DSM-III

In DSM-III, this category is called Psychosexual Dysfunctions

Disorders

  1. Inhibited Sexual Desire
  2. Inhibited Sexual Excitement
  3. Inhibited Female Orgasm
  4. Inhibited Male Orgasm
  5. Premature Ejaculation
  6. Functional Dyspareunia
  7. Functional Vaginismus
  8. Atypical Psychosexual Dysfunction

Differential Diagnosis

Physical disorder

When a physical disorder partially accounts for the symptoms of a Psychosexual Dysfunction, provided that to some extent psychological factors are also contributing to the disturbance, both diagnoses should be given. For example, Inhibited Sexual Excitement judged to be partly secondary to diabetes can be diagnosed if it is judged that it is partly secondary to performance anxiety as well. The measurement of nocturnal penile tumescence associated with REM sleep is a useful diagnostic technique for evaluating the degree to which a physical disorder is etiologically related to the disturbance. When the disturbed sexual performance is chronic, unvarying over time, and independent of situation, this also suggests that a physical disorder may be etiologically related to the disturbance. In many instances the underlying physical disorder may not have been previously diagnosed.

Other mental disorders

If another mental disorder, for example, Major Depression, is the primary cause of a disturbance in sexual functioning, such as loss of sexual desire, a Psychosexual Dysfunction should not be diagnosed. However, in some instances it will not be clear whether the disturbance in sexual functioning antedates the other mental disorder (in which case it should also be diagnosed) or whether it is secondary to the other mental disorder (in which case it should not be diagnosed). Frequently a Personality Disorder may coexist with a Psychosexual Dysfunction and may even be conceptualized as etiologic. In such cases the Psychosexual Dysfunction should be recorded, as well as the Personality Disorder. If another condition such as Marital Problem or Other Interpersonal Problem is the primary cause of a disturbance in functioning, the Psychosexual Dysfunction should be diagnosed, and both conditions noted.

Inadequate sexual stimulation

If there is inadequate sexual stimulation, in either focus, intensity, or duration, the diagnosis of Psychosexual Dysfunction involving excitement or orgasm is not made.

DSM-IV

Disorders

Sexual Desire Disorders

  1. Hypoactive Sexual Desire Disorder
  2. Sexual Aversion Disorder

Sexual Arousal Disorders

  1. Female Sexual Arousal Disorder
  2. Male Erectile Disorder

Orgasmic Disorders

  1. Female Orgasmic Disorder
  2. Male Orgasmic Disorder
  3. Premature Ejaculation

Sexual Pain Disorders

  1. Dyspareunia (Not Due to a General Medical Condition)
  2. Vaginismus (Not Due to a General Medical Condition)

Sexual Dysfunction Due to a General Medical Condition

Substance-Induced Sexual Dysfunction

Sexual Dysfunction NOS

Subtypes

Subtypes are provided to indicate the onset, context, and etiological factors associated with the Sexual Dysfunctions. If multiple Sexual Dysfunctions are present, the appropriate subtypes for each may be noted. These subtypes do not apply to a diagnosis of Sexual Dysfunction Due to a General Medical Condition or Substance-Induced Sexual Dysfunction.

Onset

One of the following subtypes may be used to indicate the nature of the onset of the Sexual Dysfunction:

Lifelong Type

This subtype applies if the sexual dysfunction has been present since the onset of sexual functioning.

Acquired Type

This subtype applies if the sexual dysfunction develops only after a period of normal functioning.

Context

One of the following subtypes may be used to indicate the context in which the Sexual Dysfunction occurs:

Generalized Type

This subtype applies if the sexual dysfunction is not limited to certain types of stimulation, situations, or partners.

Situational Type

This subtype applies if the sexual dysfunction is limited to certain types of stimulation, situations, or partners. Although in most instances the dysfunctions occur during sexual activity with a partner, in some cases it may be appropriate to identify dysfunctions that occur during masturbation.

Factors

One of the following subtypes may be used to indicate etiological factors associated with the Sexual Dysfunction:

Due to Psychological Factors

This subtype applies when psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the Sexual Dysfunction, and general medical conditions and substances play no role in the etiology of the Sexual Dysfunction.

Due to Combined Factors

This subtype applies when 1) psychological factors are judged to have a role in the onset, severity, exacerbation, or maintenance of the Sexual Dysfunction; and 2) a general medical condition or substance use is also judged to be contributory but is not sufficient to account for the Sexual Dysfunction. If a general medical condition or substance use (including medication side effects) is sufficient to account for the Sexual Dysfunction, Sexual Dysfunction Due to a General Medical Condition and/or Substance-Induced Sexual Dysfunction is diagnosed.

Differential Diagnosis

Sexual Dysfunction Due to a General Medical Condition and Substance-Induced Sexual Dysfunction

If the Sexual Dysfunction is judged to be caused exclusively by the physiological effects of a specified general medical condition, the diagnosis is Sexual Dysfunction Due to a General Medical Condition. This determination is based on history, laboratory findings, or physical examination. If the Sexual Dysfunction is judged to be caused exclusively by the physiological effects of a drug of abuse, a medication, or toxin exposure, the diagnosis is Substance-Induced Sexual Dysfunction. The clinician should inquire carefully about the nature and extent of substance use, including medications. Symptoms that occur during or shortly after (i.e., within 4 weeks of) Substance Intoxication or after medication use may be especially indicative of a Substance-Induced Sexual Dysfunction, depending on the type or amount of the substance used or the duration of use.

Other Sexual Dysfunctions

If the clinician has ascertained that the sexual dysfunction is due to both a general medical condition and substance use, both diagnoses (i.e., Sexual Dysfunction Due to a General Medical Condition and Substance-Induced Sexual Dysfunction) can be given. A primary Sexual Dysfunction diagnosis with the subtype Due to Combined Factors is made if a combination of psychological factors and either a general medical condition or a substance is judged to have an etiological role, but no one etiology is sufficient to account for the dysfunction. If the clinician cannot determine the etiological roles of psychological factors, a general medical condition, and substance use, Sexual Dysfunction Not Otherwise Specified is diagnosed.

Other mental disorders

The diagnosis of a Sexual Dysfunction is also not made if the dysfunction is better accounted for by another mental disorder (i.e., if diminished sexual desire occurs only in the context of a Major Depressive Episode). However, if the disturbance in sexual functioning antedates the mental disorder or is a focus of independent clinical attention, an additional diagnosis of Sexual Dysfunction can also be made. Commonly, if one Sexual Dysfunction is present (e.g., a Sexual Arousal Disorder), additional Sexual Dysfunctions will also be present (e.g., Hypoactive Sexual Desire Disorder). In such cases, all should be diagnosed. A Personality Disorder may coexist with a Sexual Dysfunction. If another clinical condition, such as a Relational Problem, is associated with the disturbance in sexual functioning, the Sexual Dysfunction should be diagnosed and the other clinical condition is also noted. Occasional problems with sexual desire, arousal, or orgasm that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty are not considered to be Sexual Dysfunctions.

DSM-5

Disorders

  1. Delayed Ejaculation
  2. Erectile Disorder
  3. Female Orgasmic Disorder
  4. Female Sexual Interest/Arousal Disorder
  5. Genito-Pelvic Pain/Penetration Disorder
  6. Male Hypoactive Sexual Desire Disorder
  7. Premature (Early) Ejaculation
  8. Substance/Medication-Induced Sexual Dysfunction
  9. Other Specified Sexual Dysfunction
  10. Unspecified Sexual Dysfunction
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