Classification Of Sexual Disorders Research Articles

Sexological Diagnosis: Methodology of Diagnosis and Classification of Sexual Disorders in Men

The lecture presented a methodology for assessing sexual health and staging sexological diagnosis. Based on the assessment of the vast clinical material (23 601 married/partner couples and 4113 male patients without a partner, aged 16 to 85, who sought help on their own or on the referral of other doctors to the Kyiv Center for Family Planning, Sexology and Reproductive Health for the period from 1996 to 2019) the main clinical forms of sexual disharmony and sexual dysfunction in men are presented, as well as the frequency of certain forms and their etiopathogenetic study. It also gives examples of sexological diagnoses and methods of statistical encryption according to ICD-10.

Integrating Sexual Medicine in Obstetrics and Gynecology Practice: Highlights from The Sexual Medicine Fellowship Program

Background: The health system is least prepared to manage sexual dysfunctions and lacks trainedprofessionals who can adequately assess and manage individuals with sexual dysfunctions because theneed for the service has not been documented. This is because routine data are not collected on sexualdysfunctions. This study aimed to outline the distribution of sexual dysfunctions among patients seekinghealth services in a specialized sexual medicine clinic in Nairobi (Sexology Clinic).Methods: Records of all patients seen at the clinic for 12 months were analyzed. A total of 396 patientfiles were reviewed (362 males and 34 females) using a standard tool. The sociodemographic andmedical details of the patients were analyzed. Data were entered in SPSS and summarized using tablesand figures. Disease associations with sociodemographic characteristics were analyzed. Classification ofsexual disorders was performed using the International Classification of Diseases (ICD)-11.Results: The most prevalent sexual disorders in both genders were sexual arousal disorders (76.4%),sexual desire problems (16.42%), and orgasmic disorders (3.6%). Disease distribution was found to bedependent on patient age and sex. Ethnicity, religion, and profession did not affect disease distribution.Conclusion: The distribution of sexual dysfunctions observed in Nairobi was found to be similar to thoseobserved in other populations.Recommendation: Health promotion and treatment programs for sexual dysfunction should bedeveloped to mirror those in more liberal countries because sexual medicine needs are the same. Thehealth system should collect routine sexual health data to help with future planning.

Epidemiology of sexual dysfunctions in Kenya: The case of patients seen at the Sexology Clinic, Nairobi, Kenya

Background: The health system is least prepared to manage sexual dysfunctions and lacks trainedprofessionals who can adequately assess and manage individuals with sexual dysfunctions because theneed for the service has not been documented. This is because routine data are not collected on sexualdysfunctions. This study aimed to outline the distribution of sexual dysfunctions among patients seekinghealth services in a specialized sexual medicine clinic in Nairobi (Sexology Clinic).Methods: Records of all patients seen at the clinic for 12 months were analyzed. A total of 396 patientfiles were reviewed (362 males and 34 females) using a standard tool. The sociodemographic andmedical details of the patients were analyzed. Data were entered in SPSS and summarized using tablesand figures. Disease associations with sociodemographic characteristics were analyzed. Classification ofsexual disorders was performed using the International Classification of Diseases (ICD)-11.Results: The most prevalent sexual disorders in both genders were sexual arousal disorders (76.4%),sexual desire problems (16.42%), and orgasmic disorders (3.6%). Disease distribution was found to bedependent on patient age and sex. Ethnicity, religion, and profession did not affect disease distribution.Conclusion: The distribution of sexual dysfunctions observed in Nairobi was found to be similar to thoseobserved in other populations.Recommendation: Health promotion and treatment programs for sexual dysfunction should bedeveloped to mirror those in more liberal countries because sexual medicine needs are the same. Thehealth system should collect routine sexual health data to help with future planning.

ICD-11 Paraphilic Disorders: A South African Analysis of Its Utility in the Medico-Legal Context

BackgroundIn an effort to improve the clinical utility of the ICD-10, the WHO Working Group on the Classification of Sexual Disorders and Sexual Health recommended a new classification of Paraphilic Disorders in the ICD-11 to replace the ICD-10 section on Disorders of Sexual Preference. The proposed classification may have different implications for different countries. AIM: To examine South African national laws and policies, within which Paraphilic Disorders are encountered, and to assess the implications of the new classification. MethodA South African working group - representing experts within the disciplines of criminal law, psychiatry, psychology, public health, and criminology - reviewed: (i) national laws affected by reclassification, (ii) current practices in the psycho-legal assessment of sexual offenders, (iii) the implications of the reclassification for assessment and decision-making in forensic practice and other health settings, (iv) specific implications of the reclassification for diagnosis, and (v) implications of the reclassification as it relates to the demographic and sociocultural context of South Africa. OutcomesAs a rule, South African courts do not accept the existence of a Paraphilic Disorder on its own to be sufficient grounds to absolve any defendant from criminal responsibility though defence. Nevertheless, a diagnosis such as coercive sexual sadism disorder runs the risk of medicalization of criminal behavior with inappropriate use to mitigate sentences. Clinical ImplicationsThe ICD-11 approach is clinically useful in emphasizing that a broad range of sexual behavior fall under the rubric of healthy sexual behavior, but also that compulsive sexual behavior can be pathological. Strengths and LimitationsThis analysis was conducted by an interdisciplinary expert group, aligning international forensic mental health and national legal constructs in a low-middle income country (LMIC). The analysis is limited by its reliance on expert opinion rather than empirical data. ConclusionsIt is recommended that the ICD-11 includes a cautionary statement for forensic use, highlighting the fact that the mere inclusion of a diagnosis in the ICD-11 does not necessarily have forensic relevance.Artz, L, Swanepoel, M, Combrinck, H, et al. ICD-11 Paraphilic Disorders: A South African Analysis of Its Utility in the Medico-Legal Context. J Sex Med 2020;XX:XXX–XXX.

‘Conversion Therapy’ Misleads, Harms Patients

‘Conversion Therapy’ Misleads, Harms Patients

Non-conforming, part 1: ICD-11

In 2008, Geoff Reed, who was then serving as Senior Project Officer for the Development of ICD-11 Mental and Behavioural Disorders, started receiving emails from individuals concerned about the way the ICD-11 would handle “gender identity disorders”. The emails were from transgender people and advocacy groups wanting to voice their dismay about their identities being considered a mental illness. Since 1975, the ICD has classified transgender identity, or transsexualism (as it was known then), as a mental health disorder. Reed notes that, initially, transgender classification facilitated access to the types of gender-affirming care that were then available. The goal was not to cure people of their transgender identity, as the definition in the ICD-10 makes clear, explains Reed. However, over the more than two decades since ICD-10 was published, many in the transgender community, as well as policy makers and scientists, have come to feel that classifying transgender identity as a mental health disorder is not only scientifically inaccurate, but adds to the burden of stigma they already face. Additionally, the requirement for individuals to have a diagnosis of a mental disorder before being able to pursue medical treatments, such as hormone therapy or surgery, adds significant hurdles to their access to care. These concerns about stigma and access are at the heart of the challenges facing Reed and others serving on ICD-11's Working Group on the Classification of Sexual Disorders and Sexual Health. “It was clear early on that how we've handled gender identity in previous versions of ICD hasn't worked, especially if our goal is to maximise access while trying to minimise stigma”, Reed explains. What was not as clear, however, was how to strike the balance between access and stigma for transgender people in ICD-11 while also maintaining utility for clinicians. Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11This study provides additional support for classifying health-related categories related to transgender identity outside the classification of mental disorders in the ICD-11. The reconceptualisation and related reclassification of transgender-related health conditions in the ICD-11 could serve as a useful instrument in the discussion of public health policies aimed at increasing access to appropriate services and reducing the victimisation of transgender people. Full-Text PDF

Psychiatrists Welcome India’s Historic Ruling on Homosexuality

Psychiatrists in India and around the world helped promote the culture change that allowed for the decriminalization of homosexuality.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH’s proposals for Paraphilic Disorders in ICD-11 are based on the WHO’s role as a global public health agency and the ICD’s function as a public health reporting tool.

Sexual disorders in DSM-5 and ICD-11: a conceptual framework.

The nature and classification of sexual disorders has been a focus during work on the development of DSM-5 and ICD-11. This article proposes different conceptual approaches to the sexual disorders, including classical, critical and integrative positions. Disorders associated with sexual orientation, gender dysphoria/incongruence and paraphilias/paraphilic disorders are discussed from each of these positions. A range of conventional and nonconventional consensual sexual behaviours are prevalent but not necessarily indicative of a mental disorder; there is little diagnostic validity or clinical utility for including these in the nosology. When such behaviours are clinically excessive and associated with distress or impairment, however, a disorder may be present. Debate surrounds the medicalization of some sexual behaviours that are criminal in nature. The classification of sexual behaviour as disordered is necessarily theory-dependent and value-laden. Nevertheless, reasoned debate about the relevant data and values is possible, and will hopefully further improve the diagnostic validity and clinical utility of psychiatric nosology.

Proposed declassification of disease categories related to sexual orientation in theInternational Statistical Classification of Diseases and Related Health Problems(ICD-11)

The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.

Controversies in Gender Diagnoses

This article presents the author's thoughts on gender diagnosis controversies during his tenure at the DSM-5 Workgroup on Sexual and Gender Identity Disorders and the ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health. The work summarizes some of the published conclusions of the DSM-5 and ICD-11 revision processes regarding three particular controversies: (1) stigma versus access to care; (2) the retention of a child gender diagnosis; and (3) the treatment of prepubescent transgender children. Both the DSM and ICD work groups decided that despite the stigma associated with a diagnosis, retaining an adolescent and adult gender diagnosis is necessary to maintain access to care. As for the child gender diagnosis, given the heterogeneity of this clinical population and that gender dysphoria does not persist in most children, a child diagnosis of Gender Dysphoria (DSM) and Gender Incongruence (ICD) should be retained to facilitate ongoing evaluation and management in childhood while acknowledging the uncertainty of the outcome. The treatment of extremely gender variant prepubescent children remains a controversial subject since some underlying assumptions of the treating clinicians are a matter of opinion rather than of empirical data.

Minding the body: Situating gender identity diagnoses in the ICD-11

The World Health Organization (WHO) is in the process of revising the International Statistical Classification of Diseases and Related Health Problems (ICD) and ICD-11 has an anticipated publication date of 2015. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) is charged with evaluating clinical and research data to inform the revision of diagnostic categories related to sexuality and gender identity that are currently included in the mental and behavioural disorders chapter of ICD-10, and making initial recommendations regarding whether and how these categories should be represented in the ICD-11. The diagnostic classification of disorders related to (trans)gender identity is an area long characterized by lack of knowledge, misconceptions and controversy. The placement of these categories has shifted over time within both the ICD and the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), reflecting developing views about what to call these diagnoses, what they mean and where to place them. This article reviews several controversies generated by gender identity diagnoses in recent years. In both the ICD-11 and DSM-5 development processes, one challenge has been to find a balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to healthcare. In this connection, this article discusses several human rights issues related to gender identity diagnoses, and explores the question of whether affected populations are best served by placement of these categories within the mental disorders section of the classification. The combined stigmatization of being transgender and of having a mental disorder diagnosis creates a doubly burdensome situation for this group, which may contribute adversely to health status and to the attainment and enjoyment of human rights. The ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more reflective of current scientific evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services.

Classification of Sexual Disorders

Sexual disorders have been classified in different ways by various authors, and in this paper we compare the latest versions of the two main classificatory systems used around the world, International Classification of Diseases (ICD-10)and Diagnostic and Statistical Manual (DSM-IV). While there are differences between them, there are in general more similarities, and they share many of the same problems. Paramount among these are the lack of any clear demarcation between normal and abnormal; and the fact that even a careful application of a well-thought-out system may be of limited clinical value, as it tends to obscure therapeutically relevant individual variations.