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AASECT How Hormones & Neurotransmitters Impact Sexual Function

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How Hormones & Neurotransmitters Impact Sexual Function: Coordinating Testing, Evaluation & Treatment Methods Between Medical & Non-Medical Practitioners - AASECT Annual Conference 2011

How Hormones & Neurotransmitters Impact Sexual Function: Coordinating Testing, Evaluation & Treatment Methods Between Medical & Non-Medical Practitioners - AASECT Annual Conference 2011


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  • Thank you for being so generous. There were so many sessions at once this lets us all learn together! Patti
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  • 1. How Hormones and Neurotransmitters Impact Sexual Function:
      Mark Kim Malan PhD, MPH, DACS
    • Colette Malan MSW, LCSW
    • 2. AASECT Annual Conference 2011
    • 3. Copyright 2011 Additional material used by permission and fair use
    Coordinating Evaluation, Testing & Treatment Methods between Medical and Non-Medical Practitioners
  • 4. Speakers Disclosure: We have no financial relationships or affiliations to disclose.
  • 5. Our target audience (Are you at the right presentation?)
    • Non-medically trained sexologists, educators, counselors, therapists, & researchers
    • 6. Medically trained providers who wish to coordinate patient care with non-medical sexual health providers (physician & therapist)
    • 7. Want a basic understanding of hormones & neurotransmitters that impact sexuality
    • 8. Want to know basics about hormonal lab tests
  • 9. Need for Multidisciplinary Sexuality Health Care
      “...the challenge sexual medicine is facing today is... to blend together a 'medicine without a soul' which pays little attention to the emotions, concerns, and affective dynamics associated with medical illnesses, and a 'psychology without a body' , which still under appreciates the neurobiologic basis for any feeling, memory, emotion or thought”. Graziottin, A. (2006). Introduction to female sexual disorders. In Porst, H. & Buvat, J. (eds), Standard Practice in Sexual Medicine, p. 287, Blackwell, Malden, MA.
  • 10. Our goal – Meet that need
    • Our daily clinical experience involves coordinating our clinical sexology, sex therapy & psychotherapy practice with OB/GYN's, urologists, endocrinologists, compounding pharmacists, and other medical specialists.
    • 11. Often these professionals tell us they lack specific training in sexual side effects of drugs, hormonal imbalance & treating sexual problems.
    • 12. Knowing about drug side effects, hormones, neurotransmitters and lab tests is essential in coordinating our patient care with these providers.
  • 13.
      What this presentation provides:
    • Assumes no prior knowledge of hormones
    • 14. A basic overview and introduction to hormones & neurotransmitters
    • 15. Basics of how they function in sexuality
    • 16. How to use testing to measure them
    • 17. How to coordinate treatment between therapists and medical providers
    • 18. Suggested resource books for further in depth reading and independent study.
  • 19.
      What this presentation is not:
    • Not a substitute for a comprehensive course in endocrinology and neuroscience
    • 20. Does not cover many details or the in-depth functions of hormones & neurotransmitters
  • 21. Hormone Basics: Lets get in touch with our own hormones and neurotransmitters ...right now brain
  • 22.
      How do you feel right now?
    • Notice
  • 27. Think of stepping on a rattlesnake. What emotion do you feel?
  • 28. Catch a snowflake on your tongue. What emotions do you feel?
  • 29. Think of a Romantic kiss. What emotions do you feel?
  • 30. When life gets really funny what emotions do you feel?
  • 31.
      Thoughts trigger Emotions Emotions trigger Thoughts
  • 32. Our moods are created by Hormones & Neurotransmitters
  • 33. Lets take a closer look at how they act inside the body
  • 34.
      Basics - hormones
    • Q. What is a hormone?
    • 35. A chemical secreted into blood by endocrine glands or specialized glandular cells in brain, viscera, or neuroendocrine system.
    • 36. They circulate and affect target organs & cells that have receptors for them.
    • 37. They are regulated by other hormones, neurotransmitters or feedback loops.
    • 38. Hormones are “dictators” they tell other substances what to do and how to behave. Some are “bullies” wrecking havoc in human moods and behavior.
  • 39.
      Basics - Neurotransmitters
    • Q. What is a neurotransmitter?
    • 40. A chemical produced and released by brain or nerve cells to induce activity in other brain or nerve cells.
    • 41. Like hormones, they can be “dictators” and “bullies” of human moods and behavior.
  • 42.
      Basics - glands
    • Q. What is a gland?
    • 43. A. An organ that manufactures and secretes a product.
    • 44. There are two major kinds:
      • Endocrine – Makes and releases its product directly into the blood/lymph
      • 45. Exocrine- discharges its products through ducts into intestines or outside the body
  • 46.
      Basics - glands
    • Major Endocrine glands
      • Pituitary, hypothalamus, pineal, thyroid, parathyroid, thymus, adrenal, pancreas, ovaries, testes
    • Major Exocrine glands
      • Tear glands, salivary, mammary, liver, intestinal glands, sweat, bulbo-urethral or Cowper’s (male), Bartholin’s (female), sebaceous
  • 47.
      Location of Endocrine Glands
  • 48.  
  • 49.
      Endocrine glands primary to sexual function
  • 54.
      Endocrine glands commonly associated with basic sexual functions
  • 55.
      Location of Pituitary Gland
  • 56.  
  • 57.  
  • 58.
      Basic Structure & Hormones Master glands that regulate other glands and body systems
  • 59.
      Hypothalamic Hormone Regulation of Pituitary Hormone Release
  • 60.
      Feedback loop (example - testis)
  • 61.
      Hypothalamic & Pituitary Hormonal Mechanisms
  • 62.
      Basic Structure & Hormones Regulates other glands & multiple body systems
    • Mineralcorticoids
      • Electrolyte balance
    • Glucocorticoids
      • Metabolism-Pro/Fat/Carb
    • Androgens/Estrogens
      • Gonads & Sexuality
    • Norephinephrine
      & Ephinephrine (Vasoconstrictors) (Active in attraction) Cardiac, arterial, gastrointestinal, & metabolic rates
  • 63.
      Basic Structure & Hormones Regulates fertility, sexual characteristics & behavior
  • 64.
      Basic Structure & Hormones Regulates fertility, sexual characteristics & behavior
  • 65.
      Endocrine Glands secondary to sexual function
  • 66.
      Basic Structure & Hormones Appears to regulate puberty and fertility
    • Only organ to produce melatonin
    • 67. Converts serotonin to melatonin
    • 68. Melatonin inhibits ovarian growth
    • 69. 2 nd only to kidney in high blood flow
  • 70.
      Basic Structure & Hormones Regulates metabolism and blood calcium/phosphorous
  • 71.
      Basic Structure & Hormones Regulates immune system/lymphocytes and cell functioning
  • 72.
      Basic Structure & Hormones Circulates hormones, regulates blood pressure and adrenal gland
    • Atrial natriuretic peptide (ANP)
      • Enhances urinary excretion of sodium & regulates blood pressure and adrenal hormone release
  • 73.
      Basic Structure & Hormones Regulates smooth muscle vasodilation & blood
    • Prostaglandins
      • Mediator of erection & lubrication (Smooth muscle dilation and tissue sensation)
    • Erythropoietin
      • Regulates blood cell production
    • Renin
      • Regulates blood volume & thirst
  • 74.
      Basic Structure & Hormones Regulates digestion and energy production
  • 75.
      Basic Structure & Hormones Regulates metabolism, digestion & energy
  • 76.
      The Hormonal Mobile
    • Sexual chemistry is produced in a variety of locations.
    • 77. Body systems interact holistically.
    • 78. As in an artists mobile, change in one hormonal element can effect changes elsewhere in body systems.
    • 79. Sexual function can be affected indirectly by hormones other than the primary “sex” hormones.
  • 80.
      Major Hormones & Neurochemistry that affect sexuality
  • 81.
      “ Sex Soup”
    • “ Clearly, our mating dance, the desires that drive and frustrate us, the bonds we make, the love we give and take, the hearts we break, the differences that delight and infuriate us, the mystery of attraction, 'sexual chemistry,’ the agonies and ecstasies of intimacy - all this and more, is influenced by the ever-changing bouillabaisse of chemicals in our bodies that I think of as sex soup.”
      (Crenshaw, 1996, The Alchemy of Love & Lust)
  • 82.
      Meet the Love Brigade (Ingredients of “Sex Soup”)
    • 1. DHEA – Desire
    • 83. 2. Pheromones – Attract (sensual intimacy from scent)
    • 84. 3. Oxytocin – Bonding (“superglue” triggered by touch)
    • 85. 4. PEA – Euphoria (the romantic “love” molecule)
    • 86. 5. Estrogen – Receptive (receptive sex drive)
    • 87. 6. Testosterone – Desire (assertive sex drive)
    • 88. 7. Serotonin – Switches sex drive on & off
    • 89. 8. Dopamine – Pleasure (“addicts” us to each other)
    • 90. 9. Progesterone – Repels (kills sex drive, promotes nurturing)
    • 91. 10. Prolactin – Diminishes Sex Drive (stimulates nursing)
    • 92. 11. Vasopressin – Regulates desire & attachment (monogamy)
    • 93. Supporting Cast - Over 30 other chemicals that influence sexuality in some way
      The Alchemy of Love and Lust , Crenshaw, T.L., (1996)
  • 94.
      Sex soup du jour
    • Hormones fluctuate in hourly, daily, monthly & seasonal cycles
    • 95. Instead of asking, “What sign are you?”, sexologists want to know “What hour, or day, is your hormonal cycle in?”
  • 96.
    • Sexual Hormone Peaks (sex soup menu)
    • Females cycle monthly
    • 97. Testosterone High
    • 98. Estrogen High
    • 99. Ovulating
    • 100. Progesterone High
    • 101. PMS
    • 102. Males & Females have distinct predictable sexual stages that change their nature each decade
    • Males cycle daily
    • 103. AM Testosterone peaks
    • 104. Hourly mini-cycles of hormones
  • 105.
      Basic Sex Hormone & Neurochemical Profiles (Love Brigade Close-ups)
  • 106.
      DHEA Profile
    • DHEA (Dehydroepiandrosterone)-steroid hormone
    • 107. Significant affect: Desire
    • 108. Nickname: Mother of all hormones
    • 109. Produced- Adrenal Glands
      • (secondary production – ovaries, testicles & brain)
    • Function
      • The most abundant hormone in the human body
      • 110. Most sex hormones are derived from DHEA
      • 111. Involved in sex drive, orgasm, and sex appeal
        • Increases drive more in women than men
        • 112. Pheromone precursor
      • Exercise increases DHEA - Birth control pills decrease
      • 113. Peaks at age 25 then declines
  • 114.
      Pheromone Profile
    • Odorous skin secretion derived from DHEA
    • 115. Significant affect: Attraction
    • 116. Nickname: Perfume (come hither)
    • 117. Produced – Various sites / skin
    • 118. Function
      • -Attractant transmitted through scent
      • 119. -Creates a sense of well-being and intimacy
      • 120. -Produces more sensual feeling than raw lust
      • 121. -May act on brain & nervous system through the
      • 122. vomero nasal organ (VMO)
      • 123. -Animals use to mark territory/repel competition as well as to attract
  • 124.
      Oxytocin Profile
    • Hormone
    • 125. Significant affect: Bonding
    • 126. Nickname: Hormonal superglue
    • 127. Produced – Hypothalamus
    • 128. Function
      • Human bonding (mating, parenting, sex)
      • 129. Spikes during orgasm
      • 130. Produced in response to, or anticipation of, touch
      • 131. Stimulates uterine contractions in delivery
      • 132. May stimulate contractions of ejaculatory tract
      • 133. Causes contraction of alveoli in mammary glands forcing milk into the nipples
  • 134.
      PEA Profile phenylethelamine
    • Significant Affect: Euphoria
    • 135. Nickname: The love molecule
    • 136. Produced – In brain neurons
    • 137. Function
      • “ In love” euphoria (amphetamine like substance)
      • 138. Stimulant, spikes at orgasm, ovulation
      • 139. Causes giddiness and excitement
      • 140. Found in chocolate and nutrasweet
      • 141. Acts like a diet pill – appetite supressant
      • 142. Stimulated by anticipation, erotica or fantasy
      • 143. May be significant in “love at first sight”
  • 144.
      Estrogen Profile
    • Hormones (estradiol, estrone, estriol)
    • 145. Significant affect: Receptivity
    • 146. Nickname: Marilyn Monroe
    • 147. Produced - adrenal glands, ovaries, testes, adipose tissue (fat), and the brain
    • 148. Function-
      • Sexual differentiation & development
      • 149. Receptive sex drive and sexual frequency
      • 150. Vaginal lubrication, body scent & texture
      • 151. Stabilizes mood and improves cognition & reactions
      • 152. Prevents heart disease, osteoporosis, schizophrenia
      • 153. Mild antidepressant
      • 154. Improves sense of taste and smell
  • 155.
      Testosterone Profile
    • Hormone (steroid)
    • 156. Significant affect: Assertive
    • 157. Nickname: Nature’s Aphrodisiac
    • 158. Produced - adrenal glands, ovaries, testes, & some perephial tissues
    • 159. Function-
      • Sexual differentiation & development
      • 160. Assertive & compelling sexual desire in all sexes
      • 161. Antidepressant in all sexes
      • 162. Is pulsatile (15 min), fluctuates daily and seasonally
      • 163. Increases erotic thought and fantasy
      • 164. Males average 10 times the T level of women
  • 165.
      Serotonin Profile
    • Neurotransmitter (5-HT)
    • 166. Significant Affect: Inhibitory (Modulator)
    • 167. Nickname: Dr. Jekell
    • 168. Produced – In brain neurons
    • 169. Function
      • Regulates sexual aggressiveness & partner discrimination (high cool/low hot)
      • 170. High S = (hyposexual) Peaceful, sexually selective, inhibits drive & orgasm
      • 171. Low S = (hypersexual) Aggressive, sexually indiscriminate, anxious, impulsive, rapid ejaculation
      • 172. More abundant and influential in females
  • 173.
      Serotonin / Testosterone Seesaw
      Testosterone
      Serotonin
      Serotonin
      Testosterone
      Female Natural State Male Natural State
      There is good evidence that when one substance is up the other is down
  • 174.
      Dopamine Profile
    • Neurotransmitter
    • 175. Significant Affect: Pleasure
    • 176. Nickname: Pleasure Junkie
    • 177. Produced – Hypothalamus
    • 178. Function
      • Gives pleasure & motivates action
      • 179. Intrinsic to sexual attraction, desire, arousal, response, orgasm and satisfaction
      • 180. May be what “addicts” us to each other
      • 181. Neurochemical of physical addiction/substance abuse
      • 182. Increases sex drive & facilitates orgasm
      • 183. Reciprocal to oxytocin
  • 184.
      Progesterone Profile
    • Hormone
    • 185. Significant Affect: Inhibitory
    • 186. Nickname: Antiaphrodisiac
    • 187. Produced – Ovary (in the corpus luteum)
    • 188. Function
      • Promotes nurturing and protective behavior and supports breast feeding
      • 189. Inhibits sex drive
      • 190. Decreases testosterone, genital sensation, touch perception, pheromone transmission and perception, uterine contractibility, sensitivity to oxytocin
      • 191. Reduces dopamine & pleasure
      • 192. Can cause depression and irritability
      • 193. Increases fluid retention & weight gain
  • 194.
      Prolactin Profile
      • Lactation
      • 199. Cause of low sex drive in nursing mothers
      • 200. Sexually inhibiting (in men & women)
      • 201. Involved in sperm production & genital maintenance
      • 202. Surges during stress
      • 203. High levels decrease testosterone
  • 204.
      Vasopressin Profile
    • Hormone
    • 205. Significant Affect: Modulates desire
    • 206. Nickname: Monogamy molecule
    • 207. Produced – Pituitary
    • 208. Function
      • Modulates testosterone
      • 209. Has a “tempering” influence on social sexual behavior and pheromonal communication
      • 210. Improves memory and cognition
      • 211. Activates attention and focus on sexual stimuli
  • 212.
      Sexually Excitatory Endogenous Substances
      Sexual Pharmacology – Crenshaw & Goldberg (1996) p.39
  • 231.
      Sexually Inhibiting Endogenous Substances
      Ang II and NPY
      Sexual Pharmacology – Crenshaw & Goldberg (1996) p.40
  • 243.
      Basic Ovarian Function
  • 244.
      The Ovary
  • 245.
      Pituitary/Ovary/Endometrium Cycle
  • 246.
      Production Rate of Sex Steroids in Women at Different Stages of the Menstrual Cycle
       
      DAILY PRODUCTION RATE
      SEX STEROIDS*
      Early Follicular 
      Preovulatory 
      Midluteal
      Progesterone (mg)
      1
      4
      25
      17-Hydroxyprogesterone (mg)
      0.5 
      Dehydroepiandrosterone (mg)
      7
      Androstenedione (mg)
      2.6
      4.7
      3.4
      Testosterone (  g)
      144 
      171 
      126 
      Estrone (  g)
      50 
      350 
      250 
      Estradiol (  g)
      36
      380
      250
      From Baird DT. Fraser IS. Blood production and ovarian secretion rates of esuadiol-17  and estrone in women throughout the menstrual cycle. J Clin Endocri-nol Metab 38: l009-1017. 1974. @ The Endocrine Society.
      *Values are expressed in milligrams or micrograms per 24 hours.
      Table 1. Production Rate of Sex Steroids in Women at Different Stages of the Menstrual Cycle
       
      DAILY PRODUCTION RATE
      SEX STEROIDS*
      Early Follicular 
      Preovulatory 
      1
      25
      Androstenedione (mg)
      2.6
      4.7
      3.4
      Testosterone (  g)
      144 
      171 
      126 
      Estrone (  g)
      50 
      350 
      250 
      Estradiol (  g)
      36
      380
      250
      From Baird DT. Fraser IS. Blood production and ovarian secretion rates of esuadiol-17  and estrone in women throughout the menstrual cycle. J Clin Endocri-nol Metab 38: l009-1017. 1974. @ The Endocrine Society.
      *Values are expressed in milligrams or micrograms per 24 hours.
  • 247.
      Female Cyclic Hormonal Behavioral Patterns
    • The “four seasons” of love
      • Seductive (proceptive) high gear
        • Testosterone
      • Assertive (active) low gear
        • Estrogen & Oxytocin
      • Receptive (passive) neutral
        • Estrogen
      • Aversive (negative) reverse
        • Progesterone, prolactin, vasopressin & serotonin
      • The Alchemy of Love and Lust (Crenshaw, T.L., 1997 pp 169-174).
  • 248. Biochemical Behavioral Interactions for 'Love'
    • 3 Behavioral Biochemical/Brain Systems
      • Sex Drive System (Libido/Lust)
        • androgens & estrogens (inhibitory-progesterone)
      • Attraction System
        • dopamine, norepinephrine & decreased serotonin
      • Attachment System
        • oxytocin & vasopressin
      Fisher, H.E., Aron, A., Mashek, M.A. et al. (2002). Defining the brain systems of lust, romantic attraction & attachment. Archives of Sexual Behavior, 31(5), 413-419.
  • 249. How can AASECT Educators, Counselors and Therapists apply this knowledge in the real world?
  • 250.
      Clinical, Educational & Research Applications of Hormone Measures
    • Sexual functioning
      • Adjust hormone levels
    • Gender identity
      • Masculinize or feminize
    • Fertility & Birth Control
      • Regulate conception
    • Sex offenders
      • Adjust hormone levels
    • Research
      • Measure hormonal effects
  • 251. Development of the biopsychosocial model and multidisciplinary sexuality health care
  • 252.
      Iwan Bloch M.D 1872-1922
    • Bloch, an early founder of sexual science, coined the term “sexualwissenschaft” (sexology).
    • 253. The sexologist views sexual life from a “centralized standpoint” among the comprehensive whole of available knowledge.
      Bloch, I. (1907) The Sexual Life of Our Time
  • 254.
    • Viewing sexual life from a “centralized standpoint” makes sexology multi-disciplinary in nature
    • 255. It is difficult to be an expert in the many disciplines that encompass sexology
    • 256. Basic understanding of endocrinology and its influence on sexuality is an essential part of being a sexologist, sex educator, counselor or therapist
      Sexology
      Arts
      Sciences
      Law
      Theology
      etc
  • 257.
      Biopsychosocial Model of Sexuality Heathcare
    Developed by Engel & Romano 1970-80's Recognizes a need for a multidisciplinary approach to diagnosis & treatment. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136. Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544.
  • 258. Biopsychosocial Model
  • 259.
      Biopsychosocial Sexual Influences
  • 260.
      Biopsychosocial Assessment
    • Sample Assessment - 22 year old married female
    • 261. Diagnosis - Hypoactive Sexual Desire & Vaginismus
  • 262. Comprehensive Care
      Tremendous benefit can be derived from medications that treat and cure sexual problems. They are valuable supplements to therapy, it is critical that they not be used as substitutes for therapy. Chemicals should not be used to depersonalize sex, or transform it into a mechanically successful event that disregards the emotional context of the individual or relationship.
                  • Crenshaw & Goldberg (1996) Sexual Pharmacology
  • 263. Need for teamwork
      “ ...nonphysicians need to be informed about the type of medications that can interfere with psychotherapy and sex therapy...both patients and physicians often have difficulty in discussing sexual issues...many physicians are unaware of their own ignorance in this area.”
                  • Crenshaw & Goldberg (1996) Sexual Pharmacology
  • 264.
      How Hormones are Measured with Lab Tests
    • Physician ordered tests
    • 265. Patient ordered tests
    • 266. Using mail in saliva & blood samples
    • 267. Benefits
      • Easy to use “home use” kits
      • 268. Patient/Client takes/submits sample
      • 269. Encloses payment and mails to lab
      • 270. Lab reports to health care provider and patient
  • 271. Lab Test Examples Case A
    • Married Female age 24 (premenopausal)
    • 272. Hypoactive Sexual Desire
    • 273. High Stress (2 yr old & Student)
    • 274. Anxiety
    • 275. Psychosexual shame (faith based)
    • 276. Relationship conflict (communication)
  • 277. Case A
  • 278. Lab Test Examples Case B
    • Single sexually active female age 80 (postmenopausal)
    • 279. Using estrogen replacement
    • 280. Noticing diminished libido
    • 281. Usually highly interested in sex
    • 282. Very sex positive
    • 283. Reports
      • Bone loss and hearing loss
      • 284. Aches, pains, & weight gain
  • 285. Case B
  • 286. Lab test examples Case C
    • Married female age 56 (postmeopausal)
    • 287. Bio-identical hormone replacement
    • 288. Hypoactive sexual desire
    • 289. Stress
    • 290. Anxiety
    • 291. Decreased stamina
  • 292. Case C
  • 293.
      Gender identity & hormones
    • Transsexual, Transvestite, Transgenderist, Androgyne, Intersex, etc. individuals may be interested in hormone therapy.
    • 294. Many gender specialists follow guidelines for standards of care or guidelines.
      • HBIGDA - Harry Benjamin International Gender Dysphoria Association
      • 295. IFGE – International Foundation for Gender Education
      • 296. AEGIS – American Educational Gender Education Service
  • 297.
      Common Hormone use with gender identity
    • MTF
      • Estrogen
      • 298. Progesterone
      • 299. Anti-androgen drugs
        • Spironolactone, Flutamide, Cyproterone Acetate
      • Orchidectomy
    • FTM
      • Testosterone
      • 300. Oophorectomy/Hysterectomy
      Transgender Care , Israel & Tarver, 1997
  • 301. Conclusion
    • Sexual science today recognizes the need for comprehensive biopsychosocial management of sexual concerns.
    • 302. Psychosocial sexuality care providers can better serve their patients/clients by understanding sexual biochemistry (hormones, neurotransmitters & drug affects)
    • 303. Medical & non-medical providers need to coordinate sexual health care treatment
  • 304. Sexuality Specialists often need to coordinate professional care
    • Bio - Medical
    • Psychosocial - Therapy
  • 305.
      Main References
    • How the Endocrine System Works , Neal, J.M., (2001).
    • 306. Sexual Pharmacology , Crenshaw, T.L. & Goldberg, J.P. (1996).
    • 307. Standard Practice in Sexual Medicine, Porst, H. & Buvat, J. (eds), (2006).
    • 308. The Alchemy of Love & Lust , Crenshaw, T.L. (1996).
    • 309. The CIBA Collection of Medical Illustrations 6 Vols . Netter, F.H. (1997).
    • 310. The Endocrine System , Anatomical Chart Co. (2000).
    • 311. The Science of Orgasm, Komisuruk, B.R. et al
    • 312. (2006).
    • 313. Why We Love, Fisher, H. (2005).
    • 314. www.endotext.org