Sexual Dysfunction Practice Questions

Q: Which of the following may be used in erectile dysfunction except?

Phenylephrine. In the management of erectile dysfunction (ED), the goal is to promote vasodilation and smooth muscle relaxation in the corpus cavernosum. **Phenylephrine** is the correct answer because it is a selective **alpha-1 adrenergic agonist** that causes vasoconstriction. ### Why Phenylephrine is the Exception: Phenylephrine is actually used to **treat priapism** (a prolonged, painful erection), not erectile dysfunction. By stimulating alpha-receptors, it induces contraction of the cavernous smooth muscle and vasoconstriction of the arterioles, effectively terminating the erection. ### Explanation of Other Options: * **Apomorphine:** This is a dopamine (D2) receptor agonist that acts centrally on the hypothalamus to trigger the erectile response. It was historically used as a sublingual treatment for ED. * **Alprostadil:** This is a synthetic **Prostaglandin E1 (PGE1)**. It acts locally by increasing cAMP levels, leading to smooth muscle relaxation and increased blood flow. It is administered via intracavernosal injection or intraurethral pellets. ### NEET-PG High-Yield Pearls: * **First-line treatment for ED:** Oral PDE-5 inhibitors (e.g., Sildenafil, Tadalafil). * **Mechanism of Sildenafil:** Inhibits PDE-5, preventing the breakdown of cGMP, which maintains smooth muscle relaxation. * **Contraindication:** PDE-5 inhibitors must never be used with **Nitrates** due to the risk of severe, life-threatening hypotension. * **Priapism Management:** Aspiration of blood followed by intracavernosal injection of **Phenylephrine** is the standard emergency management for ischemic priapism.

Q: What is the most accurate treatment for erectile dysfunction?

Sildenafil. **Explanation:** **Erectile Dysfunction (ED)** is defined as the persistent inability to attain or maintain a penile erection sufficient for satisfactory sexual performance. **Why Sildenafil is correct:** Sildenafil is a selective **Phosphodiesterase-5 (PDE-5) inhibitor**. It works by inhibiting the enzyme PDE-5, which normally breaks down cyclic Guanosine Monophosphate (cGMP) in the corpus cavernosum. By preventing cGMP degradation, it enhances nitric oxide-mediated smooth muscle relaxation and increases blood flow to the penis. It is currently the **first-line pharmacological treatment** for ED due to its high efficacy and oral route of administration. **Analysis of Incorrect Options:** * **Master and Johnson technique:** This refers to behavioral therapy (e.g., "sensate focus" exercises). While useful for psychogenic sexual dysfunction or premature ejaculation, it is not the primary or most accurate treatment for organic ED. * **Beta-blockers:** These are actually a **cause** of erectile dysfunction (a known side effect), not a treatment. * **Papaverine:** This is a vasodilator that can be used via intracavernosal injection. While effective, it is considered a second-line treatment due to the risk of priapism and the invasive nature of administration compared to oral PDE-5 inhibitors. **High-Yield Clinical Pearls for NEET-PG:** * **Contraindication:** Sildenafil must **never** be co-administered with **Nitrates** (e.g., Nitroglycerin), as it can lead to life-threatening hypotension. * **Side Effects:** Common side effects include headache, flushing, and **cyanopsia** (blue-tinted vision) due to cross-reactivity with PDE-6 in the retina. * **Tadalafil vs. Sildenafil:** Tadalafil has a much longer half-life (approx. 17.5 hours) compared to Sildenafil (4 hours), earning it the nickname "the weekend pill."

Question 1

A 22-year-old nulliparous woman, recently sexually active, presents with dyspareunia localized to the vaginal introitus, accompanied by involuntary pelvic muscle contractions. Her pelvic examination is otherwise normal. What is the most common cause of this condition?

Accepted Answer

Psychogenic causes

Answer

Endometriosis

Answer

Bartholin's gland abscess

Answer

Vulvar atrophy

Question 2

Which of the following statements about erectile dysfunction are false?

Accepted Answer

Psychogenic erectile dysfunction is distinguished from organic erectile dysfunction by PIPE therapy.

Answer

Sildenafil is used for treatment.

Answer

Nocturnal penile tumescence is maintained in psychological erectile dysfunction.

Answer

Sensate focus therapy aims at sensitizing nongenital areas.

Question 3

A 25-year-old woman presents with complaints of pain during intercourse for 2 months, which occurs with initial penetration and continues throughout the entire episode. She reports a previously pleasurable, pain-free relationship with her husband. Her prior investigations, including pelvic examination, Pap smear with cultures, and pelvic sonogram, were normal. She also admits to vaginal dryness and low libido during the same timeframe. She reveals that she discovered her husband's infidelity 2 months ago. What is the most appropriate recommendation for this patient?

Accepted Answer

Marriage counseling

Answer

Estrogen vaginal cream for vaginal dryness

Answer

Vaginal dilators for treatment of vaginismus

Answer

Antidepressant therapy

Question 4

Which of the following may be used in erectile dysfunction except?

Accepted Answer

Phenylephrine

Answer

Apomorphine

Answer

Alprostidil

Answer

All

Question 5

What is the most accurate treatment for erectile dysfunction?

Accepted Answer

Sildenafil

Answer

Master and Johnson technique

Answer

Beta blockers

Answer

Papaverine

Sexual Dysfunction — MCQs

Sexual Dysfunction — MCQs

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