Sexual and 

Gender Identity Disorders

Hypoactive Sexual Desire Disorder     Sexual Aversion Disorder

Female Sexual Arousal Disorder      Male Erectile Disorder

Female Orgasmic Disorder        Male Orgasmic Disorder

Premature Ejaculation      Dyspareunia        Vaginismus

Sexual Dysfunction Due to a General Medical Condition

Substance-Induced Sexual Dysfunction

Exhibitionism     Fetishism     Frotteurism      Pedophilia     Sexual Masochism

Sexual Sadism       Transvestic Fetishism      Voyeurism       Gender Identity Disorder

Return to Home Page

Type Codes for the Sexual Dysfunctions

• Specify 1 of:
  Due to Psychological Factors or
  Due to Combined Psychological Factors and a General Medical Condition

• Specify 1 of:
  Lifelong (it occurs throughout the patient's active sexual life) or
  Acquired (there has been a time when the patient did not have this sexual dysfunction)

• Specify 1 of:
  Generalized (the disorder occurs with all partners and in all situations) or
  Situational

Coding Notes

Although I have picked Female Sexual Arousal Disorder as the example, the following notes apply to many of the Sexual Disorders discussed below:

A patient who has a general medical condition (diabetes mellitus) that partly, but not completely, accounts for a problem with arousal would be diagnosed:

     Axis I 302.72 Female Sexual Arousal Disorder, Due to Combined Factors
     Axis III 250.01 Insulin-dependent Diabetes Mellitus

A patient who uses drugs and who has arousal problems due partly, but not solely, to the direct effects of drug use, would be diagnosed (other specifiers would also apply):

     Axis I 302.72 Female Sexual Arousal Disorder, Due to Combined Factors

Patients whose arousal problems are due solely to a combination of substance use (such as heroin intoxication) and a general medical condition (such as diabetes mellitus) should be given two Axis I diagnoses:

     625.8 Other Female Sexual Dysfunction Due to Diabetes Mellitus
     292.89 Heroin-Induced Sexual Dysfunction, With Impaired Arousal, With Onset During             Intoxication

Of course, you would have to supply the appropriate Axis I and Axis III codes for each of the above examples.

Hypoactive Sexual Desire Disorder

• Desire for and fantasy about sexual activity are chronically or recurrently deficient or absent. The clinician judges this on the basis of the patient's age and other life circumstances that may affect sexual functioning.

• This behavior causes marked distress or interpersonal problems.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Sexual Aversion Disorder

• To an extreme degree, the patient dislikes and avoids nearly all genital contact with a sex partner.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Female Sexual Arousal Disorder

• Chronically or recurrently, the patient cannot lubricate enough to complete the sexual activity.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.

· It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Male Erectile Disorder

• Chronically or repeatedly, the patient cannot get or keep an erection sufficient to complete the sexual activity.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.

• It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Female Orgasmic Disorder

• After a normal phase of sexual excitement, the woman's orgasm is persistently or repeatedly delayed or absent. The clinician's judgment of this is based on her sexual experience, adequacy of foreplay and norms for her age.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.

• It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Male Orgasmic Disorder

• After a normal phase of sexual excitement, the man's orgasm is persistently or repeatedly delayed or absent. The clinician's judgment of this is based on the man's age and the adequacy of duration, focus and intensity of sexual activity.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.

• It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Premature Ejaculation

• With minimal sexual stimulation, the patient often ejaculates earlier than he wants to (before, during or just after penetration). The clinician should evaluate age, novelty of partner or situation, frequency of sexual activity and other factors that can affect duration of the excitement phase.

• It is not directly caused by substance use (medication or drug of abuse).

• It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Dyspareunia

• The patient often experiences genital pain with sexual intercourse.

• It is due neither to Vaginismus nor inadequate lubrication.

• Except for another Sexual Dysfunction, no other Axis I disorder explains it better.

• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.

• It causes marked distress or interpersonal problems.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Vaginismus

• The woman repeatedly has spasms of the vaginal muscles that interfere with sexual intercourse.

• It causes marked distress or interpersonal problems.

• Except for another Sexual Dysfunction, no other Axis I disorder (such as Somatization Disorder) accounts for it better.

• It is not directly caused solely by a general medical condition.

From the choices (top of page), choose the type codes that apply. Also consider the Coding Notes there.

Sexual Dysfunction Due to a General Medical Condition

• Clinically important sexual dysfunction dominates the clinical picture.

• It causes marked distress or interpersonal problems.

• History, physical exam or laboratory findings suggest that the direct, physiological effects of a general medical condition can fully explain these symptoms.

• Another mental disorder (such as Major Depressive Disorder) cannot better explain the sexual dysfunctioning.

Coding of these conditions depends on the predominant type of dysfunction. The specific general medical condition must also be coded on Axis III.

607.84 Male Erectile Disorder Due to [State the general medical condition]

608.89 Male Dyspareunia Due to [State the general medical condition]

608.89 Male Hypoactive Sexual Desire Disorder Due to [State the general medical condition]

608.89 Other Male Sexual Dysfunction Due to [State the general medical condition]

625.0 Female Dyspareunia Due to [State the general medical condition]

625.8 Female Hypoactive Sexual Desire Disorder Due to [State the general medical condition]

625.8 Other Female Sexual Dysfunction Due to [State the general medical condition]

Coding Notes

In addition to the Axis I code, include the name and code number for the general medical condition on Axis III.

Review the notes appended to the Type Codes for the Sexual Dysfunctions (top of page) for further information about combining codes for problems due to general medical conditions and substance use.

Substance-Induced Sexual Dysfunction

• Clinically important sexual dysfunction dominates the clinical picture.

• It causes marked distress or interpersonal problems.

• History, physical exam or laboratory data substantiate that substance use fully explains the symptoms, shown by either
  -These symptoms have developed within a month of Substance Intoxication or
  -Medication use has caused the symptoms

• No other Sexual Dysfunction better explains these symptoms.*

Assign a code number based on the specific substance:

291.8 Alcohol

292.89 All others, including Amphetamine [or Amphetamine-Like Substance], Cocaine, Opioid, Sedative, Hypnotic or Anxiolytic, Other [or Unknown] Substance

Based upon the predominant feature, specify whether:
     With Impaired Desire
     With Impaired Arousal
     With Impaired Orgasm
     With Sexual Pain

Specify if: With Onset During Intoxication

Coding Notes

One of these diagnoses should only be made if the sexual symptoms are serious enough to warrant independent clinical evaluation and exceed those you would expect for a syndrome of intoxication.

*DSM-IV suggests several types of evidence that a disorder other than substance abuse better explains the symptoms. These include:

The symptoms begin before the onset of the substance abuse.

The symptoms persist long after (a month or more) the substance abuse stops.

The symptoms are more severe than you would expect from the amount and extent of substance abuse.

The patient has had previous episodes of the disorder independent of substance use.

Although the Type Codes that apply to other Sexual Dysfunctions do not apply here, see the Coding Notes in that section (page 278) for information about combining those that are Substance-Induced with those caused by a general medical condition.

Paraphilia

Exhibitionism

• Repeatedly for at least 6 months the patient has intense sexual desires, fantasies or behavior concerning genital self-exposure to an unsuspecting stranger.

• This causes clinically important distress or impairs work, social or personal functioning, or the patient has acted on these desires.

Fetishism

• Repeatedly for at least 6 months the patient has intense sexual desires, fantasies or behavior concerning the use of inanimate objects (such as shoes, underwear).

• This results in clinically important distress or impairs work, social or personal functioning.

• The objects are not used solely in cross-dressing (female clothing in Transvestic Fetishism) and are not equipment intended to stimulate the genitals (such as a vibrator).

Frotteurism

• Repeatedly for at least 6 months, the patient has intense sexual desires, fantasies or behaviors that involve touching and rubbing against a person who doesn't consent to this behavior.

• This causes clinically important distress or impairs work, social or personal functioning, or the patient has acted on these desires.

Pedophilia

• Repeatedly for at least 6 months, the patient has intense sexual desires, fantasies or behaviors concerning sexual activity with a sexually immature child (usually age 13 or under).

• This causes clinically important distress or impairs work, social or personal functioning, or the patient has acted on these desires.

• The patient is 16 or older and at least 5 years older than the child.

State whether:
     Sexually Attracted to Males
     Sexually Attracted to Females
     Sexually Attracted to Males and Females

Specify if: Limited to incest

State whether:

     Exclusive type (aroused only by children)
     Nonexclusive type

Coding Notes

Exclude from this diagnosis late adolescents who have an ongoing sexual relationship with a child who is 12 or 13 years old).

Sexual Masochism

• Repeatedly for at least 6 months, the patient has intense sexual desires, fantasies or behaviors concerning real acts of being beaten, bound, humiliated or otherwise made to suffer.

• This causes clinically important distress or impairs work, social or personal functioning.

Sexual Sadism

• Repeatedly for at least 6 months, the patient has intense sexual desires, fantasies or behaviors concerning real acts of causing physical or psychological torment or otherwise humiliating another.

• This causes clinically important distress or impairs work, social or personal functioning, or the patient has acted on these desires with a nonconsenting person

Transvestic Fetishism

• Repeatedly for at least 6 months, a heterosexual male has intense sexual desires, fantasies or behavior concerning cross-dressing.

• This causes clinically important distress or impairs work, social or personal functioning.

Specify if With Gender Dysphoria. The patient is persistently uncomfortable with gender identity or role.

Voyeurism

• Repeatedly for at least 6 months, the patient has intense sexual desires, fantasies or behaviors concerning the act of watching an unsuspecting person who is naked, disrobing or having sex.

• This causes clinically important distress or impairs work, social or personal functioning, or the patient has acted on these desires.

302.9 Paraphilia Not Otherwise Specified

Gender Identity Disorder

• The patient strongly and persistently identifies with the other sex. This is not simply a desire for a perceived cultural advantage of being the other sex. In adolescents and adults, this desire may be manifested by any of:*
  -Stated wish to be the other sex
  -Often passing as the other sex
  -Wish to live or be treated as the other sex
  -Belief that the patient's feelings and reactions are typical of the other sex

• There is strong discomfort with the patient's own sex or a feeling that the gender role of that sex is inappropriate for the patient. This is shown by any symptoms such as:**
  -Preoccupation with hormones, surgery or other physical means to change one's sex characteristics
  -Patient's belief in having been born the wrong sex

• The patient does not have a physical intersex condition.

• These symptoms cause clinically important distress or impair work, social or personal functioning.

Assign code number according to current age:

     302.85 Gender Identity Disorder in Adolescents or Adults
     302.6 Gender Identity Disorder in Children

For patients who are sexually mature, specify whether:

     Sexually Attracted to Males
     Sexually Attracted to Females
     Sexually Attracted to Both Males and Females
     Sexually Attracted to Neither Males nor Females

Coding Notes

*Children who are younger than adolescent age must have 4 or more of the following signs of identity with the other sex:
-Reiterated desire to be, or insistencee that the patient is, the other sex
-Boys prefer cross-dressing or simulatiing female garb; girls insist on wearing only male clothing
-The child persistently and strongly prrefers cross-sex roles in fantasy play or has repeatedly fantasizes about being the other sex.
-The child badly wants to participate iin games and pastimes of the other sex.
-The child strongly prefers to play witth children of the other sex.

**A boy's discomfort with his assigned sex may be shown by any of:
-Disgust with his genitals
-Assertion that his genitals will disapppear or that it would be better not to have a penis
-Rejection of rough-and-tumble play andd male activities, games and toys

**A girl's discomfort with her assigned sex may be shown by any of:
-Rejection of urinating in a seated possition
-Desire not to develop breasts or mensttruate
-Claims that she will have a penis
-Pronounced dislike for usual female cllothing

302.6  Gender Identity Disorder Not Otherwise Specified

302.9 Sexual Disorder Not Otherwise Specified

Return to Top