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Sexual Dysfunctions — DSM-5-TR Companion Reference
Summarized and paraphrased from DSM-5-TR (American Psychiatric Association, 2022). This file is for orientation and education; verify exact criteria wording, codes, and recording procedures against the official DSM-5-TR before any formal clinical, legal, insurance, or research use.
Chapter Overview
Sexual dysfunctions are a heterogeneous group of disorders characterized by a clinically significant disturbance in the ability to respond sexually or to experience sexual pleasure. The chapter covers delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, substance/medication-induced sexual dysfunction, and the other specified/unspecified categories. A person may have several sexual dysfunctions at once, and all should be diagnosed when present. The single most misunderstood rule in this class: a sexual dysfunction is not diagnosed when the difficulty is better explained by a nonsexual mental disorder, severe relationship distress or other significant stressors, the effects of a substance/medication, or another medical condition — and it is also not diagnosed when the difficulty results from inadequate sexual stimulation or from unrealistic expectations.
Disorders in this chapter
| Disorder | ICD-10-CM code(s) | One-line "what it is" |
|---|---|---|
| Delayed Ejaculation | F52.32 | Marked delay, infrequency, or absence of ejaculation in partnered activity |
| Erectile Disorder | F52.21 | Marked difficulty obtaining/maintaining an erection or reduced rigidity |
| Female Orgasmic Disorder | F52.31 | Marked delay, infrequency, absence, or reduced intensity of orgasm |
| Female Sexual Interest/Arousal Disorder | F52.22 | Reduced sexual interest/arousal shown by ≥3 of 6 indicators |
| Genito-Pelvic Pain/Penetration Disorder | F52.6 | Pain, fear, or pelvic-floor tension with vaginal penetration |
| Male Hypoactive Sexual Desire Disorder | F52.0 | Deficient desire for sexual activity and deficient erotic thoughts/fantasies |
| Premature (Early) Ejaculation | F52.4 | Ejaculation within ~1 minute of vaginal penetration, before desired |
| Substance/Medication-Induced Sexual Dysfunction | F1x.181 / .281 / .981 (class-dependent) | Sexual disturbance due to substance/medication effects |
| Other Specified Sexual Dysfunction | F52.8 | Distressing sexual symptoms with a stated reason criteria are unmet |
| Unspecified Sexual Dysfunction | F52.9 | Distressing sexual symptoms; reason criteria are unmet not specified |
Shared structure across the sexual dysfunctions
Each of the primary sexual dysfunctions follows the same skeleton (with disorder-specific Criterion A wording):
- Criterion A: the core symptom(s) on almost all or all occasions (approximately 75%–100%) of sexual activity, in identified situational contexts or, if generalized, in all contexts.
- Criterion B: symptoms have persisted a minimum of approximately 6 months.
- Criterion C: the symptoms cause clinically significant distress in the individual.
- Criterion D: the dysfunction is not better explained by a nonsexual mental disorder, or as a consequence of severe relationship distress or other significant stressors, and is not attributable to the effects of a substance/medication or another medical condition.
- Subtypes: lifelong (present since the person became sexually active) versus acquired (after a period of relatively normal sexual function); generalized (not limited to certain stimulation, situations, or partners) versus situational (only with certain stimulation, situations, or partners).
- Severity specifier: mild, moderate, or severe distress over the symptoms (definitions vary for premature [early] ejaculation, where severity is latency-based, and for substance/medication-induced sexual dysfunction, where severity is percentage-based).
- Assessment factors considered for every dysfunction: partner factors (partner's sexual problems, health status); relationship factors (poor communication, desire discrepancies); individual vulnerability (poor body image, abuse history), psychiatric comorbidity (depression, anxiety), or stressors (job loss, bereavement); cultural/religious factors; and medical factors relevant to prognosis, course, or treatment.
When a sexual problem is mostly explained by another nonsexual mental disorder (e.g., depressive, bipolar, anxiety, posttraumatic, psychotic disorder), only that disorder is diagnosed. If the problem is better explained by substance use or discontinuation, it is diagnosed as substance/medication-induced sexual dysfunction. If it is attributable to another medical condition (e.g., peripheral neuropathy), no psychiatric diagnosis is given. If severe relationship distress, partner violence, or significant stressors better explain the difficulties, a sexual dysfunction is not diagnosed, but a relationship/stressor Z code (e.g., Z63.0 Relationship distress with spouse or intimate partner) may be listed (see 31-other-conditions-that-may-be-a-focus-of-clinical-attention.md).
For gender-diverse individuals (transgender, nonbinary, agender), the diagnoses of male hypoactive sexual desire disorder and female sexual interest/arousal disorder describe symptoms not dependent on the person's sex or gender and may be applied based on clinical judgment. Diagnoses tied to reproductive anatomy (erectile disorder, premature [early] ejaculation, delayed ejaculation, genito-pelvic pain/penetration disorder) are based on the individual's current anatomy, not sex assigned at birth.
Parts of this chapter reference
| Part | Covers |
|---|---|
| Male sexual dysfunctions | Delayed ejaculation, erectile disorder, premature (early) ejaculation, male hypoactive sexual desire disorder |
| Female and other sexual dysfunctions | Female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, substance/medication-induced sexual dysfunction, other specified/unspecified sexual dysfunction, conversation guides |