F52 SEXUAL DYSFUNCTION, NOT CAUSED BY ORGANIC DISORDER OR DISEASE

G1. The subject is unable to participate in a sexual relationship as he or she should wish.
G2. The dysfunction occurs frequently, but may be absent on some occasions.
G3. The dysfunction has been present for at least six months.
G4. Not entirely attributable to any of the other mental and behavioural 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 which assess severity as well as frequency of the problem. More than one type of dysfunction can coexist.

F52.0 Lack or loss of sexual desire

A.   The general criteria for sexual dysfunction (F52) must be met.
B.   Lack or loss of sexual desire, manifest by diminution of seeking out sexual cues; thinking about sex with  associated feelings of desire or appetite; or sexual fantasies.
C.   Lack of interest in initiating sexual activity either with partner or as solitary masturbation, at a frequency  clearly lower than expected, taking into account age and context, or at a frequency very clearly reduced  from previous much higher levels.

F52.1 Sexual aversion and lack of sexual enjoyment
F52.10 Sexual aversion

A.   The general criteria for sexual dysfunction (F52) must be met.
B.   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.
C.   Not due to performance anxiety (reaction to previous failure of sexual response).

F52.11 Lack of sexual enjoyment

A.   The general criteria for sexual dysfunction (F52) must be met.
B.   Genital response (orgasm and/or ejaculation) all occur during sexual stimulation, but are not accompanied  by pleasurable sensations or feelings of pleasant excitement.
C.   Absence of manifest and persistent fear or anxiety during sexual activity (see F52.10 Sexual aversion).

F52.2 Failure of genital response

A.   The general criteria for sexual dysfunction (F52) must be met.

In addition for men:
B.   Erection sufficient for intercourse fails to occur when intercourse is attempted.
The dysfunction appears as one of the following:
(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:
B.   Failure of genital response, experienced as failure of vaginal lubrication, together with inadequate  tumescence of the labia.
The dysfunction appears as one of the following:
(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).

F52.3 Orgasmic dysfunction

A.   The general criteria for sexual dysfunction (F52) must be met.
B.   Orgasmic dysfunction (either absence or marked delay) appearing as one of the following:
(1) Orgasm has never been experienced in any situation.
(2) Orgasmic dysfunction has developed after a period of relatively normal response:
a)   general: orgasmic dysfunction occurs in all situations and with any partner
b)   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:
i)    only during sleep, never  during the waking state;
ii)    never in the presence  of the partner;
iii)   in the presence of the partner but not within her vagina.

F52.4 Premature ejaculation

A.   The general criteria for sexual dysfunction (F52) must be met.
B.   Inability to delay ejaculation sufficiently to enjoy love making, manifest as either
(1) Occurrence of ejaculation before or very soon after vaginal entry (if a time limit is required: before or  within 15 seconds of vaginal entry), or
(2) Ejaculation in absence of sufficient erection to make vaginal entry possible.
C.   Not due to prolonged abstinence of sexual activity.

F52.5 Nonorganic vaginismus

A.   The general criteria for sexual dysfunction (F52) must be met.
B.   Spasm of the perivaginal muscles sufficient to prevent penile entry or make it uncomfortable.
The dysfunction appears as one of the following:
(1)  Normal response has never been experienced.
(2)  Vaginismus has developed after a period of relatively normal response:
a)   When vaginal entry is not attempted, a normal sexual response may occur.
b)   Any attempt at sexual contact leads to generalized fear, and attempts to avoid vaginal entry (e.g. spasm of  the adductor muscles of the thighs).

F52.6 Nonorganic dyspareunia

A. The general criteria for F52 must be met.
In addition for women:
B. Pain during sexual intercourse, experienced at the entry of the vagina, throughout or only when deep thrusting of the penis occurs.
C.   Not attributable to vaginismus or failure of lubrication; dyspareunia due to organic pathology should be  classified according to the underlying disorder.

In addition for men:
B.   Pain or discomfort during sexual response. Careful recording should be established of the timing of  the pain and the exact localization.
C.   Absence of local physical factors. If found, the dysfunction should be classified elsewhere.

F52.7 Excessive sexual drive
No research criteria are attempted for this category. Researchers studying this category are recommended  to design their own criteria.
F52.8 Other sexual dysfunction, not caused by organic disorder or disease
F52.9 Unspecified sexual dysfunction, not caused by organic disorder or disease

F64 GENDER IDENTITY DISORDERS
F64.0 Transsexualism

A.   Desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make  one's body as congruent as possible with one's preferred sex through surgery and hormonal treatment.
B.   Presence of the transsexual identity for at least two years persistently.
C. Not a symptom of another mental disorder, such as schizophrenia, or associated with chromosome  abnormality.

F64.1 Dual-role transvestism

A.   Wearing clothes of the opposite sex in order to experience temporarily membership of the opposite sex.
B.   Absence of any sexual motivation for the cross-dressing.
C.   Absence of any desire to change permanently into the opposite sex.

F64.2 Gender identity disorder of childhood For females:

A. Persistent and intense distress about being a girl, and a stated desire to be a boy (not merely a desire for any perceived cultural advantages from being a boy), or insistence that she is a boy.
B. Either (1) or (2):
(1) Persistent marked aversion to normative feminine clothing and insistence on wearing stereotypical  masculine clothing, e.g. boys' underwear and other accessories.
(2) Persistent repudiation of female anatomic structures, as evidenced by at least one of the following:
(a) an assertion that she has, or will grow, a penis
(b) rejection of urinating in a sitting position
(c) assertion that she does not want to grow breasts or menstruate
C.   The girl has not yet reached puberty.
D.   The disorder must have been present for at least six months.
For males:
A.   Persistent and intense distress about being a boy and an intense desire to be a girl or, more rarely, insistence that he is a girl.

B.   Either (1) or (2):
(1) Preoccupation with female stereotypical activities, as shown by a preference for either cross-dressing or  simulating female attire, or by an intense desire to participate in the games and pastimes of girls and  rejection of male stereotypic toys, games and activities.
(2) Persistent repudiation of male anatomic structures, as indicated by at least one of the following repeated  assertions:
(a) that he will grow up to become a woman (not merely in role)
(b) that his penis or testes are disgusting or will disappear
(c) that it would be better not to have a penis or testes.
C.   The boy has not yet reached puberty.
D.   The disorder must have been present for at least six months.

F65 DISORDERS OF SEXUAL PREFERENCE

G1. Recurrent intense sexual urges and fantasies involving unusual objects or activities.
G2. Acts on the urges or is markedly distressed by them.
G3. The preference has been present for at least six months.

F65.0 Fetishism

A.   The general criteria for F65 Disorders of sexual preference must be met.
B.   The fetish (some non-living object) is the most important source of sexual stimulation; or is essential  for satisfactory sexual response.

F65.1 Fetishistic transvestism
A.   The general criteria for F65 Disorders of sexual preference must be met.
B.   The wearing of articles or clothing of the opposite set in order to create the appearance and feeling of being  a member of the opposite sex.
C.   The cross-dressing is closely associated with sexual arousal. Once orgasm occurs and sexual arousal  declines, there is a strong desire to remove the clothing.

F65.2 Exhibitionism

A.   The general criteria for F65 Disorders of sexual preference must be met.
B.   Either a recurrent or a persistent tendency to expose one's genitalia to unsuspecting strangers (usually of  the opposite sex), almost invariably associated with sexual arousal and masturbation.
C.   There is no intention or invitation to sexual intercourse with the "witness(es)".

F65.3 Voyeurism

A.   The general criteria for F65 Disorders of sexual preference must be met.
B.   Either a recurrent or a persistent tendency to look at people engaging in sexual or intimate behaviour such  as undressing, associated with sexual excitement and masturbation.
C.   There is no intention to reveal one's presence.
D.   There is no intention to have a sexual involvement with the person(s) observed.

F65.4 Paedophilia

A.   The general criteria for F65 Disorders of sexual preference must be met.
B.   A persistent or a predominant preference for sexual activity with a prepubescent child or children.
C.   The person is at least 16 years old and at least five years older than the child or children in B.

F65.5 Sado-masochism

A.   The general criteria for F65 Disorders of sexual preference must be met.
B.   A preference for sexual activity, either as recipient (masochism), or as provider (sadism), or both, which  involves at least one of the following:
(1) pain;
(2) humiliation;
(3)  bondage.
C. The sado-masochistic activity is the most important source of stimulation or necessary for sexual gratification.

F65.6 Multiple disorders of sexual preference
The likelihood of more than one abnormal sexual preference occurring in one individual is greater than  would be expected by chance. For research purposes the different types of preference, and their relative importance  to the individual, should be listed. The most common combination is fetishism, transvestism and sado-masochism.

F65.8 Other disorders of sexual preference
A variety of other patterns of sexual preference and activity may occur, each being relatively uncommon.
These include such activities as making obscene telephone calls, rubbing up against people for sexual stimulation in crowded public places (frotteurism), sexual activity with animals, use of strangulation or anoxia for intensifying sexual excitement, and a preference for partners with some particular anatomical abnormality such as an amputated limb.
Erotic practices are too diverse and many too rare or idiosyncratic to justify a separate term for each.

Swallowing urine, smearing faeces, or piercing foreskin or nipples may be part of the behavioural repertoire in sadomasochism. Masturbatory rituals of various kinds are common, but the more extreme practices, such as the insertion of objects into the rectum or penile urethra, or partial self-strangulation, when they take the place of ordinary sexual contacts, amounts to abnormalities. Necrophilia should also be coded here.