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).