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

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

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

 


Sexual Aversion Disorder

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

 


Female Sexual Arousal Disorder

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

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

 


Female Orgasmic Disorder

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

 


Male Orgasmic Disorder

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

 


Premature Ejaculation

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

 


Dyspareunia

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

 


Vaginismus

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

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

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

 


Fetishism

 


Frotteurism

 


Pedophilia

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

 


Sexual Sadism

 


Transvestic Fetishism

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

 


Voyeurism

 


302.9 Paraphilia Not Otherwise Specified


Gender Identity Disorder

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