Sexuality and Sexual Dysfunction

Delayed ejaculation

Man takes longer to finish or not at all during partnered sex

Erectile disorder

Impotence, trouble getting/maintaining an erection. Increased incidence with age, usually biological cause. ED in younger people usually a psychological issue

Male hypoactive sexual desire disorder

Decreased or absence of sexual fantasies or desire to have sex for over 6 months. Can’t be due to relationship issues

Premature ejaculation

Man finishes within one minute of penetration

Female orgasmic disorder (anorgasmia)

inability to orgasm with sufficient sex/masturbation

Female sexual interest/arousal disorder

Decreased arousal or interest in sex for over 6 months. May have decreased sexual pleasure/sensations when having sex. Can’t be due to relationship issues

Genito-Pelvic pain/penetration disorder

trouble having sex, pain during, tension in pelvic floor muscles, fear of penetration

vaginismus

involuntary constriction of vagina muscles

dyspareunia

pain before/during/after sex

Voyeuristic disorder

≥6 months of arousal from watching unsuspecting persons who are naked/disrobing/having sex. Acted on urges or causes distress/impairment. Age ≥18. 3+ episodes often satisfy "recurrent" behavior. Diagnosis possible even if urges/fantasies are denied but behavior is documented. Specifiers are “in a controlled environment” vs “in full remission” (≥5 years symptom-free outside of controlled environment)

Exhibitionistic disorder

≥6 months of arousal from exposing genitals to an unsuspecting person. Acted on urges or causes distress/impairment. Specify: Arousal to pre-pubertal children, mature individuals, or both. Specifiers: In a controlled environment or In full remission

Frotteuristic disorder

≥6 months of arousal from touching/rubbing against a non-consenting person. Acted on urges or causes distress/impairment. 3+ separate victims or repeated behavior toward same victim support diagnosis. Specifiers: In controlled environment or In full remission

Sexual masochism disorder

≥6 months of arousal from being humiliated, beaten, bound, or made to suffer. Causes distress or impairment. Specifiers: With asphyxiophilia or In controlled environment or In full remission

Sexual sadism disorder

≥6 months of arousal from inflicting pain/suffering on others. Acted on urges or causes distress/impairment. Specifiers: In controlled environment, In full remission

Pedophilic disorder

≥6 months of arousal involving sexual activity with prepubescent child (≤13). Acted on urges or causes distress/interpersonal difficulty. Age ≥16 and ≥5 years older than the child. Specify: Exclusive vs. Nonexclusive. Attracted to males, females, or both. Limited to incest

Fetishistic disorder

≥6 months of arousal from nonliving objects or specific non-genital body parts. Causes distress/impairment. Not limited to cross-dressing or sexual stimulation devices. Specify: Body parts, objects, or other. In controlled environment or in full remission

Transvestic disorder

≥6 months of arousal from cross-dressing. Causes distress or impairment. Commonly affects males; may include purging/acquisition cycles. Specify: With fetishism or auto-, gynephilia, In controlled environment or in full remission

Gender dysphoria in children

≥6 months of gender incongruence. 6+ indicators (cross dressing, friends of opposite sex only, play with toys meant for opposite sex, play opposite gender role, dislike their sexual anatomy) (one must be desire/insistence to be another gender). Causes distress or impairment. Specify: With disorder of sex development

Gender dysphoria in adolescents/adults

≥6 months of gender incongruence. 2+ indicators (e.g., desire to change sex characteristics, be treated as another gender). Causes distress or impairment. DSM-5 emphasizes experienced gender, not binary identity, Diagnosis includes range of gender expressions. Specify: With disorder of sex development or Posttransition