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53-Year-Old Woman Comes to the Office for a Routine Follow-Up

question 109

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53-year-old woman comes to the office for a routine follow-up visit. She has seen the physician for menopausal symptoms for the past 2 years and started medication for worsening hot flashes 6 months ago. She says, "I'm doing pretty well; that medication you gave me seems to have helped my hot flashes somewhat. My sleep isn't great, but it's not that different from usual. At least I'm not waking up 3 times a night anymore." Her medical problems include hypertension and chronic insomnia. Medications include enalapril and venlafaxine that was started at her last visit to target vasomotor symptoms. The patient drinks a glass of wine each day and does not use tobacco. She works as a librarian and is married to her second husband. She exercises regularly and enjoys socializing with her friends when she has the opportunity. When the physician inquires about her home life, she says her marriage is "fine" although she wishes that she and her husband had more time for each other and were more intimate. She says, "Actually, I am a little upset with my husband. He comes home from work exhausted and just wants to watch television. He doesn't understand the changes I'm going through. He doesn't seem interested in anything, including me!" The patient continues, "I guess it shouldn't matter to me as much anymore, but my sex life has been frustrating for the past 2 years. My husband and I are never in the mood at the same time; when we are, well, let's just say we're not 18 anymore! Although I wish our sex life was better, sometimes I feel like giving up because it's just not that pleasurable. It's become easier not to try." Which of the following is the most likely explanation of this patient's sexual dysfunction?

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A cost that does not change in total with changes in the volume of activity, remaining constant regardless of changes in levels of output or sales.

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The expenses associated with the electricity used by a business for its operations.

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