Substance/Medication-Induced Sexual Dysfunction 447
use disorder. If there is no comorbid substance use disorder (e.g., after a one-time heavy
use of the substance), then the 4th position character is “9,” and the clinician should record
only the substance-induced sexual dysfunction.
Specify if (see Table 1 in the chapter “Substance-Related and Addictive Disorders” for di-
agnoses associated with substance class):
With onset during intoxication:  If the criteria are met for intoxication with the sub-
stance and the symptoms develop during intoxication.
With onset during withdrawal:  If criteria are met for withdrawal from the substance
and the symptoms develop during, or shortly after, withdrawal.
With onset after medication use:  Symptoms may appear either at initiation of medi-
cation or after a modification or change in use.
Specify current severity:
Mild:  Occurs on 25%–50% of occasions of sexual activity.
Moderate: Occurs on 50%–75% of occasions of sexual activity.
Severe:  Occurs on 75% or more of occasions of sexual activity.
Recording Procedures
ICD-9-CM. The name of the substance/medication-induced sexual dysfunction begins
with the specific substance (e.g., alcohol, fluoxetine) that is presumed to be causing the
sexual dysfunction. The diagnost ic code is selected from the table included in the criteria
set, which is based on the drug class. For substa nces that do not fit into any of the classes
(e.g., fluoxetine), the code for “other substa nce” should be used; and in cases in which a
substance is judged to be an etiological factor but the specific class of substance is un-
known, the category “unknown substance” should be used.