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Sexual Function in People with Disability and Chronic Illness: A Health Professional s Guide Gaithersburg, MD: Aspen Publishers Inc, 1997, pp 511 536 Phillips NA Female sexual dysfunction: evaluation and treatment Am Fam Physician 2000;62:127 136, 141 142 Heiman, JR Orgasmic disorders in women In Leiblum SR, Rosen RC, eds Principles and Practice of Sex Therapy New York: Guilford, 2000 Barbach LG For Yourself: The Ful llment of Female Sexuality New York: Doubleday, 1975 Graber B, Kline-Graber G Female orgasm: role of the pubococcygeus J Clin Psychiatry 1979;30:34 39 Perry JD, Whipple B Pelvic muscle strength of female ejaculators: evidence in support of a new theory of orgasm J Sex Res 1981;17:22 39 Perry JD, Whipple B Multiple components of the female orgasm In: Graber B, ed Circumvaginal Musculature and Sexual Function New York: S Karger, 1982, pp 101 114 Graziottin A Implicazioni psicosessuali dell incontinenza femminile (Psychosexual implications of female incontinence), Rivista Italiana di Colon-Proctologia 1996;15(4):249 252 Belzer E, Whipple B, Moger W On female ejaculation J Sex Res 1984;20:403 406 Addiego F, Belzer EG, Comolli J, Moger W, Perry JD, Whipple B Female ejaculation: a case study J Sex Res 1981;17:13 21

Tunnel establishment is distinct from tunnel maintenance One of the challenges is detecting the failure of a specific tunnel within some trunking mechanism that carries multiple trunks To accomplish this, some sort of per-tunnel keepalive mechanism is needed Such a mechanism can be part of the tunneling protocol itself, such as the optional L2TP keepalive Alternatively, the provider can send pings or other test traffic across the tunnel Especially in multiple virtual router schemes, routing protocol traffic can be useful as a keepalive When the routing information is outside the tunnel, as in BGP/MPLS VPNs, other mechanisms are preferable Tunnels may be established using hard-state or soft-state mechanisms The hard-state approach can still establish a lifetime for the tunnel, as with the key lifetime field in the IPSec security association A soft-state approach takes down the tunnel after no traffic has passed for some predefined period of time Tunnel establishment can also be triggered by a provisioning process

Pain is almost never psychogenic, except for pain from grieving Pain has biologic basis; when it is the alerting signal of an impending or current tissue damage from which the body should withdraw, it is de ned as nociceptive [1] When pain becomes a disease per se, that is, generated within the nerves and nervous centers, it is called neuropathic [1 3] It is a complex perceptive experience, involving psychologic and relational meanings, which may become increasingly important with the chronicity of pain [1 3] Sexual pain disorders dyspareunia and vaginismus are very sensitive issues, as the pain involves emotionally charged behaviors: sexual intimacy and vaginal intercourse [4 6] Most patients have been denied for years that their pain was real, and therefore feel enormously relieved when they nally meet a clinician who trusts their symptoms and commits him/herself to a thorough understanding of the complex etiology of their sexual pain Talking with patients about sexual pain disorders requires special attention to the sensitivity of the issue and an empathic attitude to the biologic truth of pain [7] This is the basis of a very rewarding clinician patient relationship and is the basis of an effective therapeutic alliance

It may be necessary to provision the VPN infrastructure through multiple service providers In such cases, the providers will need interprovider provisioning and VPN identification Much as a BGP confederation presents a single AS number to the outside but contains multiple internal ASNs, a multiprovider VPN identifier may map to a set of publicly visible ASNs While BGP may be used to convey VPN reachability information among providers, the actual destinations may be prefixed with VPN IDs and carried using the BGP-4 multiprotocol

Dyspareunia de nes the persistent or recurrent pain with attempted or complete vaginal entry and/or penile vaginal intercourse [8] Vaginismus indicates the persistent or recurrent dif culties of the woman to allow vaginal entry of a penis, a nger, and/or any object, despite the