This is a controversial one, but it seems the consensus is that pt had sxs of major depression, and thus his libido was most likely down. But structurally/blood flow–wise, he was fine, so nocturnal erections were normal. So, concept NBME wants us to realize is that we should screen for depression in pts who complain of sexual dysfunction? Or ask about sex in pts who display sxs of depression, like that patient had in the stem of the Q.