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Sexual Issues - Physical and Behavioral

Updated: Jul 31, 2020

Sexual/Biological Disorders - Physical

Sexual Dysfunction

  • Duration – 6 months minimum

  • Symptoms:

    • Marked impact on sexual function 75-100% of the time

  • Types:

    • Lifelong

    • Acquired

    • Generalized – in different situations w different people

    • Situational – only with certain types of situations or partners or environments

    • Mild – distress is mild

    • Moderate –distress is moderate

    • Severe – severe or extreme distress

  • Sexual Dysfunction Diagnoses:

    • Delayed Ejaculation F52.32

    • Erectile Disorder F52.21

    • Female Orgasmic Disorder F52.31

    • Female Sexual Interest/Arousal Disorder F52.22

    • Genito-Pelvic Pain/Penetration Disorder F52.6

    • Male Hypoactive Sexual Desire Disorder F52.0

    • Premature Ejaculation F52.4

    • Other Specified Sexual Dysfunction F52.8

    • Unspecified Sexual Dysfunction F52.9

Gender Dysphoria

To be CLEAR: According to the DSM-5, Gender Dysphoria is a diagnosis based on the client's own feelings of dysphoria based on their gender and the biological gender they were born with. This is in no way an advocacy for stigmatizing trans-people nor does it state that trans-people are wrong in their identities. This is a diagnosis to help people struggling with their dysphoria find comfort in their own body weather they decide to stay in it or change it so that it reflects who they are.

Gender Dysphoria in Adolescents and Adults F64.1

  • Duration – 6 months

  • Symptoms: Belief one has been born in the wrong gender's body. Individual has at least two of these issues:

    • Belief one is or should be a different gender

    • Wants to be divested of one's sexual organs and associated physical anatomy due to gender dissonance

    • Longs for the sexual organs and associated anatomy of desired gender

    • Longs to experience life as the desired gender

    • Longs to become and be treated as gender other than one assigned

    • Sense that one experiences life as desired gender state in terms of thoughts, feelings, actions, and interactions

  • Types:

    • With a disorder of sexual development E25.0

      • Differential:

    • Body Dysmorphic Disorder – (not about identity as much as physical body)

    • Transvestic Disorder – (wearing clothes for pleasure-not identity)

    • Nonconformity to Gender Roles – (identity)

    • Schizophrenia and Other Psychotic Disorders – (psychotic symptoms)

Gender Dysphoria (in Children) F64.2

  • Duration: 6 months

  • Symptoms: At least six of the following:

    • Desire to be the other gender or that one is the other gender or an alternative gender

    • In boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong preference for wearing masculine clothing and resistance to typically feminine clothing

    • Strong preference for cross-gender roles in make-believe or fantasy play

    • Strong preference for toys, games, or activities stereo-typically used for engaged in by other gender

    • Strong preference for playmates of other gender

    • Boys rejection of typically masculine items and rough/tumble play; girls rejection of typically feminine items and activities

    • Strong dislike of one's sexual anatomy

    • Strong desire for primary and/or secondary sex characteristics that match experienced gender

  • Types:

    • With a disorder of sexual development E34.50

Other Specified Gender Dysphoria F64.8

Unspecified Gender Dysphoria F64.9

Sexual Disorders - Behavioral

Paraphilic Disorders

  • Recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling

  • Differential:

    • Antisocial Personality Disorder – (aggression, onset, duration)

    • Alcohol and Substance Use Disorders – (substance caused)

    • Obsessive-Compulsive Disorder – (obsession is compulsive and repetitive)

Voyeuristic Disorder F65.3

  • Duration: 6 months

  • Onset: Minimum age 18

  • Symptoms:

    • Recurrent and intense sexual arousal from observing an unsuspecting person naked, undressing, having sex, etc causing clinically significant distress.

Exhibitionistic Disorder F65.2

  • Symptoms:

    • Pattern of intense sexual excitement accompanying fantasies, desires, or behaviors associated with exposing one's genitals to a non-consenting, unsuspecting person.

    • History of at least one behavioral episode of acting out.

Frotteuristic Disorder F65.81

  • Onset – typically puberty

  • Duration – 6 months or more – remission after 5yrs

  • Symptoms:

    • Persistent, intense sexually arousing desires, fantasies or behaviors associated with rubbing against, fondling or touching a non-consenting individual.

    • Has acted out those desires or fantasies on a non-consenting individual.

Sexual Masochism Disorder F65.51

  • Duration: at least 6 months – remission after 5yrs

  • Onset: average is early adulthood

  • Symptoms:

    • Ongoing fantasy, desire, and behavior associated with being hit, beaten, belittled, bound, blindfolded, spanked, humiliated or otherwise made to endure some form or physical, mental, or emotional pain for the purpose of sexual gratification

Sexual Sadism Disorder F65.52

  • Duration: usually chronic

  • Onset: usually before age 30

  • Symptoms:

    • Ongoing fantasy, desire and behaviors associated with deriving intense sexual pleasure and excitement from the physical, mental or emotional suffering of another individual. Individual experiences functional impairment in at least one significant life area, or has acted out on their fantasies, desires or behaviors with an individual who did not consent to engage in the fantasy play.

Pedophilic Disorder F65.4

  • Duration: 6 months

  • Onset: Minimum age 16 and a minimum of 5 years senior to the targeted child/children

  • Symptoms:

    • Engages in persistent, intense fantasies, desires or physical manifestations that cause sexual arousal and involve sexual behavior with a child who has not yet reached puberty. Has acted out on the desire or fantasy in a physical way. *Note that an exclusion exists for individuals in late adolescence who are involved in an ongoing relationship with a child who is at puberty (age 12 or 13).

Festishistic Disorder F65.0

  • Onset – typically adolescence/early adulthood

  • Duration – 6 months or more – remission after 5yrs

  • Symptoms:

    • Intense sexual preoccupation, desires, fantasies, or behaviors with a specific nonsexual body part, nonliving material, or object.

    • Fetish of attention is not limited to items designed for sexual pleasure or enhancement (e.g. dildo, vibrator), and does not solely involve cross-dressing.

Transvestic Disorder F65.1

  • Duration: 6 months (remission after 5yrs)

  • Onset: typically childhood or early adolescence

  • Symptoms:

    • Intense, persistent desires, fantasies, or acting out with cross-dressing for the purpose of sexual excitement or arousal

Other Specified Paraphilic Disorder F65.89

Unspecified Paraphilic Disorder F65.9


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