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 (Current
Procedural Terminology (CPT) codes 55970 and 55980).