1.0 DESCRIPTION
1.1 Sexual
dysfunctions are characterized by disturbance in sexual desire and
in the psychophysiologic changes that characterize the sexual response
cycle and cause marked distress and interpersonal difficulty. The
sexual dysfunctions include sexual desire disorders (e.g., hypoactive
sexual desire disorder, sexual aversion disorder), sexual arousal
disorders (e.g., female sexual arousal disorder, male erectile disorder),
orgasmic disorders (e.g., female orgasmic disorder, male orgasmic
disorder, premature ejaculation), sexual pain disorders (e.g., dyspareunia,
vaginismus), sexual dysfunction due to a general medical condition,
substance-induced sexual dysfunction, and sexual dysfunction not otherwise
specified. The origin of these disorders may be organic or psychogenic.
1.2 Paraphilic
disorders are characterized by recurrent, intense
sexual urges, fantasies, or behaviors that involve unusual objects,
activities, or situations and cause clinically significant distress
or impairment in social, occupational, or other important areas
of functioning. Paraphilic disorders include voyeuristic
disorder, exhibitionistic disorder, frotteuristic disorder, pedophilic
disorder, sexual masochism disorder, sexual sadism disorder, transvestic
disorder, fetishistic disorder, other specified paraphilic disorder,
and unspecified paraphilia disorder.
2.0 POLICY
Diagnostic studies necessary to establish organic
versus psychogenic disorders, and appropriate medical and surgical
treatment related to sexual dysfunctions including sexual disinhibition
with an organic origin (e.g., disease, trauma, injury, or radical
surgery) may be cost-shared under the TRICARE Program.
3.0 EXCLUSIONS
3.1 Non-medical
(psychiatric) services for organic
sexual dysfunction.
3.2 Services and supplies provided
in connection with psychotherapy for sexual dysfunctions and paraphilic disorders. Therapy
that is wholly or partially related to treating sexual dysfunctions,
such as sex therapy, sexual advice, sexual counseling, sex behavior
modification, psychotherapy, or other similar services.
3.3 All services and supplies directly
and indirectly related to surgical treatment for gender dysphoria
(i.e., sex gender change), except when performed to correct ambiguous
genitalia, which is documented to have been present at birth (CPT
procedure codes 55970 and 55980).