HUMAN SEXUAL RESPONSE

CYCLE

A   31-year-old woman,  mother  of  four    children,   comes   to  the office  stating

she has little  interest    in  sexual  intercourse with    her husband for the past

year.   She says    sex is  painful,    but she is  able    to  experience  orgasm

occasionally.   She has had no  other   sexual  partners    than    her husband.    These

problems    are affecting   her marriage.   She had a   tubal   sterilization   procedure

performed   after   her last    delivery    two years   ago.    Medications include

thyroid replacement and fluoxetine.