Evaluation of Female Sexual Dysfunction — MCQs
What is the term for a persistent lack of sexual desire or arousal?
Which condition is most commonly associated with female sexual dysfunction characterized by painful intercourse?
F00 in ICD denotes
A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :
Which structure can be palpated through the anterior wall of the rectum, directly in front of the rectum in the midline, during a rectal examination of a 27-year-old woman?
A 62-year-old woman presents for annual examination. Her last spontaneous menstrual period was 9 years ago, and she has been reluctant to use postmenopausal hormone replacement because of a strong family history of breast cancer. She now complains of diminished interest in sexual activity. Which of the following is the most likely cause of her complaint?
For the following causes of sexual dysfunction, select the most likely clinical feature that can be caused by vascular disease.
Impotence is a feature of which of the following:
Which of the following antipsychotics is most likely to cause increased prolactin secretion?
An SSRI antidepressant, such as fluoxetine, will be prescribed for an adult patient. You should advise him or her that two of the most likely side effects or adverse responses that may eventually occur at therapeutic blood levels are which of the following?
Evaluation of Female Sexual Dysfunction Indian Medical PG Practice Questions and MCQs
Question 1: What is the term for a persistent lack of sexual desire or arousal?
- A. Female Orgasmic Disorder
- B. Genito-Pelvic Pain/Penetration Disorder
- C. Male Erectile Disorder
- D. Hypoactive Sexual Desire Disorder (HSDD) (Correct Answer)
Explanation: ***Hypoactive Sexual Desire Disorder (HSDD)*** - **HSDD** is characterized by a persistent or recurrent deficiency or absence of **sexual fantasies** and desire for **sexual activity**. - This diagnosis specifically addresses the **lack of desire or arousal**, differentiating it from other sexual dysfunctions. *Female Orgasmic Disorder* - This disorder is marked by significant difficulty, delay, or absence of **orgasm** following sufficient sexual stimulation and arousal. - While it impacts sexual experience, it does not primarily involve a lack of **desire or arousal**. *Genito-Pelvic Pain/Penetration Disorder* - This condition is defined by persistent difficulties with vaginal penetration, marked by **genito-pelvic pain**, fear/anxiety about pain, and/or tensing of pelvic floor muscles. - It focuses on **pain and physical barriers** to sexual activity, not explicitly on desire. *Male Erectile Disorder* - This disorder involves a consistent inability to attain and/or maintain an adequate **erection** until the completion of sexual activity. - While it affects a male's ability to engage in sexual activity, the primary issue is **erectile function**, not necessarily a lack of sexual desire.
Question 2: Which condition is most commonly associated with female sexual dysfunction characterized by painful intercourse?
- A. Absence of ovary
- B. Vaginismus (Correct Answer)
- C. Gonadal dysgenesis
- D. Intersex condition
Explanation: ***Vaginismus*** - **Vaginismus** is a condition characterized by involuntary spasms of the muscles surrounding the vaginal opening, leading to painful intercourse (**dyspareunia**) or inability to complete penetration. - It's a common cause of female sexual dysfunction where the primary symptom is **pain or difficulty with vaginal penetration**. *Absence of ovary* - The **absence of ovaries** primarily affects hormone production and fertility but does not directly cause involuntary vaginal muscle spasms leading to painful intercourse. - While it can lead to vaginal atrophy due to lack of estrogen, which might cause painful intercourse, it's not the most direct or common cause of the specific dysfunction described. *Gonadal dysgenesis* - **Gonadal dysgenesis** refers to abnormal development of the gonads, often leading to hormonal imbalances and infertility. - This condition is not typically associated with muscle spasms causing painful intercourse; its main manifestations are related to sexual development and endocrine function. *Intersex condition* - An **intersex condition** involves atypical development of internal and external sexual anatomy. - While intersex conditions can lead to a variety of sexual health issues, they do not inherently or most commonly present with the involuntary vaginal muscular spasms characteristic of vaginismus.
Question 3: F00 in ICD denotes
- A. mood disorders
- B. organic disorders (Correct Answer)
- C. substance use
- D. psychosis
Explanation: ***Organic disorders - CORRECT*** - **F00-F09** in the **International Classification of Diseases (ICD-10)** Chapter V (Mental and behavioural disorders) specifically denotes **organic, including symptomatic, mental disorders** - These disorders are characterized by brain disease, brain injury, or other insult leading to **cerebral dysfunction** - **F00** specifically refers to **Dementia in Alzheimer's disease** *Mood disorders - Incorrect* - Mood disorders are classified under codes **F30-F39** in ICD-10 - This category includes conditions like bipolar affective disorder, depressive episodes, and recurrent depressive disorders *Substance use - Incorrect* - Mental and behavioral disorders due to psychoactive substance use are classified under codes **F10-F19** in ICD-10 - This section covers disorders resulting from the use of alcohol, opioids, cannabis, sedatives, hypnotics, and other substances *Psychosis - Incorrect* - Specific psychotic disorders like schizophrenia are classified under codes **F20-F29** in ICD-10 - Psychosis can be a symptom of various mental disorders, including some organic conditions
Question 4: A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :
- A. Malignancy of the vulva
- B. Malignancy of the cervix
- C. Malignancy of the endometrium (Correct Answer)
- D. Malignancy of the ovary
Explanation: ***Malignancy of the endometrium*** - **Postmenopausal bleeding** is the classic presenting symptom of **endometrial cancer**, which must be ruled out in all such cases. - **Diabetes** is a known risk factor for endometrial cancer, along with obesity, hypertension, and unopposed estrogen exposure. *Malignancy of the vulva* - Vulvar cancer typically presents with a **pruritic lesion**, lump, or ulcer on the vulva, rather than solely with vaginal bleeding. - While bleeding can occur from an advanced vulvar lesion, it is not the primary or most common presentation for new onset postmenopausal bleeding. *Malignancy of the cervix* - Cervical cancer often presents with **postcoital bleeding** or irregular vaginal bleeding in premenopausal women, or less commonly, postmenopausal bleeding. - Screening with **Pap smears** typically detects precancerous changes or early cervical cancer, making it less likely to be the first presentation with postmenopausal bleeding in a well-screened population. *Malignancy of the ovary* - Ovarian cancer is often asymptomatic in its early stages and presents with non-specific symptoms like **abdominal distension**, bloating, or pelvic pain. - **Vaginal bleeding** is not a typical symptom of ovarian cancer, unless the tumor is very large, involves adjacent structures, or is a hormone-producing tumor.
Question 5: Which structure can be palpated through the anterior wall of the rectum, directly in front of the rectum in the midline, during a rectal examination of a 27-year-old woman?
- A. Bladder
- B. Body of uterus
- C. Cervix of uterus (Correct Answer)
- D. Pubic symphysis
Explanation: Cervix of uterus - The cervix is located posterior to the bladder and inferior to the body of the uterus, making it palpable through the anterior rectal wall via the rectovaginal septum [2]. - Its firm, rounded structure can be felt as a distinct nodule directly anterior to the rectum in the midline during a digital rectal examination. - This is a standard clinical finding in pelvic examination. Bladder - The bladder is anterior to the uterus and cervix; an empty bladder is usually not palpable through the anterior rectal wall. - A distended bladder would be palpable, but it would be a soft, fluctuating mass, not a firm structure like the cervix. Body of uterus - The body of the uterus is superior to the cervix and in the typical anteverted position (normal in ~80% of women), it is angled anteriorly and superiorly, generally beyond the reach of a digital rectal exam for direct palpation through the anterior rectal wall [1]. - In the less common retroverted uterus, the body may be palpable through the posterior fornix of the vagina or through the rectum, but this is not the typical anatomical relationship. Pubic symphysis - The pubic symphysis is a bony joint located at the very anterior aspect of the pelvis, far too anterior and superior to be palpable through the anterior wall of the rectum. - It forms the anterior boundary of the bony pelvis, while the rectum is situated posteriorly within the pelvic cavity.
Question 6: A 62-year-old woman presents for annual examination. Her last spontaneous menstrual period was 9 years ago, and she has been reluctant to use postmenopausal hormone replacement because of a strong family history of breast cancer. She now complains of diminished interest in sexual activity. Which of the following is the most likely cause of her complaint?
- A. Decreased vaginal length
- B. Untreatable sexual dysfunction
- C. Decreased ovarian function (Correct Answer)
- D. Alienation from her partner
Explanation: ***Decreased ovarian function*** - The woman's age and history of menopause 9 years prior strongly suggest **decreased ovarian function**, leading to **estrogen deficiency**. - **Estrogen deficiency** causes vaginal atrophy, dryness, and dyspareunia, which can significantly diminish interest in sexual activity. *Decreased vaginal length* - While vaginal atrophy can occur with menopause, leading to a narrower and less elastic vagina, a significant "decreased vaginal length" is less common as a primary cause of diminished sexual interest. - The primary physiological change affecting sexual interest due to estrogen loss is **vaginal dryness** and **dyspareunia**, rather than an anatomical change in length. *Untreatable sexual dysfunction* - Postmenopausal sexual dysfunction related to estrogen deficiency is often **treatable** with local vaginal estrogen therapy or other interventions. - Assuming it's untreatable without further assessment is premature and inaccurate, especially given the clear physiological changes associated with menopause. *Alienation from her partner* - While relationship issues can certainly affect sexual interest, the clinical history points to a **physiological cause** (postmenopausal estrogen deficiency). - There is no information in the scenario to suggest alienation from her partner, making this answer less likely than a direct physiological cause.
Question 7: For the following causes of sexual dysfunction, select the most likely clinical feature that can be caused by vascular disease.
- A. failure of erection with absent nocturnal penile tumescence (NPT) (Correct Answer)
- B. absence of orgasm with normal libido and erectile function
- C. ejaculatory dysfunction
- D. decreased libido
Explanation: **_failure of erection with absent nocturnal penile tumescence (NPT)_** - **Vascular disease** often impairs blood flow to the penis, which is essential for achieving and maintaining an erection [1]. - **Absent nocturnal penile tumescence (NPT)** indicates an organic cause of erectile dysfunction, frequently due to vascular insufficiency rather than psychological factors [1], [2]. *ejaculatory dysfunction* - While ejaculatory dysfunction can occur with sexual health issues, it is less directly linked to the **vascular supply** than erectile function [2]. - Conditions like **neurological damage** or medication side effects are more common causes of ejaculatory dysfunction [2]. *absence of orgasm with normal libido and erectile function* - An inability to achieve orgasm with intact libido and erectile function typically suggests a **neurological** or **psychological** etiology. - **Vascular disease** primarily affects the physical ability to achieve an erection, not the sensory or psychological components of orgasm [1]. *decreased libido* - **Decreased libido (sex drive)** is more commonly associated with hormonal imbalances (e.g., low testosterone), psychological stress, depression, or certain medications [1]. - While vascular disease can contribute to overall poor health, it is not a direct or primary cause of **reduced sexual desire** [1].
Question 8: Impotence is a feature of which of the following:
- A. Poliomyelitis
- B. Amyotrophic lateral sclerosis
- C. Meningitis
- D. Multiple sclerosis (Correct Answer)
Explanation: ***Multiple sclerosis*** - **Erectile dysfunction** (impotence) is a common symptom in men with multiple sclerosis, often resulting from **demyelination** in nerve pathways controlling sexual function [1], [2]. - MS can affect various neurological functions, leading to problems with **autonomic nervous system** control, sensation, and motor coordination, all of which can impact sexual health. *Poliomyelitis* - Poliomyelitis primarily affects the **anterior horn cells** of the spinal cord, leading to acute **flaccid paralysis** of muscles. - While it can cause muscle weakness and atrophy, it is not typically associated with chronic impotence or sexual dysfunction as a primary feature. *Amyotrophic lateral sclerosis* - ALS is a progressive neurodegenerative disease affecting **motor neurons**, leading to muscle weakness, atrophy, and spasticity. - It primarily impacts voluntary muscle movement and does not directly cause impotence, although the physical limitations and psychological stress can indirectly affect sexual function. *Meningitis* - Meningitis is an inflammation of the **meninges** (membranes surrounding the brain and spinal cord) caused by infection. - Its symptoms include headache, fever, and neck stiffness, and while severe cases can lead to neurological complications, impotence is not a typical direct consequence.
Question 9: Which of the following antipsychotics is most likely to cause increased prolactin secretion?
- A. Olanzapine
- B. Ziprasidone
- C. Clozapine
- D. Risperidone (Correct Answer)
Explanation: ***Risperidone*** - **Risperidone** is a potent **D2 receptor antagonist**, and also blocks 5-HT2A receptors, leading to a significant increase in **prolactin secretion** [1]. - This effect is due to its high affinity for the **dopamine D2 receptor** in the tuberoinfundibular pathway, which inhibits dopamine's tonic suppression of pituitary prolactin release [2]. *Olanzapine* - While it can cause some **prolactin elevation**, it is generally less potent in this regard compared to risperidone. - Its receptor binding profile, including antagonism at D2 and 5-HT2A receptors, has a more balanced effect on prolactin [1]. *Ziprasidone* - **Ziprasidone** is known for having a relatively low propensity to cause **prolactin elevation** due to its more complex receptor profile and rapid dissociation from D2 receptors. - This medication also has a short half-life and complex metabolism, further contributing to its lower risk of sustained hyperprolactinemia. *Clozapine* - **Clozapine** is associated with a very low risk of **prolactin elevation** because it is a weak D2 receptor antagonist, and its D2 blockade is quickly reversible [1]. - It also has strong anticholinergic properties and other receptor interactions that counteract the typical prolactin-elevating effects of D2 blockade [3].
Question 10: An SSRI antidepressant, such as fluoxetine, will be prescribed for an adult patient. You should advise him or her that two of the most likely side effects or adverse responses that may eventually occur at therapeutic blood levels are which of the following?
- A. Sexual dysfunction and sleep disturbances (Correct Answer)
- B. Sexual dysfunction and nausea
- C. Headache and diarrhea
- D. Tremor and weight gain
Explanation: ***Sexual dysfunction and sleep disturbances*** - **Sexual dysfunction** is one of the most common and persistent adverse effects of SSRIs, affecting 40-65% of patients and continuing throughout treatment at therapeutic levels [2], [3]. - **Sleep disturbances** (insomnia or altered sleep architecture) can persist during long-term SSRI therapy and are among the eventual side effects patients experience [1], [2], [3]. - Both effects are characteristic of chronic SSRI use and significantly impact patient compliance and quality of life. *Sexual dysfunction and nausea* - While **sexual dysfunction** is indeed very common and persistent, **nausea** is typically a transient side effect that occurs during the first 1-2 weeks of treatment and usually resolves with continued use [2]. - The question specifically asks about *eventual* occurrence at therapeutic levels over time, making nausea less appropriate as it is not a chronic issue. *Tremor and weight gain* - **Tremor** is not among the most common side effects of SSRIs and occurs less frequently than sexual dysfunction or sleep disturbances. - **Weight gain** can occur with some SSRIs (particularly paroxetine), but fluoxetine is actually considered weight-neutral or may even cause weight loss in some patients, making this combination less likely for fluoxetine specifically [1]. *Headache and diarrhea* - Both **headache** and **diarrhea** are common initial side effects when starting SSRIs but typically improve or resolve within the first few weeks of treatment [1]. - These are transient effects rather than eventual persistent side effects that characterize long-term therapeutic use.
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