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Table 241 Differential diagnosis Incontinence at orgasm Weak pelvic oor muscles Contains: urea, creatinine Volume: >15 ml Urine characteristics Associated with daily or night symptoms of incontinence Intensity of orgasm may be inhibited for fear of leaking Urodynamic examinations indicate detrusor instability Female ejaculation Strong pelvic oor muscles Contains: glucose, fructose, prostatic speci c androgen, prostatic acid phosphatase Volume: 3 5 ml Clear, pale white liquid with no urine No symptoms of urgency and/or stress incontinence Is associated with intense pleasure at orgasm Urodynamic examination shows a continent bladder

The VPN exists to carry data Tunnels interconnect user nodes, but the tunnels usually need protocols for their own operation Most tunnels need some sort of encapsulation of user data before they can carry it

What you need, and for how long; Why you need it; and The way you hope their participation will benefit them A realistic and confident attitude about the amount you need, and willingness to offer a competitive return (either through interest payments, a share of the cash flow if it s an income-producing property, or a stake in the property itself that will deliver a return when you decide to sell the property see also the section on partnership in this chapter) bolsters your ability to secure the support you need Setting a realistic time frame for the investment will also give your potential financier the information required to decide whether to buy in Because you re approaching someone you know, be sure to limit the potential for personal conflict by having a legal agreement in place that safeguards interests on all sides Don t let the convenience of tapping a friend for the cash you need become a source of bad feeling You want the deal to be a winning prospect for all concerned By the same token, don t promise something you can t deliver

Modi ed from Graziottin (1996) [40], Belzer et al (1984) [41], Addiego et al (1981) [42], Ladas et al (2005) [30], and Zaviacic (1999) [32]

13

Orgasmic Disorders in Women Based on the information emerging from the clinical history, the healthcare provider should look for: Hormonal balance Signs and symptoms of vulvar dystrophia and, speci cally, of clitoral and vaginal involution and traumatic consequences of ritual genital mutilation Signs and symptoms of incontinence, or of either hypotonic or hypertonic pelvic oor, or female ejaculation (education and permission-giving is needed here) Iatrogenic in uences, when potentially orgasmicinhibiting drugs are prescribed

It is now fair to say that all serious proposals for provider-provisioned VPNs are based on some kind of tunneling Dial-up VPNs involve the provider, but are really customer-provisioned There are a variety of tunneling protocols available today, all of which were developed for purposes other than VPNs (see Table 132) Some of these protocols may need extensions to make them more VPN-friendly Think of a tunnel as a simulated layer 2 link onto which the VPN imposes its IP That the tunnel itself uses IP internally is irrelevant to the VPN user To create any tunnel in a VPN environment, the appropriate protocols need to be aware of:

Some people make a habit of treating their family differently than they treat their friends Ironically, that sometimes means worse rather than better However, we feel strongly that you should treat everyone with whom you do business in a professional manner That s especially true of family, because the close relationship and trust you have with them is more at jeopardy where money s involved Although family members can help boost your own resources, and even provide expertise when it comes to real estate investing, make sure you manage the relationship properly This includes everything from the moment you raise the possibility, through any challenges or difficulties you face, right up to the time you cash out and distribute the proceeds of the investment Approaching family to invest in your next real estate venture doesn t always have to be an option of last resort In several situations it s more than just a convenient idea, it s good business sense, too: When a family member has the cash you need to close a deal When a family member has not only cash but also expertise that can help you develop your investment portfolio as well as your investing skills When a family member is willing to become a full partner and meets the criteria you would set for any other business partner

1 Persistence and recurrence despite active intervention 2 Erectile dysfunction It is estimated that more than 25% of patients with priapism will have some degree of ED