acute withdrawal or severe intoxication; or there is other evidence suggesting the
existence of an independent non-substance/medication-induced sexual dysfunc-
tion (e.g., a history of recurrent non-substance/medication-related episodes). 
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress in the individual.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or
substance withdrawal only when the symptoms in Criterion A predominate in the clinical
picture and are sufficiently severe to warrant clinical attention.
Coding note: The ICD-9-CM and ICD-10-CM codes for the [specific substance/medica-
tion]-induced sexual dysfunctions are indicated in the table below. Note that the ICD-10-CM
code depends on whether or not there is a comorbid substance use disorder present for the
same class of substance. If a mild substance use disorder is comorbid with the substance-
induced sexual dysfunction, the 4th position character is “1,” and the clinician should record
“mild [substance] use disorder” before the substance-induced sexual dysfunction (e.g., “mild
cocaine use disorder with cocaine-induced sexual dysfunction”). If a moderate or severe
substance use disorder is comorbid with the substance-induced sexual dysfunction, the 4th
position character is “2,” and the clinician sh ould record “moderate [substance] use disorder”
or “severe [substance] use disorder,” depending on the severity of the comorbid substance