General Internal Medicine Question 111

Answer & Critique

Correct Answer: B

Educational Objective: Identify mood disorder as a cause of erectile dysfunction.

Key Point

Characteristic features of inorganic erectile dysfunction are sudden onset of symptoms and persistence of nocturnal or morning erections.

This patient has erectile dysfunction (ED) secondary to a mood disorder, most likely major depressive disorder. Characteristic features of inorganic (psychological) ED are sudden onset of symptoms and persistence of nocturnal or morning erections, which indicates that the anatomic and physiologic mechanisms for erection are intact. This patient has guilt, low energy, and decreased interest, all of which are symptoms of depression. Patients with inorganic ED can be reassured that their condition is likely to resolve with time and effective treatment of their mood disorder.

This middle-aged man is not likely to have hypogonadism. His testicles are of normal volume, and he reports continued sexual desires. One of the earliest symptoms of hypogonadism is substantial reduction or absence of sexual thoughts.

This patient has poor sleep; however, he is not overweight and reports no snoring, gasping, apnea, or daytime somnolence. Depression is the most likely cause for this patient's fatigue, given his guilt, anhedonia, and inorganic ED.

Although an early sign of prolactinoma is ED, the persistence of nocturnal and morning erections in this patient makes an organic cause unlikely. Additionally, he lacks other symptoms of prolactinoma, such as headache, visual changes, or decreased body and facial hair.


Beckman TJ, Abu-Lebdeh HS, Mynderse LA. Evaluation and medical management of erectile dysfunction. Mayo Clin Proc. 2006 Mar;81(3): 385-90. PMID: 16529142

This content was last updated in January 2016.

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