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NBME 21 Answers

nbme21/Block 2/Question#33

A 68-year-old man comes to the physician because of ...

Libido: normal; Nocturnal erections: normal

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 +7  upvote downvote
submitted by imgdoc(29),

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.





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.

yotsubato  Couldnt a psychogenic cause reduce libido? +  
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 +6  
home_run_ball  whoops meant to comment on the other comment +  




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





 +0  upvote downvote
submitted by yotsubato(288),

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.

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. +  
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? +1  
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) +