|CD-10-CM. The name of the substance/medication-induced sexual dysfunction begins with the specific substance (e.g., alcohol, ﬂuoxetine) that is presumed to be causing the sexual dysfunction. The diagnostic code is selected from the table included in the criteria set, which is based on the drug class and presence or absence of a comorbid substance use disorder. For substances that do not fit into any of the classes (e.g., ﬂuoxetine), the code for ”other substance” should be used; and in cases in which a substance is judged to be an eti- ological factor but the specific class of substance is unknown, the category "unknown sub- stance” should be used.
When recording the name of the disorder, the comorbid substance use disorder (if any) is listed first, followed by the word “with,” followed by the name of the substance-induced sexual dysfunction, followed by the specification of onset (i.e., onset during intoxication, onset during withdrawal, with onset after medication use), followed by the severity spec- ifier (e.g., mild, moderate, severe). For example, in the case of erectile dysfunction occur- ring during intoxication in a man with a severe alcohol use disorder, the diagnosis is
F10.281 moderate alcohol use disorder with alcohol-induced sexual dysfunction, with on- set during intoxication, moderate. A separate diagnosis of the comorbid severe alcohol use disorder is not given. If the substance-induced sexual dysfunction occurs without a co- morbid substance use disorder (e.g., after a one-time heavy use of the substance), no ac- companying substance use disorder is noted (e.g., F15.981 amphetamine-induced sexual dysfunction, with onset during intoxication). When more than one substance is judged to play a significant role in the development of the sexual dysfunction, each should be listed separately (e.g., F14.181 mild cocaine use disorder with cocaine-induced sexual dysfunc- tion, with onset during intoxication, moderate; F19.981 ﬂuoxetine-induced sexual dys- function, with onset after medication use, moderate).
The major feature is a disturbance in sexual function that has a temporal relationship with substance/medication initiation, dose increase, or substance/ medication discontinuation.
Sexual dysfunctions can occur in association with intoxication with the following classes of substances: alcohol; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including co- caine); and other (or unknown) substances. Sexual dysfunctions can occur in association with withdrawal from the following classes of substances: alcohol; opioids; sedatives, hyp- notics, or anxiolytics; and other (or unknown) substances. Medications that can induce sex- ual dysfunctions include antidepressants, antipsychotics, and hormonal contraceptives.
The most commonly reported side effect of antidepressant drugs is difficulty with or- gasm or ejaculation. Problems with desire and erection are less frequent. Approximately 30% of sexual complaints are clinically significant. Certain agents, such as bupropion and mirtazapine, appear not to be associated with sexual side effects.
The sexual problems associated with antipsychotic drugs, including problems with sexual desire, erection, lubrication, ejaculation, or orgasm, have occurred with typical as well as atypical agents. However, problems are less common with prolactin-sparing anti- psychotics than with agents that cause significant prolactin elevation.
Although the effects of mood stabilizers on sexual function are unclear, it is possible that lithium and anticonvulsants, with the possible exception of lamotrigine, have adverse effects on sexual desire. Problems with orgasm may occur with gabapentin. Similarly, there may be a higher prevalence of erectile and orgasmic problems associated with benzodiaz- epines. There have not been such reports with buspirone.