Male Sexual Flashcards
Clinical Vignette: A 50-year-old male presents with questions about his sexual response mechanisms. You consider the bulbocavernous reflex as part of his physiological response.
Multiple-Choice Options:
A) Pudendal nerve (motor) is activated
B) Pelvic nerves are activated
C) Thoracolumbar sympathetic neurons are activated
D) Sacral parasympathetic neurons and interneurons are activated
Correct Answer: A
In-depth Explanation:
A: The pudendal nerve (motor) is activated, which leads to the bulbocavernous reflex (Correct, based on paragraph 1).
B: Pelvic nerves are associated with low-intensity continuous stimulation and detrusor inhibition, not with noxious, abrupt stimulation.
C: Thoracolumbar sympathetic neurons are involved in high-intensity continuous stimulation, leading to ejaculation.
D: Sacral parasympathetic neurons and interneurons are involved in low-intensity continuous stimulation, leading to penile erection and detrusor inhibition.
Memory Tool: Noxious Abrupt triggers Pudendal Motor: N.A.P.M.
Reference Citation: Based on Table 68.3, paragraph 1.
Rationale: Understanding the spinal reflex mechanisms is crucial for the correct diagnosis and treatment of male sexual function disorders.
Clinical Vignette: A 25-year-old male is concerned about the spontaneity of his erections. You discuss the role of low-intensity continuous stimulation in sexual response.
Multiple-Choice Options:
A) Sacral motor neurons are activated
B) Penile erection occurs
C) Ejaculation occurs
D) Bulbocavernous reflex occurs
Correct Answer: B
In-depth Explanation:
A: Sacral motor neurons are activated during noxious, abrupt stimulation, not during low-intensity continuous stimulation.
B: Penile erection occurs in response to low-intensity continuous stimulation (Correct, based on paragraph 2).
C: Ejaculation occurs in response to high-intensity continuous stimulation.
D: Bulbocavernous reflex occurs in response to noxious, abrupt stimulation.
Memory Tool: Low Intensity, Penile Erection: L.I.P.E.
Reference Citation: Based on Table 68.3, paragraph 2.
Rationale: Recognizing the role of low-intensity continuous stimulation is essential for understanding and advising on male sexual response.
Clinical Vignette: A 40-year-old male with a history of urinary incontinence reports that he experiences fewer symptoms during sexual arousal. You ponder the underlying spinal reflexes at play.
Multiple-Choice Options:
A) Sacral motor neurons are responsible
B) Sacral parasympathetic neurons and interneurons activate pudendal nerve
C) Sacral parasympathetic neurons and interneurons activate pelvic nerves
D) Thoracolumbar sympathetic neurons are responsible
Correct Answer: C
In-depth Explanation:
A: Sacral motor neurons are responsible for bulbocavernous reflex, not detrusor inhibition.
B: Pudendal nerve activation results in the bulbocavernous reflex, not detrusor inhibition.
C: Pelvic nerves are activated during low-intensity continuous stimulation, leading to detrusor inhibition and bladder neck closure (Correct, based on paragraph 2).
D: Thoracolumbar sympathetic neurons lead to ejaculation, not detrusor inhibition.
Memory Tool: Detrusor Inhibition: Pelvic Nerves for Closure: D.I.P.N.C.
Reference Citation: Based on Table 68.3, paragraph 2.
Rationale: Understanding spinal reflexes that lead to detrusor inhibition helps in managing patients with urinary incontinence who might experience changes during sexual arousal.
Clinical Vignette: A 30-year-old male complains of premature ejaculation. You consider the neuroanatomy behind ejaculation as part of his treatment plan.
Multiple-Choice Options:
A) Sacral motor neurons activate the pudendal nerve
B) Thoracolumbar sympathetic neurons are involved
C) Sacral parasympathetic neurons and interneurons are involved
D) Pelvic nerves cause detrusor inhibition
Correct Answer: B
In-depth Explanation:
A: Sacral motor neurons are involved in bulbocavernous reflex but not directly in ejaculation.
B: Thoracolumbar sympathetic neurons are specifically involved in high-intensity continuous stimulation that leads to ejaculation (Correct, based on paragraph 3).
C: Sacral parasympathetic neurons and interneurons are involved in low-intensity stimulation, leading to penile erection.
D: Pelvic nerves are involved in detrusor inhibition, not ejaculation.
Memory Tool: High-Intensity, Thoracolumbar Sympathetic for Ejaculation: H.I.T.S.E.
Reference Citation: Based on Table 68.3, paragraph 3.
Rationale: Understanding the neural pathways for ejaculation can inform treatment plans for conditions like premature ejaculation.
Clinical Vignette: A 55-year-old male presents with erectile dysfunction. Upon inquiry, he states that tactile stimulation does not lead to an erection as easily as before. You consider the spinal reflexes involved.
Multiple-Choice Options:
A) Sacral motor neurons are involved
B) Sacral parasympathetic neurons and interneurons activate pelvic nerves
C) Thoracolumbar sympathetic neurons are activated
D) Pudendal nerve (motor) is activated
Correct Answer: B
In-depth Explanation:
A: Sacral motor neurons are primarily activated during noxious, abrupt stimulation leading to the bulbocavernous reflex.
B: Sacral parasympathetic neurons and interneurons activate pelvic and cavernous nerves, leading to penile erection during low-intensity continuous stimulation (Correct, based on paragraph 2).
C: Thoracolumbar sympathetic neurons are involved in high-intensity continuous stimulation leading to ejaculation.
D: Pudendal nerve (motor) activation leads to the bulbocavernous reflex, not penile erection.
Memory Tool: Tactile Stimulation for Penile Erection: T.S.P.E.
Reference Citation: Based on Table 68.3, paragraph 2.
Rationale: Accurate knowledge of the neural pathways involved in penile erection is crucial for diagnosis and treatment of erectile dysfunction.
Clinical Vignette: A 28-year-old male has concerns about delayed ejaculation. You evaluate the role of spinal reflexes and associated nerves.
Multiple-Choice Options:
A) Pudendal nerve only
B) Pudendal, pelvic, and cavernous nerves
C) Pelvic and cavernous nerves only
D) Thoracolumbar sympathetic neurons only
Correct Answer: B
In-depth Explanation:
A: Pudendal nerve is involved but not solely responsible for ejaculation.
B: High-intensity continuous stimulation activates pudendal, pelvic, and cavernous nerves, leading to ejaculation (Correct, based on paragraph 3).
C: Pelvic and cavernous nerves are involved, but not solely responsible for ejaculation.
D: Thoracolumbar sympathetic neurons are involved in the neural pathway, but they are not nerves.
Memory Tool: High-Intensity to Pudendal, Pelvic, Cavernous: H.I.P.P.C.
Reference Citation: Based on Table 68.3, paragraph 3.
Rationale: Knowing the array of nerves involved in ejaculation is essential for diagnosing and treating ejaculatory disorders.
Clinical Vignette: A 60-year-old male is evaluated for postoperative urinary retention. You’re contemplating the role of noxious, abrupt stimulation on bladder function.
Multiple-Choice Options:
A) Detrusor inhibition and closure of bladder neck occur
B) Bladder contraction occurs
C) Penile erection occurs
D) Bulbocavernous reflex is triggered
Correct Answer: D
In-depth Explanation:
A: Detrusor inhibition and bladder neck closure occur with low-intensity continuous stimulation, not with noxious, abrupt stimulation.
B: Bladder contraction is not mentioned in the table regarding noxious, abrupt stimulation.
C: Penile erection is associated with low-intensity continuous stimulation.
D: Noxious, abrupt stimulation activates sacral motor neurons leading to the bulbocavernous reflex (Correct, based on paragraph 1).
Memory Tool: Noxious Abrupt for Bulbocavernous: N.A.B.
Reference Citation: Based on Table 68.3, paragraph 1.
Rationale: Understanding the reflexes associated with noxious, abrupt stimulation can guide you in managing urinary retention or other bladder-related issues.
Clinical Vignette: A 35-year-old male complains of loss of penile sensation. During physical examination, you plan to evaluate the bulbocavernous reflex.
Multiple-Choice Options:
A) Sacral parasympathetic neurons and interneurons
B) Thoracolumbar sympathetic neurons
C) Sacral motor neurons
D) Pelvic nerves
Correct Answer: C
In-depth Explanation:
A: Sacral parasympathetic neurons and interneurons are involved in low-intensity continuous stimulation, not in bulbocavernous reflex.
B: Thoracolumbar sympathetic neurons are involved in high-intensity continuous stimulation leading to ejaculation.
C: Sacral motor neurons are activated during noxious, abrupt stimulation and lead to the bulbocavernous reflex (Correct, based on paragraph 1).
D: Pelvic nerves are involved in low-intensity continuous stimulation leading to detrusor inhibition and penile erection.
Memory Tool: Bulbocavernous Reflex: Sacral Motor: B.R.S.M.
Reference Citation: Based on Table 68.3, paragraph 1.
Rationale: Identifying the neurons involved in the bulbocavernous reflex is key for diagnosis and treatment planning in conditions involving loss of penile sensation.
Clinical Vignette: A 45-year-old male patient presents with complaints of delayed ejaculation. He is interested in exploring pharmacological options.
Multiple-Choice Options:
A. Cabergoline 0.5–2.0 mg every 3 days
B. Pramipexole 0.5 mg
C. Amantadine 100–200 mg bid
D. Bupropion 300 mg bid
Correct Answer: A
In-depth Explanation:
A (Correct): Cabergoline at 0.5–2.0 mg every 3 days is listed as an option for delayed ejaculation (Table 71.7).
B (Incorrect): Pramipexole should be 0.125–0.25 mg, not 0.5 mg as listed (Table 71.7).
C (Incorrect): Amantadine is for two days before coitus at a range of 100–400 mg or 100–200 mg bid (Table 71.7).
D (Incorrect): Bupropion should be 150 mg daily or bid, not 300 mg bid as listed (Table 71.7).
Memory Tool: “CAB” - Cabergoline Always Better for delayed ejaculation (Not actually always better, but it helps you remember).
Specific Reference Citation: Table 71.7
Rationale: Understanding the proper dosages and drugs for specific urological conditions such as delayed ejaculation is essential for patient management.
Clinical Vignette: A 35-year-old male has been experiencing issues with anejaculation and is interested in medications he can take as needed, rather than daily. Which drug could he take as needed only before coitus?
Multiple-Choice Options:
A. Amantadine
B. Pseudoephedrine
C. Cyproheptadine
D. Buspirone
Correct Answer: C
In-depth Explanation:
A (Incorrect): Amantadine can be taken daily but also for two days before coitus (Table 71.7).
B (Incorrect): Pseudoephedrine is to be taken the day before and the day of coitus, making it not strictly as-needed (Table 71.7).
C (Correct): Cyproheptadine can be taken 3–4 hours before coitus, making it a true as-needed option (Table 71.7).
D (Incorrect): Buspirone is a daily treatment with dosages of 5–15 mg bid (Table 71.7).
Memory Tool: “Cy-pronounce-it ‘As-needed’” for Cyproheptadine.
Specific Reference Citation: Table 71.7
Rationale: Identifying as-needed versus daily treatment options can be crucial for tailoring treatment to individual patient preferences and lifestyles.
Clinical Vignette: A 52-year-old male patient has been experiencing anejaculation. He inquires about intranasal medication options.
Multiple-Choice Options:
A. Amantadine
B. Oxytocin
C. Bupropion
D. Reboxetine
Correct Answer: B
In-depth Explanation:
A (Incorrect): Amantadine is not intranasal; it is taken orally (Table 71.7).
B (Correct): Oxytocin is the only drug listed that can be administered as 24 IU intranasal during coitus (Table 71.7).
C (Incorrect): Bupropion is an oral medication and is not administered intranasally (Table 71.7).
D (Incorrect): Reboxetine is also an oral medication, not an intranasal one (Table 71.7).
Memory Tool: “Oxy-IN” - Oxytocin is Intranasal.
Specific Reference Citation: Table 71.7
Rationale: Knowing the route of administration for different medications is crucial for personalized patient care.
Clinical Vignette: A 30-year-old man presents with delayed ejaculation. He is looking for a medication that he could use daily.
Multiple-Choice Options:
A. Reboxetine
B. Pseudoephedrine
C. Pramipexole
D. Buspirone
Correct Answer: D
In-depth Explanation:
A (Incorrect): Reboxetine is not listed under daily options (Table 71.7).
B (Incorrect): Pseudoephedrine is taken the day before coitus and on the day of coitus, not daily (Table 71.7).
C (Incorrect): Pramipexole is not specified to be taken daily (Table 71.7).
D (Correct): Buspirone is listed as 5–15 mg bid, suitable for daily use (Table 71.7).
Memory Tool: “Daily Bus” - Buspirone for daily use.
Specific Reference Citation: Table 71.7
Rationale: Tailoring daily medication options for conditions like delayed ejaculation can help enhance a patient’s quality of life.
Clinical Vignette: A 40-year-old male patient presents with delayed ejaculation and prefers a medication that he only needs to take before sexual activities. Which medication could he consider?
Multiple-Choice Options:
A. Pseudoephedrine
B. Reboxetine
C. Pramipexole
D. Amantadine
Correct Answer: A
In-depth Explanation:
A (Correct): Pseudoephedrine is taken 60–120 mg q6h the day before coitus and then twice on the day of coitus (Table 71.7).
B (Incorrect): Reboxetine is not specified for as-needed use before coitus (Table 71.7).
C (Incorrect): Pramipexole is not indicated as an as-needed medication for coitus (Table 71.7).
D (Incorrect): Amantadine requires two days of pre-treatment before coitus, not ideal for spontaneous activity (Table 71.7).
Memory Tool: “Pseudo-pre” for Pseudoephedrine is to be taken pre-coitus.
Specific Reference Citation: Table 71.7
Rationale: Choosing the appropriate as-needed medication can significantly impact patient satisfaction and compliance.
Clinical Vignette: A 29-year-old male is diagnosed with delayed ejaculation. The physician is considering medications with a dosing schedule that involves taking the drug twice a day. Which of the following is an option?
Multiple-Choice Options:
A. Amantadine
B. Cyproheptadine
C. Buspirone
D. Oxytocin
Correct Answer: C
In-depth Explanation:
A (Incorrect): Amantadine has a dosing option of 100–200 mg bid, but it is also taken for two days before coitus, making it less ideal for a strict bid schedule (Table 71.7).
B (Incorrect): Cyproheptadine is taken 3–4 hours before coitus and doesn’t have a bid schedule (Table 71.7).
C (Correct): Buspirone can be taken as 5–15 mg bid, fitting the twice-a-day requirement (Table 71.7).
D (Incorrect): Oxytocin is administered intranasally during coitus and doesn’t follow a bid schedule (Table 71.7).
Memory Tool: “Bus-bid” for Buspirone is taken bid.
Specific Reference Citation: Table 71.7
Rationale: Being able to recommend medications with specific dosing schedules is important for physicians to improve patient adherence.
Vignette: A 45-year-old man presents with Peyronie’s Disease. He is concerned about medication options and asks about Potaba.
Options:
A) Increases serotonin levels
B) Increases monoamine oxidase activity
C) Blocks the TGF-β1–mediated pathway of inflammation
D) Induces the production of TGF-β
Correct Answer: B
Explanation:
A) Incorrect. Potaba decreases serotonin levels, not increases.
B) Correct. Potaba increases monoamine oxidase activity, which results in a decrease of serotonin levels and enhancement of the antifibrotic properties of tissues.
C) Incorrect. This is the mechanism for Pentoxifylline.
D) Incorrect. This is the mechanism for Tamoxifen.
Memory Tool: Potaba sounds like “Mono-ba,” reminding you that it increases monoamine oxidase activity.
Reference Citation: Table 73.1, Oral Agents for Peyronie’s Disease
Rationale: Understanding the mechanism of action for different medications is critical for choosing the most appropriate treatment for Peyronie’s Disease.
