NBME 21 Libido: normal; Nocturnal erections: normal (NBME Answers)

Retired NBME 21 Answers

nbme21/Block 2/Question#33 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Libido: normal; Nocturnal erections: normal 🔍 / 📺 / 🌳 / 📖
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+19 upvote downvote
submitted by ∗imgdoc(183)

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I thought about it like this: Patient is having psychogenic ED - its all in his head, libido is normal and nocturnal erections are normal.

If his Testosterone level was low - Libido decreased. If his nervous system (parasympathetic/sympathetic) was damaged - nocturnal erections decreased.

Hope this helps.

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sars Idk about this. My thoughts: -libido is a product of testosterone and emotions (psychogenic) -tumescence is a product of pelvic splanchnics S2-S4 (parasympathetic) -patient's issues are 1 month old (aka recent) and his wife died 2 years ago & testosterone is normal (therefore libido normal) -patient can jack off, therefore penile stimulation reflex arc is intact and pelvic splanchnics are working (nocturnal tumescence normal) +3

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submitted by ∗dr_jan_itor(87)

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He misses his wife man, isn't ready for other women. Psychogenic ED. physically hes fine

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+3 upvote downvote
submitted by ∗yotsubato(1208)

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Why is his Libido normal? It's totally expected that he may have reduced libido after his wife died 2 years ago from some horrible prolonged illness.

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nala_ula perhaps it's more to do with the fact that he can get erections when masturbating, outside of nocturnal erections which are not mediated by sexual desire. So his libido must be intact since he has sexual desire evident in being able to masturbate. +1

nala_ula At least, that's the way I saw it. +

home_run_ball "Testosterone concentration is within the reference range" and the fact that he has no difficulty masturbating = normal libido. Low testosterone would contribute to low libido And if he had low libido he would have difficulty masturbating +

thisisfine The way I made the decision about normal vs. decreased libido is also that he presented to his doctor due to difficulty maintaining an erection while trying to have sex - meaning he has the libido to try to have sex. Does that make sense? +2

btl_nyc It also says there are no signs of depression, which would cause the low libido after his wife died. +

temmy two years is a enough time to mourn...just saying +

temmy thisisfine, it makes absolute sense. That is the same way i saw it +

dr_jan_itor He misses his wife man, isn't ready for other women. Psychogenic ED. physically hes fine (can crank his meat) +

+3 upvote downvote
submitted by ∗haliburton(224)

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from AAFP ED of mixed organic and psychogenic origin is common. Psychogenic causes are more likely when the patient has normal erections with masturbation or when nocturnal penile tumescence is normal.

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yotsubato Couldnt a psychogenic cause reduce libido? +2

home_run_ball whoops meant to comment on the other comment +

+1 upvote downvote
submitted by ∗basic_pathology(25)

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Organic ED: ED during masturbation, no nocturnal erections, +/- decreased libido

Psycogenic ED: no ED during masturbation, yes nocturnal erections, no decreased libido

https://www.researchgate.net/figure/Clinical-differences-between-organic-and-psychogenic-sexual-dysfunction_tbl4_51760982

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+0 upvote downvote
submitted by ∗syoung07(58)

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if you are 68 and still dating Palmala Handerson, your libido isnt low my friends.

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drdoom amen +

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submitted by ∗jhan17(2)

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"Inadequate or absent nocturnal erections suggest organic dysfunction, whereas a normal result indicates a high likelihood of a psychogenic etiology."

https://www.medscape.com/answers/444220-69961/what-is-the-role-of-nocturnal-penile-tumescence-testing-in-the-workup-of-erectile-dysfunction-ed

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