The Changes in ICD-11 Related to Sexual Health and Dysfunction and Their Implication for Clinical Practice

The classification of sexual health-related conditions was reformulated in 11th revision of International Classification of Diseases (ICD-11) following current evidence, best practice, and taking human rights into consideration, which is expected to reflect and provide guidance for more integrative clinical approaches. Overcoming the artificial, yet historical, distinction between "organic" and "non-organic" conditions, sexual dysfunctions classified in the "Mental and Behavioral Disorders" and "Disorders of Genitourinary System" in ICD-10 were listed in a new chapter called "Conditions Related to Sexual Health." In practice, this approach has been consistently recommended. However, diagnostical clasification was not congruent with the recommendation. Dysfunctions, defined with a non-normative but individual-based threshold, are categorized according to different stages of the sexual response cycle, similar to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5). However, similarities and distinctions in the clinical presentation of the dysfunction in men and women were also considered, resulting in differences from the DSM-5 approach. Gender Incongruence is classified in this newly formed "Conditions Related to Sexual Health" chapter, not with mental disorders as in the earlier version, reflecting the current non-pathologizing understanding of gender diversity. Furthermore, the criteria for these conditions were revised to embrace the variability in the experience of gender identity. In addition, the residuals of sexual orientation-related diagnostic categories were removed. Paraphilic disorders categories replaced "Disorders of sexual preference" in ICD-10, with significant modifications in conceptualization and classification.