Sexual Dysfunction — MCQs

Sexual Dysfunction Indian Medical PG Practice Questions and MCQs

Question 11: What is frigidity?

A. Inability to initiate sexual arousal in males
B. Inability to initiate sexual arousal in females
C. Inability to initiate and maintain sexual arousal in males
D. Inability to initiate and maintain sexual arousal in females (Correct Answer)

Explanation: **Explanation:** **Frigidity** is a traditional clinical term used to describe **Female Sexual Interest/Arousal Disorder (FSIAD)**. It is characterized by a persistent or recurrent deficiency (or absence) of sexual fantasies and desire for sexual activity, along with the **inability to initiate or maintain** the physical response of sexual excitement (such as lubrication or swelling) until the completion of the sexual act. 1. **Why Option D is Correct:** The definition of frigidity encompasses both the psychological desire and the physiological arousal phase. It is not merely a failure to start the process but also the failure to sustain the arousal necessary for a satisfactory sexual experience. 2. **Why Options A & C are Incorrect:** These options refer to male sexual dysfunction. The male equivalent of inability to initiate or maintain arousal is **Erectile Dysfunction (ED)** or Impotence. Frigidity is a gender-specific term historically reserved for females. 3. **Why Option B is Incorrect:** While it correctly identifies the gender, it is incomplete. Sexual dysfunction is defined by the failure of the entire arousal cycle, including the maintenance of the response, not just the initiation. **High-Yield Clinical Pearls for NEET-PG:** * **Modern Nomenclature:** In the DSM-5, "Frigidity" and "Hypoactive Sexual Desire Disorder" in women have been merged into **Female Sexual Interest/Arousal Disorder (FSIAD)**. * **Vaginismus:** Often confused with frigidity, this is the involuntary contraction of pelvic floor muscles making penetration painful or impossible, despite potential presence of desire. * **Dyspareunia:** Painful intercourse, which can be a cause or a consequence of arousal disorders. * **Common Causes:** Psychogenic factors (anxiety, past trauma) are most common, but organic causes like menopause (atrophic vaginitis) and drugs (SSRIs, OCPs) must be ruled out.

Question 12: Bremelanotide is used for which of the following conditions?

A. Hypoactive sexual desire disorder (Correct Answer)
B. Lower urinary tract symptoms
C. Hormone refractory prostate cancer
D. Metastatic renal cell carcinoma

Explanation: **Explanation:** **Bremelanotide** is a novel pharmacotherapy approved for the treatment of **Hypoactive Sexual Desire Disorder (HSDD)** in premenopausal women. **1. Why Option A is Correct:** Bremelanotide is a **melanocortin receptor agonist** (specifically targeting the MC4 receptor). Unlike Flibanserin (which acts on serotonin receptors), Bremelanotide works by modulating brain pathways involved in sexual desire and arousal. It is administered as a **subcutaneous injection** into the abdomen or thigh at least 45 minutes before anticipated sexual activity. It is indicated only for "acquired, generalized" HSDD, not for desire disorders caused by relationship issues or medical/psychiatric conditions. **2. Why Other Options are Incorrect:** * **Option B (LUTS):** Lower urinary tract symptoms are typically managed with alpha-blockers (e.g., Tamsulosin) or 5-alpha reductase inhibitors (e.g., Finasteride). * **Option C (Prostate Cancer):** Hormone refractory prostate cancer is treated with agents like Abiraterone, Enzalutamide, or Cabazitaxel. * **Option D (Renal Cell Carcinoma):** Metastatic RCC is managed with tyrosine kinase inhibitors (e.g., Sunitinib) or immunotherapy (e.g., Nivolumab). **High-Yield Clinical Pearls for NEET-PG:** * **FDA Approval:** Approved in 2019 (Brand name: Vyleesi). * **Mechanism:** MC4 receptor agonist. * **Route:** Subcutaneous (on-demand), unlike Flibanserin which is oral (daily). * **Side Effects:** The most common side effect is **nausea**. It can also cause a transient increase in blood pressure and focal hyperpigmentation (melasma). * **Contraindication:** Patients with uncontrolled hypertension or known cardiovascular disease.

Question 13: Which of the following is the drug of choice for Hypoactive sexual desire disorder in females?

A. Sildenafil
B. Flibanserin (Correct Answer)
C. Mianserin
D. Lorcaserin

Explanation: **Explanation:** **Hypoactive Sexual Desire Disorder (HSDD)** in females is characterized by a persistent or recurrent deficiency of sexual fantasies and desire for sexual activity, causing marked distress. **1. Why Flibanserin is Correct:** Flibanserin is the first FDA-approved drug specifically for the treatment of HSDD in premenopausal women. It is a **multifunctional serotonin agonist-antagonist (MSAA)**. Its mechanism involves: * **Agonism** at 5-HT1A receptors. * **Antagonism** at 5-HT2A receptors. This action results in a decrease in serotonin (which inhibits sexual desire) and an increase in dopamine and norepinephrine (which stimulate sexual desire) in the prefrontal cortex. **2. Analysis of Incorrect Options:** * **A. Sildenafil:** A PDE-5 inhibitor used for erectile dysfunction in males. It has no proven efficacy in increasing sexual desire in females. * **C. Mianserin:** A tetracyclic antidepressant with sedative properties; it is not indicated for sexual dysfunction and may actually cause sexual side effects. * **D. Lorcaserin:** A selective 5-HT2C receptor agonist previously used as an anorexiant (weight loss drug), now largely withdrawn from several markets due to safety concerns. **3. High-Yield Clinical Pearls for NEET-PG:** * **Bremelanotide:** Another approved treatment for HSDD; it is a **Melanocortin receptor agonist** administered via subcutaneous injection. * **Contraindication:** Flibanserin should not be taken with **alcohol** due to the risk of severe hypotension and syncope. * **Administration:** Flibanserin is taken **once daily at bedtime** to mitigate side effects like dizziness and somnolence. * **Diagnosis:** HSDD is only diagnosed if the lack of desire is not due to a co-existing psychiatric condition, relationship issues, or medication side effects.

Question 14: Females with orgasmic difficulties are advised to perform which exercises to strengthen pubococcygeal muscles?

A. Kegel's exercises (Correct Answer)
B. Jacobson's stent
C. Pelvic floor muscle exercises
D. Johnson's exercises

Explanation: **Explanation:** **Correct Answer: A. Kegel's exercises** The pubococcygeal (PC) muscle is a key component of the levator ani group that supports the pelvic organs and surrounds the vaginal opening. During female orgasm, this muscle undergoes involuntary, rhythmic contractions. Strengthening the PC muscles through **Kegel’s exercises** increases local blood flow, enhances neuromuscular control, and improves the intensity and frequency of orgasmic responses. These exercises involve repetitive voluntary contraction and relaxation of the pelvic floor muscles and are the first-line behavioral therapy for female orgasmic disorder. **Analysis of Incorrect Options:** * **B. Jacobson’s stent:** This is a distractor. Jacobson’s progressive muscle relaxation is a technique for stress reduction, but there is no medical entity known as "Jacobson's stent" related to pelvic health. * **C. Pelvic floor muscle exercises:** While Kegel’s exercises *are* a type of pelvic floor muscle exercise, "Kegel's" is the specific eponym and medically standard term used in clinical practice and examinations for this specific therapeutic indication. * **D. Johnson’s exercises:** This is a distractor and does not refer to a recognized medical exercise for sexual dysfunction. **NEET-PG High-Yield Pearls:** * **Primary Indication:** Apart from sexual dysfunction, Kegel’s exercises are the gold standard for managing **Stress Urinary Incontinence (SUI)** and mild **Pelvic Organ Prolapse (POP)**. * **Mechanism:** They specifically target the **Levator Ani** muscle group (Pubococcygeus, Puborectalis, and Iliococcygeus). * **Clinical Tip:** Patients are often taught to identify the correct muscle by attempting to "stop the flow of urine" mid-stream (though they should not do this regularly while voiding).

Question 15: Hymenal tear following first sexual intercourse most commonly occurs at which position:

A. 11 o'clock
B. 6 o'clock (Correct Answer)
C. 12 o'clock
D. All of the above

Explanation: ***Correct: 6 o'clock*** - The **hymen** is most commonly torn at the **6 o'clock position** (inferiorly) due to the direction of typical coital forces during first intercourse. - This area is usually the **thinnest** and **least supported**, making it more susceptible to tearing during initial penetration. - This is the most consistently reported site for initial hymenal tears in forensic and gynecological literature. *Incorrect: 11 o'clock* - While hymenal tears can occur at other positions, the **11 o'clock position** is not the most common site of rupture during first intercourse. - Tears at superior or lateral positions are less frequent unless there are unusual circumstances or anatomical variations. *Incorrect: 12 o'clock* - The **12 o'clock position** (superiorly) is less commonly the primary site of hymenal rupture during first intercourse. - The majority of tears are observed inferiorly (at 6 o'clock) due to the anatomy and mechanics of penetration. *Incorrect: All of the above* - While it is possible for the hymen to tear at **multiple positions** or in various configurations, the question asks for the *most common* position. - The 6 o'clock position is the most consistently reported site for initial hymenal tears, not all positions equally.

Question 16: 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.

Practice by Chapter

Female Sexual Response Cycle

Practice Questions

Desire Disorders

Practice Questions

Arousal Disorders

Practice Questions

Orgasmic Disorders

Practice Questions

Sexual Pain Disorders

Practice Questions

Impact of Gynecologic Conditions on Sexual Function

Practice Questions

Psychological Aspects of Female Sexuality

Practice Questions

Hormonal Influences on Sexual Function

Practice Questions

Evaluation of Female Sexual Dysfunction

Practice Questions

Treatment Approaches to Sexual Dysfunction

Practice Questions

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