Sexual dysfunctions: Clinical

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Sexual dysfunctions: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 50-year-old man comes to the office for a regular follow-up appointment. He tells the physician that he has been feeling depressed recently because he has not been able to have sexual intercourse with his wife due to an inability to maintain an erection. He feels that this is affecting his relationship with his wife. His medical history is significant for hypertension treated with hydrochlorothiazide and hyperlipidemia treated with simvastatin. Both of these medications were started at his last physical examination about 4 months ago. His examination is completely normal. Which of the following is the best treatment option?


Sexual dysfunctions are a group of dysfunctions that prevent individuals from wanting or enjoying sexual activity. They can have a profound impact on a person’s life, and can lead to high levels of distress and anxiety.

There are many factors which may lead to sexual dysfunctions.

Emotional factors include depression, sexual fears or guilt, past sexual trauma, and anxiety.

Physical factors include pain and discomfort during sex.

Additionally, drugs, such as alcohol, nicotine, or narcotics, premenstrual syndrome, pregnancy, the postpartum period, and menopause can all affect a person’s libido and the ability to experience sexual pleasure.

Sexual dysfunctions can be divided into four subtypes: lifelong or acquired and generalized or situational.

Lifelong is when the sexual problem has been present from first sexual experiences; acquired applies to problems that develop after a period of relatively normal sexual function; generalized is when the problem occurs across many types of stimulation, situations, or partners; and situational refers to sexual difficulties that only occur in certain contexts.

In all the disorders, the sexual dysfunction should not be better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other stressors, and it shouldn’t be attributable to another medical condition.

Additionally, the symptoms must persist for at least 6 months and should cause significant distress.

Sexual dysfunctions can be further divided into three categories: male sexual disorders which include delayed ejaculation, erectile disorder, male hypoactive sexual desire disorder, and premature ejaculation; female sexual disorders which include female orgasmic disorder, female sexual interest or arousal disorder, and genito-pelvic pain or penetration disorder; and three common disorders, namely substance or medication-induced sexual dysfunction, other specified sexual dysfunction, and unspecified sexual dysfunction.

First up in male sexual dysfunctions, is delayed ejaculation, which causes either a marked delay in ejaculation, marked infrequency of ejaculation, or absence of ejaculation.



  1. "Clinical Practice Guidelines for Management of Sexual Dysfunction" Indian J Psychiatry. (2017 Jan)

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