Sexual Dysfunction

Chapter 152 Sexual Dysfunction




Clinical Case Problem 1: A 65-Year-Old Man with Hypertension and Erectile Dysfunction


A 65-year-old man with hypertension, congestive heart failure, and peptic ulcer disease comes to your office for his regular blood pressure check. Although his blood pressure is now under control, he complains of an inability to maintain an erection. He is currently taking α-methyldopa, propranolol, verapamil, hydrochlorothiazide, and cimetidine.


On examination, his blood pressure is 125/76   mm Hg. His pulse is 56 beats/minute and regular. The rest of the cardiovascular examination and the rest of the physical examination are normal.



Select the best answer to the following questions




1. Which of the following medications is the least likely to be the cause of this patient’s erectile dysfunction (ED)?


a. α-methyldopa

b. propranolol

c. verapamil

d. hydrochlorothiazide

e. cimetidine

2. Which of the following is generally considered to be the most common cause of sexual dysfunction in both men and women?


a. pharmacologic agents

b. panic disorder

c. generalized anxiety disorder (GAD)

d. major depressive disorder (MDD)

e. dysthymic disorder

3. Which of the following is considered a normal change in sexual functioning in the aging male?


a. increased time needed to achieve erection

b. decreased need for direct tactile stimulation to promote erection

c. inability to maintain erection between ejaculations

d. increased forcefulness of ejaculation

e. increasing presence of hemospermia

4. Which of the following is the most common sexual complaint in younger men?


a. hypoactive sexual desire disorder

b. male erectile disorder

c. orgasmic disorder

d. premature ejaculation

e. none of the above

5. Which of the following is the most common sexual complaint in older men?


a. hypoactive sexual desire disorder

b. ED

c. orgasmic disorder

d. premature ejaculation

e. none of the above

6. Which of the following statements regarding male sexual dysfunction is most accurate?


a. there is a strong association between increased exercise and sexual dysfunction

b. the estimated prevalence of ED in the United States is 18%

c. it is usually the treatment for cardiovascular disease rather than the disease itself that leads to sexual dysfunction

d. male sexual dysfunction in a younger patient tends to be organic in origin

e. male sexual dysfunction in an older patient tends to be psychologically based

7. Which of the following organic disorders is the most common cause of organic male sexual dysfunction?


a. benign prostatic hypertrophy

b. hyperthyroidism

c. Parkinson disease

d. diabetes mellitus

e. atherosclerosis of the abdominal aorta

8. What is the most important aspect of the evaluation of male sexual dysfunction?


a. the history

b. the physical examination

c. nocturnal penile tumescence measurement

d. ratio of penile to brachial blood pressure

e. serum testosterone measurement

9. Which of the following laboratory tests may be indicated in a male patient with sexual dysfunction?


a. complete blood count (CBC)

b. blood urea nitrogen (BUN) and serum creatinine

c. thyroid function studies

d. serum testosterone level

e. all of the above

10. Which of the following is (are) an important counseling aspect(s) in the treatment of male sexual dysfunction?


a. reducing performance anxiety by prohibiting intercourse

b. reducing anxiety by identification and verbalization

c. instructing in sensate focus techniques

d. instructing in interpersonal communication skills

e. all of the above

11. Which of the following treatments should be considered in the initial management of male sexual dysfunction?


a. sildenafil

b. vacuum assist device

c. penile prosthesis

d. intracavernous injections of alprostadil

e. all of the above

12. Which of the following is specifically indicated as a treatment for premature ejaculation?


a. the penile squeeze technique

b. the injection of testosterone

c. structured behavior modification programs

d. the intermittent injection of medroxyprogesterone

e. the intraarterial penile injection of local vasoconstrictors


Clinical Case Problem 2: A 24-Year-Old Woman Who Is Unable to Have Sexual Intercourse


A 24-year-old woman who has been married for 6   months comes to your office in tears. She and her husband have been unable to have sexual intercourse. She says that when he tries to penetrate her, she “tenses up” and is “unable to go any further.”


Her significant history includes being raped at the age of 12   years. The patient has vivid memories of this event.


Her general physical examination is normal. At this time, you do not attempt a vaginal examination.



13. Which of the following statements regarding vaginismus is true?


a. vaginismus is under voluntary control

b. there is no association between vaginismus and traumatic sexual experiences

c. most women with vaginismus also have difficulty with sexual arousal

d. vaginismus is a condition of involuntary spasm or constriction of the musculature surrounding the vaginal outlet

e. by definition, vaginismus occurs only during attempted sexual intercourse

14. Regarding the diagnosis and treatment of vaginismus, which of the following statements is false?


a. throughout the diagnostic examination, the woman must feel that she is in control and may terminate the examination at any time

b. the diagnosis of vaginismus can often be made without insertion of a speculum

c. it is helpful if the sexual partner is involved in all aspects of the treatment process

d. the insertion of vaginal dilators is not a recognized part of the treatment protocol

e. sensate focus techniques are an important part of the treatment protocol

15. Which of the following is the most common female sexual dysfunction disorder?


a. anorgasmy

b. delayed orgasm

c. hypoactive sexual desire disorder

d. sexual aversion disorder

e. none of the above

16. Which of the following statements regarding female sexual arousal disorder is false?


a. it is more common in women than in men

b. the diagnosis takes into account the focus, intensity, and duration of the sexual activity

c. if sexual stimulation is inadequate in focus, intensity, or duration, the diagnosis cannot be made

d. in women, it is not associated with inadequate vaginal lubrication

e. in women, it is often associated with inhibited female orgasm

17. Of the following causes, which is the most common cause of hypoactive sexual desire disorder in women?


a. major psychiatric illness

b. major psychiatric illness in the woman’s partner

c. exhaustion from work and family responsibilities

d. major physical illness in the woman

e. alcoholism in the woman’s partner

18. Which of the following statements regarding inhibited female orgasm is false?


a. it is the most common female sexual dysfunction

b. primary anorgasmia is more common among unmarried women than among married women

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Sexual Dysfunction

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