associated with female sexual dysfunction and infertility (P <0.0001). No significant correlation in duration of infertility or type of infertility was observed with female sexual dysfunction.Conclusions: Female sexual dysfunction as the cause or the effect should be ascertained in infertility.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 26-30

Sexual Pain Disorders in Spanish Women Drug Users

ABSTRACTBackground: The impact of pain in sexuality, couple relationships and the quality of life is very well known. Objectives: The relationship between substance abuse and the presence of sexual pain disorder is assessed, together with anxiety and sexual attitudes. Method: Two samples were selected. One sample for women with a history of substance abuse (n = 129), and another one of women nonconsumers (n = 129). The Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Sexual Opinion Survey (SOS) and the State Trait Anxiety Inventory (STAI) questionnaires were used. Results: The results indicate that women consumers obtained a higher mean scores in sexual pain disorder (4.88 > 2.89, that is 65.12%), plus higher mean scores on state anxiety (23.82 > 14.56) and trait anxiety (30.93 > 16.95), and lower average figure in erotophilia (84.93 < 95.81). It was also verified that the period of abstinence does not improve sexual response. Conclusions: Substance consumption affects sexual response in women negatively. Sexual response does not improve with abstinence period.

Sexual Response Models: Toward a More Flexible Pattern of Women's Sexuality

IntroductionRecent research suggests that none of the current theoretical models can sufficiently describe women's sexual response, because several factors and situations can influence this. AimTo explore individual variations of a sexual model that describes women's sexual responses and to assess the association of endorsement of that model with sexual dysfunctions and reasons to engage in sexual activity. MethodsA sample of 157 randomly selected hospital employees completed self-administered questionnaires. Main Outcome MeasuresTwo models were developed: one merged the Master and Johnson model with the Kaplan model (linear) and the other was the Basson model (circular). Sexual function was evaluated by the Female Sexual Function Index and the Brief Sexual Symptom Checklist for Women. The Reasons for Having Sex Questionnaire was administered to investigate the reasons for which women have sex. ResultsWomen reported that their current sexual experiences were at times consistent with the linear and circular models (66.9%), only the linear model (27%), only the circular model (5.4%), and neither model (0.7%). When the groups were reconfigured to the group that endorsed more than 5 of 10 sexual experiences, 64.3% of women endorsed the linear model, 20.4% chose the linear and circular models, 14.6% chose the circular model, and 0.7% selected neither. The Female Sexual Function Index, demographic factors, having sex for insecurity reasons, and sexual satisfaction correlated with the endorsement of a sexual response model. When these factors were entered in a stepwise logistic regression analysis, only the Female Sexual Function Index and having sex for insecurity reasons maintained a significant association with the sexual response model. ConclusionThe present study emphasizes the heterogeneity of female sexuality, with most of the sample reporting alternating between the linear and circular models. Sexual dysfunctions and having sex for insecurity reasons were associated with the Basson model.

PS-05-007 Models of sexual response in women with diabetes mellitus

PS-05-007 Models of sexual response in women with diabetes mellitus

PS-05-001 The effects of aversive classical conditioning on sexual response in women with genito-pelvic pain disorder and sexually functional controls

PS-05-001 The effects of aversive classical conditioning on sexual response in women with genito-pelvic pain disorder and sexually functional controls

Altered states of consciousness are related to higher sexual responsiveness.

Altered states of consciousness lead to profound changes in the sense of self, time and space. We assessed how these changes were related to sexual responsiveness during sex. 116 subjects reported (a) intensity of awareness concerning body, space and time, and (b) satisfaction, desire, arousal, and orgasm occurrence. We differentiated vaginal intercourse orgasm from noncoital orgasm. Female vaginal intercourse orgasm was further differentiated as with or without concurrent clitoral masturbation. Overall, sexual responsiveness was related to greater body awareness and lesser time and space awareness. Satisfaction, desire, and arousal were especially associated with less time awareness in women. Female orgasms during vaginal intercourse were related to greater body awareness and lesser time awareness, but noncoital orgasms were unrelated. Our findings provide empirical support for the hypotheses that altered states of consciousness with attentional absorption are strongly related to sexual responsiveness in women, and to a lesser extent in men.

P-235 YI Sexual Dysfunction Assessment in Inflammatory Bowel Disease Patients

Inflammatory Bowel Disease (IBD) is a term used for diseases such as the Crohn's Disease (CD) and Ulcerative colitis (UC), both characterized by a chronic intestinal inflammation. IBD can change the patients' quality of life and sexuality. Sexuality is an important factor concerning personal satisfaction and quality of life in general. Few professionals touch on this subject during clinical practice. It's up to nursing care the patient's reception and the opening of a wider communication channel between patients and the professionals. The objectives of this study were to study the prevalence of sexual dysfunction in IBD patients and presenting the importance of this subject's approach by the nurse. It was an observational study with 99 IBD outpatients; 118 controls were paired by gender and age. The Crohn's Disease Activity Index (CDAI) was used to assess the clinical activity of CD patients. Mayo score was used to assess the clinical activity of UC patients. The Inflammatory Bowel Disease Questionnaire (IBDQ) was used to measure the healthy related quality of life. The hospital anxiety and depression scale (HADS) was used to measure anxiety and depression. The women's sexual response assessment was done through the Female Sexual Function Index (FSFI) and men's sexual health was done with the International Index of Erectile Function (IIFE). The mean age was 38.89 ± 10.15 years; 57% were women; 73% were in a consensual relationship; 8% were smokers; 97% heterosexual. 57% presented CD, 36% in clinic activity; 43% had UC, 16% in clinic activity; 42% undergone biological therapy. 2% were ostomates and 31% presented perianal disease. Regarding quality of life and psychological aspects, 65% presented an excellent/good quality of life; 48% were anxious (P = 0.0963); 24% were depressed (P = 0.2353) and 90% presented high self-esteem (P = 0.3137), with no statistic difference when compared to control group. Regarding sexual factors, 13% of the patients presented dyspareunia, 5% of the men reported use of medication to facilitate erection (P = 1.0), 28% presented medium to moderate erectile dysfunction (P = 0.1122), 81% were satisfied with their sexual life (P = 0.5625). 93% of the women presented sexual dysfunction (P = 0.6990), 73% reported having vaginal lubrication during the sex act (P = 0.3083), 80% were satisfied with their sexual life (P = 0.2601) and 29% were in sexual abstinence (P = 0.6843). There was sexual dysfunction prevalence on this target population, with no difference between the patients and the control group. Nurses have an important role during the whole assistance, since they can clarify doubts and contribute to education, comprehension regarding the disease, adherence to the treatment, improving the relationship between the medical team and the patients and their families, leading to treatment acceptance, evolving into a good and accompanied life quality.

Does Sex Really Matter? Examining the Connections Between Spouses' Nonsexual Behaviors, Sexual Frequency, Sexual Satisfaction, and Marital Satisfaction.

We examined the interplay between husbands' and wives' positive and negative nonsexual interpersonal behaviors, frequency of sexual intercourse, sexual satisfaction, and feelings of marital satisfaction. To do this, we conducted an in-depth face-to-face interview and completed a series of telephone diaries with 105 couples during their second, third, and fourteenth years of marriage. Consistent with the argument that women's sexual response is tied to intimacy (Basson, 2000), multilevel analyses revealed that husbands' positive interpersonal behaviors directed toward their wives-but not wives' positivity nor spouses' negative behaviors (regardless of gender)-predicted the frequency with which couples engaged in intercourse. The frequency of sexual intercourse and interpersonal negativity predicted both husbands' and wives' sexual satisfaction; wives' positive behaviors were also tied to husbands' sexual satisfaction. When spouses' interpersonal behaviors, frequency of sexual intercourse, and sexual satisfaction were considered in tandem, all but the frequency of sexual intercourse were associated with marital satisfaction. When it comes to feelings of marital satisfaction, therefore, a satisfying sex life and a warm interpersonal climate appear to matter more than does a greater frequency of sexual intercourse. Collectively, these findings shed much-needed light on the interplay between the nonsexual interpersonal climate of marriage and spouses' sexual relationships.

Designing model for improving relationship of wives with men with erectile dysfunction

Designing model for improving relationship of wives with men with erectile dysfunction

Straight but Not Narrow; Within-Gender Variation in the Gender-Specificity of Women's Sexual Response.

Gender differences in the specificity of sexual response have been a primary focus in sexual psychophysiology research, however, within-gender variability suggests sexual orientation moderates category-specific responding among women; only heterosexual women show gender-nonspecific genital responses to sexual stimuli depicting men and women. But heterosexually-identified or “straight” women are heterogeneous in their sexual attractions and include women who are exclusively androphilic (sexually attracted to men) and women who are predominantly androphilic with concurrent gynephilia (sexually attracted to women). It is therefore unclear if gender-nonspecific responding is found in both exclusively and predominantly androphilic women. The current studies investigated within-gender variability in the gender-specificity of women’s sexual response. Two samples of women reporting concurrent andro/gynephilia viewed (Study 1, n = 29) or listened (Study 2, n = 30) to erotic stimuli varying by gender of sexual partner depicted while their genital and subjective sexual responses were assessed. Data were combined with larger datasets of predominantly gyne- and androphilic women (total N = 78 for both studies). In both studies, women reporting any degree of gynephilia, including those who self-identified as heterosexual, showed significantly greater genital response to female stimuli, similar to predominantly gynephilic women; gender-nonspecific genital response was observed for exclusively androphilic women only. Subjective sexual arousal patterns were more variable with respect to sexual attractions, likely reflecting stimulus intensity effects. Heterosexually-identified women are therefore not a homogenous group with respect to sexual responses to gender cues. Implications for within-gender variation in women’s sexual orientation and sexual responses are discussed.

Women's Endorsement of Models of Sexual Response: Correlates and Predictors.

Few studies have investigated endorsement of female sexual response models, and no single model has been accepted as a normative description of women's sexual response. The aim of the study was to establish how women from a population-based sample endorse current theoretical models of the female sexual response--the linear models and circular model (partial and composite Basson models)--as well as predictors of endorsement. Accordingly, 174 heterosexual women aged 18-55 years were included in a cross-sectional study: 74 women diagnosed with female sexual dysfunction (FSD) based on DSM-5 criteria and 100 non-dysfunctional women. The description of sexual response models was used to divide subjects into four subgroups: linear (Masters-Johnson and Kaplan models), circular (partial Basson model), mixed (linear and circular models in similar proportions, reflective of the composite Basson model), and a different model. Women were asked to choose which of the models best described their pattern of sexual response and how frequently they engaged in each model. Results showed that 28.7% of women endorsed the linear models, 19.5% the partial Basson model, 40.8% the composite Basson model, and 10.9% a different model. Women with FSD endorsed the partial Basson model and a different model more frequently than did non-dysfunctional controls. Individuals who were dissatisfied with a partner as a lover were more likely to endorse a different model. Based on the results, we concluded that the majority of women endorsed a mixed model combining the circular response with the possibility of an innate desire triggering a linear response. Further, relationship difficulties, not FSD, predicted model endorsement.

AB029. Meeting sexual health requirements in menopause

Many underlying psycho-physiological complexities can alter the normal manifestation of sexual responses in women. While these factors may be hormonal changes associated with pregnancy or lactation, medical or surgical debilitating illnesses, relationship issues or socio-cultural and environmental factors, a major hallmark along the life stages is menopause per se. The transition from reproductively active period to menopause is the key to a variety of physiological, psychological, functional and relationship adjustments and associated sexual difficulties. Particularly, the rapid hormonal descent during menopause appears to be the basis for personal distress in approximately 50% of women presenting with female sexual dysfunction (FSD) in their late fifties and beyond. Abrupt oestrogen decline in the postmenopausal period can lead to vaginal epithelial atrophy, dryness and pain in addition to negative impacts on sexual response and satisfaction. For this reason, surgical menopause is even more likely to precipitate FSD than a natural menopause. The interventional approaches require to be appropriately tailored to reduce the hormonal loss and level of personal distress in women going through this inevitable life-time adjustment. Although emotional, social and cultural taboos or boundaries may exert a significant impact on how Asian women react to sexuality in aging, a multitude of other factors warranting clinical attention is likely to co-exist in these older women. Therefore, integrating counseling and therapy with respective medical interventions for the predisposing and/or co-morbid conditions would optimize clinical outcomes for both the patient and her partner. Renewed emphasis through DSM V classification envisages a pro-active approach so that these women will continue to lead a healthy and fulfilling life, well beyond menopause. Therapeutic intervention classically uses hormonal treatment - estrogen as the mainstay and although evidence-based therapeutic relief with testosterone (in desire or interest disorders) is demonstrable, it remains non-FDA approved. Promising drugs include Flibanserin for efficacy in hypoactive sexual desire disorder (HSDD) in view of its preferential affinity for serotonin 5-HT (1A agonist and 2A antagonist) and dopamine D receptors and the new SERM, Ospemifene, which is FDA approved for dyspareunia and in the clinical management of genitourinary syndrome of menopause. While the future promises pharmaco-therapeutic advancements through several drugs in pipeline, it is imperative to ensure that the concomitant psychosocial or cultural limitations are also holistically addressed.

Uncovering category specificity of genital sexual arousal in women: The critical role of analytic technique.

Based on analytic techniques that collapse data into a single average value, it has been reported that women lack category specificity and show genital sexual arousal to a large range of sexual stimuli including those that both match and do not match their self-reported sexual interests. These findings may be a methodological artifact of the way in which data are analyzed. This study examined whether using an analytic technique that models data over time would yield different results. Across two studies, heterosexual (N = 19) and lesbian (N = 14) women viewed erotic films featuring heterosexual, lesbian, and gay male couples, respectively, as their physiological sexual arousal was assessed with vaginal photoplethysmography. Data analysis with traditional methods comparing average genital arousal between films failed to detect specificity of genital arousal for either group. When data were analyzed with smoothing regression splines and a within-subjects approach, both heterosexual and lesbian women demonstrated different patterns of genital sexual arousal to the different types of erotic films, suggesting that sophisticated statistical techniques may be necessary to more fully understand women's genital sexual arousal response. Heterosexual women showed category-specific genital sexual arousal. Lesbian women showed higher arousal to the heterosexual film than the other films. However, within subjects, lesbian women showed significantly different arousal responses suggesting that lesbian women's genital arousal discriminates between different categories of stimuli at the individual level. Implications for the future use of vaginal photoplethysmography as a diagnostic tool of sexual preferences in clinical and forensic settings are discussed.

Sexual Response in Women with Type 1 Diabetes Mellitus: A Controlled Laboratory Study Measuring Vaginal Blood Flow and Subjective Sexual Arousal.

Previous studies have indicated that women with diabetes mellitus are at higher risk to develop sexual dysfunctions. In the current study, we hypothesized that lower genital arousal response-as a consequence of diabetes-related damage to nerves and blood vessels-might play a part in these higher prevalence rates. Vaginal blood flow, subjective sexual response, and clitoral sensitivity were compared between women with diabetes and healthy controls, and associations with diabetes complications were investigated. In pre- and postmenopausal women with type 1 diabetes (n = 42) and healthy controls (n = 46), vaginal blood flow was measured as vaginal pulse amplitude (VPA). VPA was assessed at rest, during erotic film viewing, and during vibrotactile clitoral stimulation. Subjective sexual arousal was measured using a questionnaire. Clitoral sensitivity was assessed by a vibration perception test. Data on diabetes complications were obtained from medical records, and neuropathy was assessed by quantitative sensory testing. VPA, subjective sexual arousal, and clitoral sensitivity were not significantly different between women with diabetes and controls. Nevertheless, women with diabetes who had retinopathy showed significantly lower VPA than women without retinopathy, and women with diabetes who had neuropathy showed significantly higher sensation thresholds for vibrotactile clitoral stimulation. The results do not support the hypothesis of a disrupted genital arousal response in women with diabetes. However, the observed associations between retinopathy and vaginal blood flow, and between neuropathy and clitoral sensitivity, suggest that diabetes-related complications might adversely affect the physiological basis of female sexual response.

Effects of Gender and Sexual Activity Cues on the Sexual Responses of Women with Multidimensionally Defined Bisexuality

Literature examining gender-specificity of sexual response has not investigated the sexual arousal patterns of women with mixed-gender sexual interests. This study examined the genital and self-reported sexual response of women endorsing one or more dimensions of bisexuality (i.e., sexual identity, sexual attractions, romantic attractions, sexual fantasies, sexual behaviors) in response to audiovisual films that varied by gender and sexual activity level. Contrary to hypotheses, women exhibited and reported greater sexual response to female than male stimuli, for all dimensions of bisexuality. Consistent with our hypotheses and previous research, women's sexual responses generally increased with the level of sexual activity occurring in the films. Implications for our understanding of women's sexual response and sexual interests are discussed.

Gender-Specificity of Genital Response and Self-Reported Sexual Arousal in Women Endorsing Facets of Bisexuality

Gender-specific sexual arousal has been examined in women with sexual attractions toward predominantly women or men, but not in women reporting sexual attractions to both genders. In this study, women who endorsed one or more facets of bisexuality—sexual orientation, sexual identity, romantic attraction, sexual fantasy, sexual behavior—listened to narratives describing sexual and nonsexual interactions with female and male partners while their genital response and self-reported sexual arousal were assessed. Contrary to expectations, across the bisexuality facets, female gender cues produced a greater degree of genital response and self-reported sexual arousal than male gender cues, regardless of the number of facets of bisexuality that were endorsed. This pattern of results replicates those obtained by Timmers, Bouchard, and Chivers (2015) using audiovisual stimuli. Implications for our understanding of women's sexual attractions and response are discussed.

Extinction of aversive classically conditioned human sexual response.

Research has shown that acquired subjective likes and dislikes are quite resistant to extinction. Moreover, studies on female sexual response demonstrated that diminished genital arousal and positive affect toward erotic stimuli due to aversive classical conditioning did not extinguish during an extinction phase. Possible resistance to extinction of aversive conditioned sexual responses may have important clinical implications. However, resistance to extinction of aversive conditioned human sexual response has not been studied using extensive extinction trials. This article aims to study resistance to extinction of aversive conditioned sexual responses in sexually functional men and women. A differential conditioning experiment was conducted, with two erotic pictures as conditioned stimulus (CSs) and a painful stimulus as unconditioned stimuli (USs). Only one CS (the CS+) was followed by the US during the acquisition phase. Conditioned responses were assessed during the extinction phase. Penile circumference and vaginal pulse amplitude were assessed, and ratings of affective value and subjective sexual arousal were obtained. Also, a stimulus response compatibility task was included to assess automatic approach and avoidance tendencies. Men and women rated the CS+ more negative as compared with the CS-. During the first trials of the extinction phase, vaginal pulse amplitude was lower in response to the CS+ than in response to the CS-, and on the first extinction trial women rated the CS+ as less sexually arousing. Intriguingly, men did not demonstrate attenuated genital and subjective sexual response. Aversive conditioning, by means of painful stimuli, only affects sexual responses in women, whereas it does not in men. Although conditioned sexual likes and dislikes are relatively persistent, conditioned affect eventually does extinguish.

Cambios ecográficos en el bulbo uretral durante la respuesta sexual femenina: un estudio piloto

ObjectiveThe urethral sphincter submucosa is part of the urinary continence mechanism and it is rich in spongy tissue. The study hypothesis was that this submucosa has erectile properties and therefore must undergo echographic changes during the sexual response in women. Material and methodA pilot study was done in 9 healthy women with an average age of 30.1 years, after receiving prior written informed consent. For the ultrasound examination we used a General Electric Voluson® E8 HD. At the beginning we made an ultrasound in basal state and a second time during sexual arousal by self-stimulation. In the 4 former cases we measured the urethral sphincter and in the following 5 participants we also registered the vascularization and intraurethral echogenicity. Images were registered and the data were analyzed with statistical package SPSS® v. 22. ResultsDiscrete but significant increase in the volume of the urethral sphincter during sexual arousal (P=.016) is found in the series. In the last 5 cases of the study in addition we found important vascular changes and a significant change in echographic reference values of the urethral submucosa: it changed from markedly hypoechogenic to be isoechogenic. We found 3 longitudinal vessels along submucosa with transversal afferents from Santorini plexus and from urethrovaginal wall. DiscussionWith the caution typical of a pilot study, a discrete increase of urethral volume and important changes in the urethral submucosa of echogenicity and vascularization were noticed during female sexual arousal. These results support the hypothesis that the urethral submucosa is part of the erectile female system. We offer a new way of research utilizing introital echography as a tool to evaluate anatomical and functional female genital sexual response.