A 42-Year-Old Man Comes to the Office with Concerns About

question 14

Multiple Choice

A 42-year-old man comes to the office with concerns about his sexual function.  The patient reports an abrupt inability to participate in sexual intercourse for the past 2 months.  He is variably able to achieve an erection during foreplay but is unable to maintain an erection sufficient to engage in intercourse.  The patient reports normal sexual desire.  He has been married for 4 years and says, "I am ready to start a family, but my wife is focused on her job right now and is not as excited as I am."  Medical history is notable for hypertension, migraine headaches, and irritable bowel syndrome.  Current medications include lisinopril and as-needed polyethylene glycol and ibuprofen.  The patient does not use tobacco or illicit drugs and drinks 1 or 2 cans of beer on weekends.  He exercises several times per week.  Family history is notable for hypertension in his parents.  Blood pressure is 124/68 mm Hg, pulse is 70/min, and BMI is 23 kg/m².  Physical examination shows normal heart sounds.  Extremities are warm and peripheral pulses are normal.  The patient's genitalia and body hair distribution are normal.  Visual fields are intact.  Blood cell counts and serum chemistry are within normal limits.  Which of the following is the best response and next step concerning this patient's symptoms?

• A)Your symptoms are common as people age.  We should start medication to improve your erectile function.
• B)Your symptoms are likely due to a low testosterone level.  We should check the hormone levels in your blood.
• C)Your symptoms are likely due to impairment of the nerves supplying your genitals.  We should do an MRI of the spine.
• D)Your symptoms may be due to a blockage in a blood vessel.  We should obtain imaging tests to further evaluate this issue.
• E)Your symptoms may involve complex ways the mind can affect the body.  Please tell me more about your relationship with your wife.

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