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Discussion Starter · #1 ·
An elderly couple comes to see you in clinic. The husband is 78 years old; the wife is 82 years old. They have been married for nearly 60 years. She starts the interview by stating that over the past 3 months, her husband has lost interest in any form of sexual activity. He retorts that it simply takes him longer to achieve an erection, and that he needs longer to "recover" between episodes of intercourse. When you ask him how long it had been since their last sexual encounter, he states he cannot recall. Which of the following is the next best step to take?
• A. Perform further psychological testing
• B. Privately ask the husband about his extramarital affair
• C. Reassurance of normal aging physiology
• D. Referral to a marriage counselor
• E. Order a head MRI
 

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hmm... i think i would go with

E. Order a head MRI
 

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Discussion Starter · #6 ·
The correct answer is A.
Although the husband’s description of longer times to erection and an increased refractory period are normal in the elderly patient, loss of sexual interest should raise a red flag. Reassurance would be inappropriate. In this case, the wife’s statements ("3 months") and the husband’s inability to recall their last sexual encounter are sufficient evidence to investigate this further, either with psychological or laboratory testing. On the other hand, it would be premature to skip ahead to ordering a head MRI without more of a clinical indication.
It would be inappropriate to assume the husband is having an extramarital affair. There is no evidence in the question stem that this couple needs a marriage counselor.
 
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