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ICD-10 - Sexual Dysfunction, Not Caused by Organic Disorder or Disease

[From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993.] ...

G1. The subject is unable to participate in a sexual relationship as he or she would wish.
G2. The dysfunction occurs frequently, but may be absent on some occasions.
G3. The dysfunction has been present for at least 6 months.
G4. The dysfunction is not entirely attributable to any of the other mental and behavioral disorders in ICD-10, physical disorders (such as endocrine disorder), or drug treatment.
Comments
Measurement of each form of dysfunction can be based on rating scales that assess severity as well as frequency of the problem. More than one type of dysfunction can coexist.
Lack or loss of sexual desire

  1. The general criteria for sexual dysfunction must be met.
  2. There is a lack or loss of sexual desire, manifest by diminution of seeking out sexual cues, or thinking about sex with associated feelings of desire or appetite, or of sexual fantasies.
  3. There is a lack of interest in initiating sexual activity either with a partner or as solitary masturbation, resulting in a frequency of activity clearly lower than expected, taking into account age and context, or in a frequency very clearly reduced from previous much higher levels.

Sexual aversion and lack of sexual enjoyment
Sexual aversion

  1. The general criteria for sexual dysfunction must be met.
  2. The prospect of sexual interaction with a partner produces sufficient aversion, fear, or anxiety that sexual activity is avoided, or, if it occurs, is associated with strong negative feelings and an inability to experience any pleasure.
  3. The aversion is not the result of performance anxiety (reaction to previous failure of sexual response).

Lack of sexual enjoyment

  1. The general criteria for sexual dysfunction must be met.
  2. Genital response (orgasm and/or ejaculation) occurs during sexual stimulation, but is not accompanied by pleasurable sensations or feelings of pleasant excitement.
  3. There is no manifest and persistent fear or anxiety during sexual activity (see sexual aversion).

Failure of genital response

  1. The general criteria for sexual dysfunction must be met. In addition, for men:
  2. Erection sufficient for intercourse fails to occur when intercourse is attempted. The dysfunction takes one of the following forms:
    1. full erection occurs during the early stages of lovemaking but disappears or declines when intercourse is attempted (before ejaculation if it occurs);
    2. erection does occur, but only at times when intercourse is not being considered;
    3. partial erection, insufficient for intercourse, occurs, but not full erection;
    4. no penile tumescence occurs at all.

In addition, for women:

  1. There is failure of genital response, experienced as failure of vaginal lubrication, together with inadequate tumescence of the labia. The dysfunction takes one of the following forms.
    1. general lubrication fails in all relevant circumstances;
    2. lubrication may occur initially but fails to persist for long enough to allow comfortable penile entry;
    3. Situational: lubrication occurs only in some situations (e.g., with one partner but not another, or during masturbation, or when vaginal intercourse is not being contemplated).

Orgasmic dysfunction

  1. The general criteria for sexual dysfunction must be met.
  2. There is orgasmic dysfunction (either absence or marked delay of orgasm), which takes one of the following forms:
    1. orgasm has never been experienced in any situation;
    2. orgasmic dysfunction has developed after a period of relatively normal response:
      1. general: orgasmic dysfunction occurs in all situations and with any partner;
      2. situational:
        For women: orgasm does occur in certain situations (e.g., when masturbating or with certain partners); For men, one of the following can be applied:
        1. orgasm occurs only during sleep, never during the waking state;
        2. orgasm never occurs in the presence of the partner;
        3. orgasm occurs in the presence of the partner but not during intercourse.

Premature ejaculation

  1. The general criteria for sexual dysfunction must be met.
  2. There is an inability to delay ejaculation sufficiently to enjoy lovemaking, manifest as either of the following:
    1. occurrence of ejaculation before or very soon after the beginning of intercourse (if a time limit is required: before or within 15 seconds of the beginning of intercourse);
    2. ejaculation occurs in the absence of sufficient erection to make intercourse possible.
  3. The problem is not the result of prolonged abstinence from sexual activity.

Nonorganic vaginismus

  1. The general criteria for sexual dysfunction must be met.
  2. There is spasm of the perivaginal muscles, sufficient to prevent penile entry or make it uncomfortable. The dysfunction takes one of the following forms:
    1. normal response has never been experienced;
    2. vaginismus has developed after a period of relatively normal response;
      1. when vaginal entry is not attempted, a normal sexual response may occur;
      2. any attempt at sexual contact leads to generalized fear and efforts to avoid vaginal entry (e.g., spasm of the adductor muscles of the thighs).

Nonorganic dyspareunia

  1. The general criteria for sexual dysfunction must be met.

In addition, for women:

  1. Pain is experienced at the entry of the vagina, either throughout sexual intercourse or only when deep thrusting of the penis occurs.
  2. The disorder is not attributable to vaginismus or failure of lubrication, dyspareunia of organic origin should be classified according to the underlying disorder.

In addition, for men:

  1. Pain or discomfort is experienced during sexual response. (The timing of the pain and the exact localization should be carefully recorded.)
  2. The discomfort is not the result of local physical factors. If physical factors are found, the dysfunction should be classified elsewhere.

Excessive sexual drive
No research criteria are attempted for this category. Researchers studying this category are recommended to design their own criteria.
Other sexual dysfunction, not caused by organic disorder or disease
Unspecified sexual dysfunction, not caused by organic disorder or disease



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