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).