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Retired NBME 24 Answers

nbme24/Block 4/Question#49 (reveal difficulty score)
A 27-year-old man sustains a spinal cord ...
Penile stimulation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: neurology erections

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 +29  upvote downvote
submitted by โˆ—sattanki(82)
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Apparently there is a completely separate spinal cord reflex where direct penile stimulation leads to an erection. This reflex only needs an intact arc in S2-S4, so as long as this region is not injured, an erection can still occur. However, with transection at C8, then the psychogenic erection reflex cannot occur, as this requires descending fibers from the cortex.

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lsmarshall  Just saw a good summary of nerves/vessels involved saying, "pelvic parasympathetic fibers from S2-S4 can cause cavernous arteriole vasodilation via the cavernous nerve without of central stimulation." +8
seagull  S2-3-4 keeps the penis off the floor +45
drdoom  Modifying @seagull into iambic pentameter: โ€œS2, S3, and Number 4 / keeps the big ole penis / off the floorโ€ +3
myoclonictonicbionic  I can assure you the validity of answer (speaking from experience) +2
raddad  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896089/ Under the "autonomic control" header +2
llamastep1  I've always wondered how quadraplegics got it up. I guess their girls help em lol +
jj375  This article is shockingly helpful. Scroll down to the 3 types of erections (psychogenic, reflexogenic, nocturnal) https://craighospital.org/resources/sexual-function-for-men-after-spinal-cord-injury +1



 +10  upvote downvote
submitted by โˆ—cinnapie(38)
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Why does every NBME have one or two erection related questions??

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youssefa  Cause we all know what bout to happen to us in this exam :D +45
niboonsh  lmfaooooooo +1
corgilobacter  erections are a very hard subject +13
ytho  per observation: med students forget what penile stimulation is because they're too busy reading underground forums trying to understand erroneous written assessments... commence negative feedback mechanism +



 +6  upvote downvote
submitted by โˆ—susyars(41)
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From a girls perspective, is really hard to understand this penis/erection physiology questions

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john055  hahaha. thats hilarious lol +
thisshouldbefree  from a males perspective it is really hard to understand the mensural cycle +10
j44n  I'm a man.... and i still miss every boner question +1



 +5  upvote downvote
submitted by โˆ—syoung07(58)
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Robin Williams once said "God gave men two heads and only enough blood to work one at a time". Might help yall conceptualize that the penis has a "brain" of its own. The erotic dreams, reading and viewing erotic material all require input from the brain to reach the penis whereas penile stimulation is a local reflex.

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ih8payingfordis  Same. I was able to eliminate reading erotic literature, viewing erotic material and erotic dreams from the get go. +



 +1  upvote downvote
submitted by โˆ—charcot_bouchard(574)
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Apparently theres role of sympathetic system in psychogenic erection and its comes from T11-L2. So if patient have transaction at L5 they lose reflex erection but still retain psychogenic one.

ABove T9 transaction cause loss of psychogenic erection

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charcot_bouchard  Below L5* (Not at) +



 +0  upvote downvote
submitted by โˆ—paperbackwriter(161)
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Worth noting that not only is there a separate reflex arc for non-psychogenic ejaculation, but that glandular secretion, emission (contraction of everything besides the penis muscles), and ejaculation (contraction of penis muscles i.e. ischiocavernosus and bulbospongiosus) are all under reflex control.

-- All efferents are parasympathetic EXCEPT for emission (sympathetic) and ejaculation (somatic). -- all afferents are pudendal n. except for psychogenic erection which starts with higher centers

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 +0  upvote downvote
submitted by โˆ—mhalliburton(1)
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Reflex erection--> somatic tactile stimuli to penis Can still happen if a spinal-cord transection occurs cranial to T10/T12.

verses

Sympathetic--> psychogenetic erection Males with cord transections above T9 are unable to achieve psychogenic erections.

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