Srp Arh Celok Lek. 2013 Mar-Apr;141(3-4):268-274 DOI: 10.

2298/SARH1304268D
268 ПРЕГЛЕД ЛИТЕРАТУРЕ / REVIEW ARTICLE

The Evolution of the Female Sexual Response

Concept: Treatment Implications
Aleksandar Damjanović1,2, Dragana Duišin1, Jasmina Barišić1
Clinic for Psychiatry, Clinical Center of Serbia, Belgrade, Serbia;
1

School of Medicine, University of Belgrade, Belgrade, Serbia

2

SUMMARY
Sexual dysfunctions have been the most prevalent group of sexual disorders and include a large number of
populations of both sexes. The research of sexual behavior and treatment of women with sexual distress arises
many questions related to differences in sexual response of men and women. The conceptualization of this
response in modern sexology has changed over time. The objective of our paper was to present the changes
and evolution of the female’s sexual response concept in a summarized and integrated way, to analyze the
expanded and revised definitions of the female sexual response as well as implications and recommendations
of new approaches to diagnostics and treatment according to the established changes. The lack of adequate
empirical basis of the female sexual response model is a critical question in the literature dealing with this
issue. Some articles report that linear models demonstrate more correctly and precisely the sexual response
of women with normal sexual functions in relation to women with sexual dysfunction. Modification of this
model later resulted in a circular model which more adequately presented the sexual response of women
with sexual function disorder than of women with normal sexual function. The nonlinear model of female
sexual response constructed by Basson incorporates the value of emotional intimacy, sexual stimulus and
satisfaction with the relationship. Female functioning is significantly affected by multiple psychosocial factors
such as satisfaction with the relationship, self-image, earlier negative sexual experience, etc. Newly revised,
expanded definitions of female sexual dysfunction try to contribute to new knowledge about a highly
contextual nature of woman’s sexuality so as to enhance clinical treatment of dysfunctions. The definitions
emphasize the evaluation of the context of women’s problematic sexual experiences.
Keywords: female; sexual response; treatment; sexual behavior; sexual disorders

INTRODUCTION produced a circular model which more ade-

quately presents the sexual response of women
Sexual expression represents a part of human with sexual function disorder. Recent nonline-
behavior range, which differs physiologically ar model of female sexual response constructed
and psychologically among genders. The study by Basson [1, 2, 3] incorporates the value of
of sexual behavior and male sexual dysfunc- emotional intimacy, sexual stimulus and satis-
tion as well as the success of erectile dysfunc- faction with the relationship.
tion (ED) treatment has actuated the interest
for better understanding of sexual problems in
women as well as adjustment of treatment to The review of present sexual
newly developed knowledge. response models
The research of sexual behavior and treat-
ment of women with sexual distress arises Linear model
many questions related to differences in sexual
response of men and women. The conceptuali- In 1966, Masters and Johnson [4] proposed a
zation of this response in modern sexology has linear model of male and female sexual response
changed over time. composed of four stages. According to this mod-
The paper was designed to present the el, sexual response begins with excitement phase
changes and evolution of the female sexual (sexual arousal), proceeding to plateau phase,
response concept in a summarized and inte- orgasm and finally resolution [4] (Figure 1).
grated way, to analyze the revised definitions Some time later, in 1979, Kaplan [5] added
of the woman’s sexual functioning as well as the concept of sexual desire to the model, con-
the implications and recommendations of new densing the response model into three phases:
approaches to diagnostics and treatment. desire, arousal and orgasm. Over the past dec-
The lack of adequate empirical basis of ade, the present framework of sexual response
female sexual response model is a critical has been questioned, before all in the domain of
question in the literature addressing this is- female sexual response for a number of reasons:
sue. Some articles [1] report that linear mod- 1) It is assumed that men and women have
Correspondence to: els demonstrate more correctly and precisely similar sexual response. If such an assumption
Dragana DUIŠIN the sexual response of women with normal was adopted as scientific truth, it might produce
Višnjićeva 3, 11000 Belgrade
Serbia sexual functioning in relation to women with pathologization of normal sexual behavior of
[email protected] sexual dysfunction. Modification of this model women [6].
Srp Arh Celok Lek. 2013 Mar-Apr;141(3-4):268-274 269

Circular model

Upon recognition that all women do not fit into the linear
model of sexual response, in 1977 Whipple and Brash-Mc-
Greer [9] suggested a circular model of the female sexual
response. This concept is based on the Reed’s model, con-
sisting of four stages: seduction (encompassing desire),
sensations (excitement and plateau), surrender (orgasm),
and reflection (Figure 2) [9]. By making the Reed’s model
circular, Whipple and Brash-McGreer [9] demonstrate
that pleasant and satisfying sexual experiences may have
reinforcing effect on a woman, leading to the seduction
phase of the next sexual experience. If, during reflection,
the sexual experience did not provide pleasure and satis-
Figure 1. Female sexual response model developed by Masters and faction, the woman might not have a desire to repeat the
Johnson [4]
experience.

Nonlinear model

More recent nonlinear model of sexual response con-

structed by Basson [1, 2, 3, 8] incorporates the importance
of emotional intimacy, sexual stimuli, and satisfaction with
relationship (Figure 3).
This model acknowledges that female sexual function-
ing proceeds in a more complex manner than male sexual
response. According to the model, female functioning is
significantly affected by numerous psychosocial issues
such as satisfaction with the relationship, self-image, pre-
vious negative sexual experiences, etc.
According to Basson, women have many reasons for
engaging in sexual activity besides sexual hunger or drive,
as the traditional model suggests. Although many women
may experience spontaneous desire and interest in a new
sexual relationship or after a long separation from a part-
Figure 2. Circular model of female sexual response developed by ner, in long-term relationships they do not frequently think
Whipple and Brash-McGreer [9] of sex or have spontaneous hunger and need for sexual
activity. Basson suggests that a desire for increased emo-
2) The clinical practice has demonstrated that many tional closeness and intimacy or overture to a partner may
women do not move progressively and sequentially predispose a woman to participate in sexual activity.
through the described phases of sexual response. Ac- The Basson’s model emphasizes that the goal of sexual
cording to Whiple [7], women may not have all phases activity for women is not necessarily orgasm but rather
of sexual response in their experience. For example, they personal satisfaction, which can be manifested as physical
may move from the excitement phase into the orgasmic
and satisfaction phase without experiencing the sexual
desire or they may experience sexual desire, excitement
and satisfaction without orgasm.
One of contemporary researchers, Basson, asserts that
much of female sexual desire is actually responsive rather
than spontaneous per se. Basson [8] states that female
sexual response is often a reaction to her partner’s inter-
est in sex rather than spontaneous guiding, i.e. controlling
by her own libido.
3) Biological models by Masters and Johnson, and
Kaplan’s as well, have been, before all, criticized for not
taking into account the non-biological experience such
as pleasure and satisfaction into consideration [9], and
additionally not placing the sexuality in the context of Figure 3. Nonlinear model of female sexual response developed by
relationship [6]. Basson [1]

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270 Damjanović A. et al. The Evolution of the Female Sexual Response Concept: Treatment Implications

satisfaction (orgasm) and/or emotional satisfaction (a feel-

ing of intimacy and connection with a partner) [2, 3, 8].

Female sexual functioning: revised and

expanded definitions

Clinical experience and research in this field suggest the

necessity for correction of previously accepted models of
female sexual response, which leads to new conceptualiza-
tion. The revised concept of female sexual response com-
bines interpersonal, contextual, personal, psychological
and biological factors. Such approach has resulted in rec-
ommendations for the revision of the definitions of female
sexual disorders, which may be adequately incorporated in
a new version of DSM (Diagnostic and Statistical Manual
of Mental Disorders) classification of the American Psy-
chiatric Association [10].
Past definitions contained in the DSM-IV classification
of mental diseases were focused on the absence of sexual Figure 4. Female sex response cycle (modified from Basson) [43]
fantasies and sexual desire before experiencing the sexual
activity and arousal, although the frequency of this type aforementioned phases. Women describe an overlapping
of desire may vary among women who have no sexual of sexual response phases in varying sequences that repre-
complaints. In addition, past definitions were focused on sent the “mixture” of psychological and corporeal response
vaginal moisture and lubrication, i.e. the entities moder- (Figure 4) [7, 8, 12]. Nevertheless, woman’s motivation to
ately correlating with subjective arousal and satisfaction. engage in sex is far more complex than a simple presence
Revised definitions take into account many other fac- or absence of sexual desire (defined as contemplation, fan-
tors, primarily reflecting the significance of subjective tasies on sex and sexual desire with particular partner).
sexual arousal. The conceptualization underlying the cir- Figure 4 illustrates the sexual response cycle. It clearly
cular sexual response cycle where the stages overlap in a shows the responsiveness of desire which is seen during
variable way may accelerate not only the evaluation but sexual experience as well as variability of the initial (spon-
the treatment of dysfunction as well. taneous) desire. The “initial” phase is characterized by sex-
The studies on female sexual functioning in the last ual neutrality but with positive motivation. The reasons for
two decades have questioned former attitudes, defini- the woman to begin or agree to have sex include desire to
tions and diagnostic categories which are still found in express her love, accept and share physical pleasure, feel
2000 DSM-IV TR [11, 12]. Previous definitions of female emotional closeness, satisfy her partner and upgrade the
sexual dysfunctions were based on linear human sexual sense of good feeling. The aforementioned reasons guide
response model by Masters and Johnson [4] and subse- the woman to willingly find out and consciously focus on
quently revised by Kaplan [5]. This model assumes linear the sexual stimulus. Stimuli are processed psychically un-
progression from the initial awakening of sexual desire to der the influence of biological and psychological factors,
arousal focusing on the vaginal moisture and lubrication, and the resulting condition is a subjective sexual excite-
up to orgasmic release and resolution. Resulting diagnostic ment. Continuous stimulation provides sexual arousal and
categories such as disorder of decreased sexual desire, fe- satisfaction that become more intensive, making them a
male sexual arousal disorder and orgasmic disorder reflect trigger of desire. Sexual satisfaction, with or without or-
linear genital model of sexual functioning. gasm, leads to the stimulation that is sufficiently continued
Recent reports of the International Committee, Ameri- and that the woman may remain focused, enjoying in sen-
can Foundation for Urologic Disease, question the need sation of sexual arousal and freed from negative outcome
for revision and expansion of the definitions of female such as pain [2].
sexual functioning [13]. The Committee relies on empiri- Recent study by Cain et al. [14] established the woman’s
cal and clinical studies as well as clinical experiences which reasons for having sex, such as expression of love, pleasure,
were the basis for the Second International Consensus of partner’s desire, tension-free feeling, or for not having sex,
Sexual Medicine [1] and Publications [1, 3]. such as lack of interest, fatigue or physical problems – hers
or partner’s, not having a partner. The authors’ findings as
well as the results of other studies were compatible with
Normal female sexual functioning sexual response presented in Figure 4. At the beginning
of sexual experience, the woman need not have sexual
Clinical and empirical studies on women who have no desire per se. Her motivation to be sexual is complex and
sexual complaints have come to the conclusion that includes augmentation of emotional closeness with her
sexual response differs from linear progression through partner (emotional intimacy) and frequently the increase

doi: 10.2298/SARH1304268D
Srp Arh Celok Lek. 2013 Mar-Apr;141(3-4):268-274 271

of her own good feeling and self-image (feeling of her own mental health as poorer. Healthier women reported 59%
attractiveness, femininity, being accepted and appreciated, lesser distress related to their sexual activities. The feeling
loved and/or desired, or diminishing of her own anxiety or of emotional closeness with their partner during sexual
feeling guilty for having sex so often) [15-19]. activity decreased from “mild distress” probability in 33%
When the woman wants to be aroused and enjoys in compared to “absence of distress” and “significant distress”
sexual experience, she is focused on the sexual stimulation in 43% of the time. In other words, the higher the degree
accomplished by her and her partner. If stimulation is de- of the emotional intimacy with her partner, the lesser the
sired and there is sufficient available time so that she could degree of distress. Other contextual factors reducing the
remain focused, her sexual arousal and pleasure becomes arousal include safety considerations (risks of unwanted
intensified. Naturally, the type of stimulation, required pregnancy and sexually transmitted diseases, emotional
time and context (erotic and interpersonal) are highly in- and physical security), lack of privacy, insufficiently erotic
dividual. Positive emotional and physical outcomes will situations, and lack of time or extreme haste.
augment the resulting motivation.
Some women report on spontaneous desire (Figure 4)
leading to excitement and higher enthusiasm to disclose or Personal psychological factors
to be receptive to sexual stimulus. There is a broad spec-
trum of such type of desire among women, and it may be Female arousal is frequently influenced by nonsexual distrac-
associated with menstrual cycle [20]; it grows with aging tions of everyday activities, and sometimes by sexual distrac-
[21] and in all age periods it commonly increases with new tions as well (e.g.: concern whether she will be sufficiently
relations [11, 19]. excited, achieve orgasm, and delayed or premature ejacula-
It is not clear how many women have a low sexual de- tion of the male partner or lack of female orgasm) [28]. Em-
sire or even the lack of spontaneous desire, and how many pirical studies demonstrated a high correlation of women’s
of them experience a trigger of desire during sex activity complaints about sexual desires with low self-image, unstable
[12, 22, 23]. Sexual fantasies could free the woman and temper and tendency to be worried and anxious (no criteria
accordingly she can stay focused on the sexual stimulus of clinical definitions of temper disorders) [29, 30].
rather than on the indication of sexual desire. Other inhibitory factors involved recollection of past
Robust correlation between subjective arousal and negative sexual experiences, including those that were
genital congestion (erection), established in men, cannot forced or abusive, and expectation of negative outcomes
be found in women [24, 25, 26]. Female sexual arousal of sexual experiences (e.g., dyspareunia or the partner’s
is more strongly modulated by thoughts and emotions sexual dysfunction) [31].
triggered by the state of sexual excitement [27]. Previous
definitions of sexual arousal disorders were focused only
on genital lubrication and/or moistening, having ignored Biological factors
numerous studies over the past twenty years which dem-
onstrated that there was a modest correlation of genital Lately, biological and pathophysiological background of
enlargement and female subjective experience of arousal normal and disordered female sexual response has drawn
as a reaction to sexual stimulation. the attention of many researchers. The majority of basic
sciences and animal experiments in the respective field
are far much broader than the framework of this paper,
THE CAUSES OF FEMALE SEXUAL DYSFUNCTION and therefore, only some significant results are presented.
Certain studies were concentrated on attempts to accom-
The model of the sexual response cycle (Figure 4) more plish a higher therapeutic efficiency and a higher degree of
clearly accentuates the significance of female ability to be- improvement, with the trend of avoiding drug side-effects
come subjectively aroused. Many psychological and bio- on female sexuality, as in the case of antidepressants.
logical factors may have negative effects on sexual arousal; Sexual dysfunction is a relatively common side-effect
interpersonal, contextual, personal and other. during the use of antidepressants [32, 33]. Among treated
women, much older, married women with a low to second-
ary-level education, and without full-time job were more
Interpersonal and contextual factors prevalent, and they used concomitantly drugs of various
types, had co-morbid conditions that could interfere with
A recent national study on sexual distress carried out sexual functioning or the history of antidepressant-related
on a sample of American heterosexual women [22, 23] sexual dysfunctions. In addition, they considered sexual
showed that emotional relations with the partner dur- functioning as irrelevant, resulting from earlier sexual expe-
ing sexual activity and general emotional good condition riences which provided little comfort and pleasure [34-37].
were two most potent predictors of distress absence in Current studies address the role of dopamine and other
sex. The women who ranked their mental condition as neurotransmitters, their effects on sex hormone receptors,
healthy (using the standard psychological instruments) as well as the impact of sex hormones on neurotransmit-
reported a lesser degree of distress related to their sexual ters. Animal experiments showed that estrogenized wom-
relations in comparison to women who evaluated their en changed their sexual behavior after the administration

www.srp-arh.rs
272 Damjanović A. et al. The Evolution of the Female Sexual Response Concept: Treatment Implications

of progesterone. The studies demonstrated that identical Diagnosis and treatment

changes occurred after dopamine use or in the presence
of a male [38, 39]. Intriguing is the study by Segraves et Considering that female sexual function is a result of an
al. on 75 non-depressive premenopausal women with the actual psychosocial and interpersonal context, which is
diagnosis of hypoactive sexual desire disorder (according determined to some extent by female sexual medical his-
to the DSM-IV), who received bupropion (antidepressant tory and medicaments, the International Committee [2]
- dopaminergic drug; the average dose of 389 mg/day) or recommended the evaluation of three factors that may
placebo [40]. The subjects treated with this drug exhibited effect sexual dysfunction: previous psycho-sexual devel-
significant improvement such as a higher level of satisfac- opment, actual life context and medical factors (including
tion, arousal and orgasm. It was noted that these changes co-morbid conditions, drugs and earlier surgical inter-
were followed by increased sexual drive. ventions).
New biological studies have investigated the role of Essentially, sexual dysfunction can be a symptom of
testosterone in sexual functioning. About a half of daily some other disorder. It is important to avoid pathologiza-
testosterone production in the woman originates from the tion of women by diagnosing the sexual disorder based on
ovaries. Some women with a sudden loss (reduction) of normal response, such as fatigue or side-effects of drugs.
ovarian androgen production lose sexual arousal. Recently, At the same time, it is vital to avoid the implication that
it has been reported that the physiological testosterone dysfunction would be absent or discredited, if the cause
supplementation in high doses (contrary to pharmaco- was not primarily identified in the patient.
logical evidence) leads to the increase of arousal and more Upon meticulous collection of data from the patient’s
intensive orgasmic experience, but not to more contempla- history, the therapeutist helps the female patient to con-
tion, fantasies or spontaneous wishes of sex [41]. struct her cycle of sexual response, which is then followed
To be reminded of animal models, and dopaminergic by the identification of the scope of the problems [13, 42].
or testosterone supplementation may augment the level of Such approach provides the insight and direction of many
arousal in some women, however, the same effect may be changes required from a woman and her partner. For ex-
achieved by changing the environmental factors (a new ample, the partner’s premature ejaculation can involve the
partner) [38, 40, 41]. subject of treatment, improvement of sexual context, treat-
ment of depression, prescription of local estrogen, advice
of the couple to undergo marriage therapy, and advice of
Definitions and prevalence one or both partners for referral to psychotherapy that
will be focused on the samples of reflection and behavior
Based on the latest work of the International Committee, resulting from probable traumas or negative experiences
American Urologic Foundation [2], the prevalence rates of from childhood or any later period of life.
recently defined categories was to a large extent unknown,
since little attention has been paid to subjective experience
of arousal. They used to be encompassed by the older term Conclusion
“hypoactive sexual desire disorder”, described by women
as the lack of spontaneous or initial desire, the deficit of Acceptance of an evidence-based conceptualization of
which was not included in the new definition of female women’s sexual response combining interpersonal, con-
sexual dysfunction. It is estimated that the prevalence of textual, personal psychological and biological factors has
hypoactive sexual desire among women of 30%-40% could led to recently published recommendations for the revision
be incorrect. If the lack of spontaneous or initial desire was of the definitions of women’s sexual disorders published
widely accepted as non-disorder, the number of women in the American Psychiatric Association’s Diagnostic and
diagnosed with sexual disorder would be significantly Statistical Manual (DSM–IV-TR). It is evidence-based data
lower as expected. that there is only a modest correlation between subjective
The official data on female orgasmic disorder are not experience of sexual arousal and objective measures of
reliable, considering that this disorder is frequently asso- increased genital vasocongestion.
ciated with arousal disorder; the DSM-IV-TR 2000 [10] Newly revised, expanded definitions of female sexual
postulates that female non-orgasmic level must be high dysfunctions strive to confirm and lead to new knowledge
so as to fit in the definition of female orgasmic disorder. of the highly contextual nature of female sexuality [43,
Data on the prevalence of dyspareunia or vaginism dif- 44]. They emphasize the value of assessing the context of
fer significantly from one study to another. A total cumula- women’s problematic sexual experiences and support the
tive incidence rate of the subjects reporting the inability of clinical treatment of dysfunctions. Definitions of sexual
having sex due to pain rated 10%. dysfunction continue to reflect the phases of sexual re-
The publications related to the prevalence of sexual sponse and clarify the tendency towards overlapping of
arousal and internet researches have appeared only recently. phases.

doi: 10.2298/SARH1304268D
Srp Arh Celok Lek. 2013 Mar-Apr;141(3-4):268-274 273

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274 Damjanović A. et al. The Evolution of the Female Sexual Response Concept: Treatment Implications

Еволуција концепта женског сексуалног одговора – импликације за лечење

Александар Дамјановић1,2, Драгана Дуишин1, Јасмина Баришић1
1
Клиника за психијатрију, Клинички центар Србије, Београд, Србија;
2
Медицински факултет, Универзитет у Београду, Београд, Србија

КРАТАК САДРЖАЈ с по­ре­ме­ћа­јем сек­су­ал­ног функ­ци­о­ни­са­ња. Мо­ди­фи­ка­ци­јом

Сек­су­ал­не дис­функ­ци­је су нај­пре­ва­лент­ни­ја гру­па сек­су­ал­ овог мо­де­ла на­кнад­но је на­стао цир­ку­лар­ни мо­дел, ко­ји је
них по­ре­ме­ћа­ја ко­је се ја­вља­ју код ве­ли­ког бро­ја осо­ба оба био пре­ци­зни­ји у пред­ста­вља­њу сек­су­ал­ног од­го­во­ра же­
по­ла. Ис­тра­жи­ва­ња сек­су­ал­ног по­на­ша­ња же­на, као и ле­че­ на с по­ре­ме­ћа­јем сек­су­ал­ног функ­ци­о­ни­са­ња, не­го же­на
ње же­на са сек­су­ал­ним дис­тре­сом, по­кре­ћу број­на пи­та­ња у с нор­мал­ним сек­су­ал­ним функ­ци­о­ни­са­њем. Не­ли­не­ар­ни
ве­зи с раз­ли­ка­ма у сек­су­ал­ном од­го­во­ру му­шка­ра­ца и же­на. мо­дел жен­ског сек­су­ал­ног од­го­во­ра ко­је је кон­стру­и­сао Ба­
Кон­цеп­ту­а­ли­за­ци­ја овог од­го­во­ра у са­вре­ме­ној сек­со­ло­ сон (Bas­son) ин­кор­по­ри­ра зна­чај емо­ци­о­нал­не ин­тим­но­сти,
ги­ји вре­ме­ном се ме­ња­ла. Циљ овог ра­да је да про­ме­не и сек­су­ал­ног сти­му­лу­са и за­до­вољ­ства парт­нер­ским од­но­сом.
ево­лу­ци­ју кон­цеп­та жен­ског сек­су­ал­ног од­го­во­ра при­ка­же Функ­ци­о­ни­са­ње же­на је зна­чај­но под ути­ца­јем број­них пси­
на са­жет, ин­те­гра­ти­ван на­чин, по­том да при­ка­же и ана­ли­ хо­со­ци­јал­них фак­то­ра, као што су за­до­вољ­ство парт­нер­
зи­ра пре­по­ру­че­не про­ши­ре­не и ре­ви­ди­ра­не де­фи­ни­ци­је ским од­но­сом, сли­ка о се­би, прет­ход­на не­га­тив­на сек­су­ал­на
жен­ског сек­су­ал­ног функ­ци­о­ни­са­ња, као и им­пли­ка­ци­је и ис­ку­ства и сл. Но­ве ре­ви­ди­ра­не и про­ши­ре­не де­фи­ни­ци­је
пре­по­ру­ке но­вих при­сту­па ди­јаг­но­сти­ци и ле­че­њу у скла­ сек­су­ал­них дис­функ­ци­ја код же­на по­ку­ша­ва­ју да до­при­не­су
ду с утвр­ђе­ним про­ме­на­ма. Не­до­ста­так од­го­ва­ра­ју­ће ем­пи­ но­вим са­зна­њи­ма о кон­тек­сту­ал­ној при­ро­ди жен­ске сек­су­
риј­ске осно­ве мо­де­ла жен­ског сек­су­ал­ног од­го­во­ра је кри­ ал­но­сти, као и да по­бољ­ша­ју ефи­ка­сност кли­нич­ког ле­че­
тич­но пи­та­ње у ли­те­ра­ту­ри ко­ја се ба­ви овом те­ма­ти­ком. ња дис­функ­ци­ја. Де­фи­ни­ци­је на­гла­ша­ва­ју зна­чај ева­лу­а­ци­је
По­је­ди­ни ра­до­ви ука­зу­ју на то да ли­не­ар­ни мо­дел мно­го кон­тек­ста про­бле­ма­тич­них жен­ских сек­су­ал­них ис­ку­ста­ва.
тач­ни­је и пре­ци­зни­је при­ка­зу­је сек­су­ал­ни од­го­вор же­на с Кључ­не ре­чи: же­не; сек­су­ал­ни од­го­вор; ле­че­ње; сек­су­ал­но
нор­мал­ним сек­су­ал­ним функ­ци­о­ни­са­њем у од­но­су на же­не по­на­ша­ње, сек­су­ал­не дис­функ­ци­је

Примљен • Received: 13/07/2011  Прихваћен • Accepted: 12/08/2011

doi: 10.2298/SARH1304268D