Sexual Dysfunction

Last Modified: N/A

Date Created: December 2021

MPC:

  • 01023 Erectile Dysfunction
  • 01023 Ejaculatory Dysfunction
  • 00520 Female Sexual Interest/Arousal Disorder (New)
  • 00520 Male Hypoactive Sexual Desire Disorder (New)
  • 00523 Female Orgasmic Disorder (New)
  • 30276 Genito-Pelvic Pain/Penetration Disorder (New)
  • 00417 Sexual Dysfunction (New)
  • 62900 Other Diseases of GU System

ICD-9: V41.7

ICD-10 (ICD - 10 version 2019): F52; F52.0; F52.1; F52.2; F52.3; F52.4; F52.5; F52.6; F52.7; F52.8; F52.9; R37; R10.2

This publication is available upon request in alternate formats.
PDF Version

On this page

  1. Sexual Dysfunction
    • Overview
    • Definitions
  2. Female Sexual Dysfunction
  3. Male Sexual Dysfunction
  4. References for Sexual Dysfunction

1. Sexual Dysfunction

Normal sexual function is a complex interplay between the mind and the body involving interactions among vascular, neurologic, hormonal, and psychological systems. Sexual dysfunction occurs when physical or psychological problems interfere with the sexual response cycle.

For the purposes of this VAC Entitlement Eligibility Guideline (EEG), “Sexual Dysfunction” means:

A clinically significant, persistent problem occurring during the sexual response cycle that prevents the individual from experiencing satisfaction from sexual activity on all or almost all occasions (approximately 75%-100%), where the problem has persisted for at least six months.

For purposes of this guideline:

Female: means cis female, a person assigned female at birth who identifies as a woman.

Male: means cis male, a person assigned male at birth who identifies as a man.

Sex/gender diverse: means a person with differences in sexual development, people who do not identify within the binary terms of sex and/or gender as a man or a woman, and people who identify as transgender.

For people who are sex/gender diverse, the applicable sections of the guideline will be determined on a case-by-case basis.

Individuals undergoing a sex/gender-affirming process may have changing symptoms of sexual dysfunction as they progress through social and somatic transition. The applicable sections of the guideline will be determined on a case-by-case basis.

For entitlement purposes, a specific diagnosis is preferred, with the following exceptions:

  • In the case of those seeking entitlement due to sexual trauma related to service, the general diagnosis of “Sexual Dysfunction” may be accepted. In these cases, the diagnosis of “Sexual Dysfunction” will include any/all sexual dysfunctions put forward for entitlement, including those listed below under Female Sexual Interest/Arousal Disorder, and Male Hypoactive Sexual Desire Disorder.
  • For sex/gender diverse people, including those who use medical interventions to alter biology such as through the use of cross-sex hormone treatment and/or genital surgery, the diagnosis of “Sexual Dysfunction” may be accepted on individual merit.

Sexual dysfunctions are a heterogeneous group of disorders. An individual may have several sexual dysfunctions at the same time.

Sexual Dysfunction conditions are included in both the Diagnostic and Statistical Manual of Mental Health Disorders Fourth Edition (DSM-4) and Fifth Edition (DSM-5). While the diagnoses referenced within this EEG are derived mainly from the DSM-4 and the DSM-5, the etiology (cause) of sexual dysfunction may include organic, psychogenic or a mix of organic and psychogenic factors. The diagnosis of a sexual dysfunction condition must be determined by the treating qualified medical practitioner i.e., Family Physician, Nurse Practitioner, Obstetrician/Gynecologist, Urologist, Psychiatrist.

Note: The diagnosis of Sexual Dysfunction or a sexual dysfunction condition cannot be provided by a psychologist.

For the purposes of this EEG, Sexual Dysfunction includes but is not limited to:

  • Female Sexual Interest/Arousal Disorder
  • Female Orgasmic Disorder/Anorgasmia
  • Genito-Pelvic Pain/Penetration Disorder
  • Male Hypoactive Sexual Desire Disorder
  • Ejaculatory Disorder - includes but is not limited to: Delayed Ejaculation; Premature (Early) Ejaculation; An-ejaculation /Anorgasmia; Retro-grade Ejaculation; Painful Ejaculation/Post Ejaculatory Pain.
  • Erectile Disorder

For the purposes of this EEG, Sexual Dysfunction does NOT include:

  • Hyperactive Sexual Desire Disorder
  • Persistent Genital Arousal Disorder
  • Gender Dysphoria (DSM-5)
  • Gender Identity Disorder (DSM-IV)
  • Permanent Infertility
  • Sterility
  • Diseases of the Genitalia

2. Female Sexual Dysfunction

Definition

For the purposes of this EEG, Female Sexual Dysfunction includes but is not limited to:

  • Female Sexual Interest/Arousal Disorder
  • Female Orgasmic Disorder/Anorgasmia
  • Genito-Pelvic Pain/Penetration Disorder – includes: dyspareunia, vaginismus.

For the purposes of this EEG, Female Sexual Dysfunction does NOT include:

  • Hyperactive Sexual Desire Disorder
  • Persistent Genital Arousal Disorder
  • Gender Dysphoria (DSM-5)
  • Gender Identity Disorder (DSM-IV)
  • Permanent Infertility
  • Sterility
  • Diseases of the Genitalia

Diagnostic Standard

For the purposes of this EEG, VAC accepts the diagnoses of conditions of Female Sexual Dysfunction from the treating qualified medical practitioner i.e., Family Physician, Nurse Practitioner, Obstetrician/Gynecologist, Psychiatrist.

Note: Entitlement should be granted for a chronic condition only. For VAC purposes “chronic” means that the condition has existed for at least 6 months. Signs and symptoms are generally expected to persist despite medical attention, although they may wax and wane over the 6-month period and thereafter.

Diagnosing Female Sexual Dysfunction in general, or a specific sub-type requires that the condition is clinically significant, experienced on all or almost all occasions of sexual activity (approximately 75%-100%), and has persisted for at least six months.

Anatomy and Physiology

The female reproductive system consists of the uterus, ovaries, fallopian tubes, cervix, accessory glands, vagina and vulva (external genital area). The vulva includes the mons pubis, labia majora, labia minora, Bartholin glands, and clitoris. The sexual response cycle has been described as consisting of four phases: desire (libido), arousal (excitement), orgasm, and resolution. This framework however may not apply consistently to all sexual responses, as the phases may vary in sequence, overlap, repeat, or be absent during some or all sexual encounters. Also, subjective satisfaction with the sexual experience may not require achieving all response phases, including orgasm.

The female hormone estrogen is important for sexual function. Declining levels of estrogen as in the peri/postmenopausal states has been associated with changes in sexual function, particularly decreased libido. Androgens (DHEA-S, dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone) likely also play a role in female sexual function; however, the magnitude of this role is uncertain.

Sexual function, how the body reacts in different stages of the sexual response cycle, is influenced by psychological factors and/or organic factors including trauma, illness and some medications. Healthy sexuality depends on the interaction of neurologic, endocrine and vascular responses in a psychological context that allows a positive response to sexual stimuli. Disturbances in any of these areas can lead to sexual disorders/sexual dysfunction.

Clinical Features

Female sexual dysfunction takes on different forms, including lack of sexual desire, impaired arousal, inability to achieve orgasm, pain with sexual activity, or a combination of these issues. Low sexual desire and inability to reach orgasm are frequently reported concerns. The symptom, reduced libido (loss of interest in sexual activity) increases with age, and it frequently accompanies other sexual disorders.

Female sexual dysfunction may be categorized as:

  1. Sexual desire and arousal disorders,
  2. Orgasmic disorders,
  3. Sexual pain disorders, including dyspareunia (painful intercourse) and vaginismus (involuntary contraction of the muscles of the pelvic floor).

Female Sexual Interest/Arousal Disorder

Equivalent terms for this type of Female Sexual Dysfunction include: Hypoactive Sexual Desire, Sexual Aversion Disorder, Female Sexual Arousal Disorder.

Female Sexual Interest/Arousal Disorder includes experiencing any of the following:

  • Absent/reduced interest in sexual activity;
  • Absent/reduced sexual/erotic thoughts or fantasies;
  • No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate;
  • Absent/reduced sexual excitement/pleasure during sexual activity;
  • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual);
  • Absent/reduced genital or non-genital sensations during sexual activity.

The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.

The diagnosis associated with these symptoms is determined by the treating qualified health professional.

A “desire discrepancy”, in which a female has lower desire for sexual activity than her partner, is not sufficient to diagnose Female Sexual Interest/Arousal Disorder.

**Note: For VAC purposes loss of/decreased libido is considered a symptom often associated with other conditions. Loss of/decreased libido, is not considered an independent condition for entitlement if the medical information indicates that it is a symptom of, or due to the following:

  1. Mental health condition;
  2. Systemic condition - such as cancer, endocrine disorders including reduced estrogen levels, neurological disorders, renal failure, obesity and inability to exercise;
  3. Pain condition (local or generalized) - such as inflammatory arthritis, fibromyalgia, back conditions, hip conditions, etc.

As noted above loss of/decreased libido is a symptom. Therefore, loss of/decreased libido alone is insufficient to establish a diagnosis of Female Sexual Interest/Arousal Disorder. If the information concerning the symptoms being experienced and/or the provided diagnosis is not clear or is contradictory, consultation with Medical Advisory is recommended.

Female Orgasmic Disorder/Anorgasmia

Female Orgasmic Disorder/Anorgasmia means the presence of either of the following symptoms:

  • Marked delay in, marked infrequency of, or absence of orgasm;
  • Markedly reduced intensity of orgasmic sensations.

Many females require clitoral stimulation to reach orgasm, and a relatively small proportion of females report that they always experience orgasm during penetrative vaginal intercourse. Thus, a female experiencing orgasm through clitoral stimulation but not during intercourse does not meet the criteria for a clinical diagnosis of Female Orgasmic Disorder/Anorgasmia. Orgasmic difficulties that are the result of inadequate sexual stimulation also do not meet the criteria for a clinical diagnosis of Female Orgasmic Disorder/Anorgasmia. In these cases, a diagnosis of Female Orgasmic Disorder/Anorgasmia would not be made.

Genito-Pelvic Pain/Penetration Disorder

For the purposes of this EEG, Genito-Pelvic Pain/Penetration Disorder includes:

  • Dyspareunia (recurrent or persistent genital pain associated with sexual intercourse not caused exclusively by a lack of lubrication or by vaginismus and associated with increased distress or interpersonal difficulty);
  • Vaginismus (recurrent or persistent involuntary spasm of the outer third vaginal muscles that interferes with sexual intercourse by preventing penetration and is associated with increased distress or interpersonal difficulty).

Genito-Pelvic Pain/Penetration Disorder means recurrent difficulties with one (or more) of the following:

  • Vaginal penetration during intercourse;
  • Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts;
  • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration;
  • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

Entitlement Considerations

On this page

A. Causes And / Or Aggravation

Female Sexual Dysfunction may be classified as:

  • Organic (i.e., vasculogenic, neurogenic, local vaginal/perineal factors, hormonal, drug-induced);
  • Psychogenic; or
  • Mixed psychogenic and organic.

The timelines cited below are not binding. Each case should be adjudicated on the evidence provided and its own merits.

Note: The factors listed in Section A of the Entitlement Considerations include specific timelines for the clinical onset or aggravation of Female Sexual Dysfunction condition(s). The timelines are not binding. Each case should be adjudicated on the evidence provided and its own merits. If the medical evidence indicates an alternate timeline, consultation with Medical Advisory is recommended.

Note: The following list of factors is not all inclusive. Factors, other than those listed in Section A, may be claimed to cause or aggravate Female Sexual Dysfunction condition(s). Other factors may be considered based upon the individual merits and medical evidence provided for each case. Consultation with Medical Advisory is recommended.

  1. For psychogenic sexual dysfunction, suffering from a clinically significant psychiatric disorder at the time of clinical onset. Note: The symptom, loss of libido, is included in psychiatric conditions.
  2. Experiencing sexual trauma related to service, prior to the time of clinical onset.
  3. Taking a medication from the specified list of drugs that is supported by the timelines/time of clinical onset. See Appendix A.
  4. Undergoing a course of therapeutic radiation for cancer where the lower abdomen, pelvis or perineal region was in the field of radiation, before the clinical onset.
  5. Experiencing blunt or penetrating trauma to the vulva, vagina, perineum or pelvis (includes pelvic fracture), including surgical trauma and traumatic childbirth.
  6. Malignancy of the perineum, vagina, uterus, fallopian tubes or ovaries.

In general, sexual dysfunction(s) resulting from:

  • Constitutional symptoms (such as weakness, fatigue, loss of interest, loss of libido, etc.) associated with systemic conditions such as cancer, endocrine disorders, neurological disorders, renal failure, obesity and inability to exercise, etc. are considered to be included in the primary entitled condition. If the medical evidence suggests a possible relationship, consultation with Medical Advisory is recommended;
  • Pain due to local or more generalized conditions such as inflammatory arthritis, fibromyalgia, back conditions or hip conditions, etc. are considered to be included in the primary entitled condition causing the pain. If the medical evidence suggests a possible relationship, consultation with Medical Advisory is recommended.

This excludes #4, #5 and #6 above.

B. Medical Conditions Which Are to Be Included in Entitlement / Assessment.

  • Female Sexual Dysfunction
  • Female Sexual Interest/Arousal Disorder
  • Female Orgasmic Disorder/Anorgasmia
  • Genito-Pelvic Pain/Penetration Disorder

C. Common Medical Conditions Which May Result in Whole or In Part from Female Sexual Dysfunction And / Or It’s Treatment.

No consequential medical conditions were identified at the time of publication of this EEG.

Medical conditions consequential to Female Sexual Dysfunction and/or it’s Treatment are only granted entitlement if the individual merits and medical evidence of the case determines a consequential relationship exists. Consultation with Medical Advisory is recommended.

Appendix A

The following medications may cause Female Sexual Dysfunction while on the medication. This list is not all inclusive. If the medical evidence suggests a medication not listed here in Appendix A may be contributing to the claimed Female Sexual Dysfunction condition(s), consultation with Medical Advisory is recommended.

**Note: Cannabis for medical purposes is not considered a medication for the purposes of this EEG. Cannabis authorized for medical purposes does not meet the safety and efficacy standards required by the Food and Drug Regulations (FDR) and is not sold as a medication in Canada and does not have a DIN.

Female Sexual Interest/Arousal Disorder and Anorgasmia

  • Citalopram / Celexa
  • Clomipramine / Anafranil
  • Desvenlafaxine / Pristiq
  • Escitalopram / Cipralex
  • Fluoxetine / Prozac
  • Fluvoxamine / Luvox
  • Paroxetine / Paxil
  • Sertraline / Zoloft
  • Venlafaxine / Effexor (XR)

Genito-Pelvic Pain/Penetration Disorder

  • Association with medications not established.

3. Male Sexual Dysfunction

Definition

For the purposes of this EEG, Male Sexual Dysfunction includes:

  • Male Hypoactive Sexual Desire Disorder
  • Ejaculatory Disorders - include: Delayed Ejaculation, Premature (Early) Ejaculation, An-ejaculation/ Anorgasmia; Retro-grade Ejaculation; Painful ejaculation/post-ejaculation pain.
  • Erectile Disorder

For the purposes of this EEG, Male Sexual Dysfunction does NOT include:

  • Hyperactive Sexual Desire Disorder
  • Persistent Genital Arousal Disorder
  • Gender Dysphoria (DSM-5)
  • Gender Identity Disorder (DSM-IV)
  • Permanent Infertility
  • Sterility
  • Diseases of the Genitalia

Diagnostic Standard

For the purposes of this EEG, VAC accepts the diagnoses of conditions of Male Sexual Dysfunction from the treating qualified medical practitioner i.e., Family Physician, Nurse Practitioner, Urologist, Psychiatrist.

Note: Entitlement should be granted for a chronic condition only. For VAC purposes “chronic” means that the condition has existed for at least 6 months. Signs and symptoms are generally expected to persist despite medical attention, although they may wax and wane over the 6-month period and thereafter.

Diagnosing Male Sexual Dysfunction in general, or a specific sub-type, requires that the condition is clinically significant, experienced on all or almost all occasions of sexual activity (approximately 75%-100%), and has persisted for at least six months.

Anatomy and Physiology

The male reproductive system consists of the penis, scrotum (epididymis and testicles) and part of the urethra outside of the body, and the vas deferens, ejaculatory ducts, part of the urethra, seminal vesicles, prostate gland and bulbourethral glands inside the body. Testosterone plays an integral role in normal male sexual function. Other primary hormones involved in the function of the male reproductive system are follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

The sexual response cycle may be described as consisting of four phases: desire (libido), arousal (excitement), orgasm(ejaculation), and resolution. This framework however may not apply consistently to all sexual responses, as the phases may vary in sequence, overlap, repeat, or be absent during some or all sexual encounters. Also, subjective satisfaction with the sexual experience may not require achieving all response phases, including orgasm.

The initial obligatory event required for male sexual activity, the acquisition and maintenance of penile erection, is primarily a vascular phenomenon, triggered by neurologic signals, and facilitated only in the presence of an appropriate hormonal milieu and psychological mindset.

Sexual function, how the body reacts in different stages of the sexual response cycle, is influenced by psychological factors and/or organic factors including trauma, illness and some medications. Healthy sexuality depends on the interaction of neurological, endocrine, and vascular responses in a psychological context that allows a positive response to sexual stimuli. Disturbances in any of these areas can lead to sexual disorders/sexual dysfunction.

Clinical Features

Male sexual dysfunctions may be categorized as:

  1. Sexual desire and arousal disorders;
  2. Erectile disorders; and
  3. Ejaculatory disorders.

Erectile Disorder, also termed Erectile Dysfunction, most often affects males over 40 years of age, and prevalence increases with age. It is the most frequent type of sexual dysfunction reported in males. Testosterone deficiency may result in ED. The symptom reduced libido (loss of interest in sexual activity), increases with age, and it frequently accompanies other sexual disorders. Normal testosterone levels are important for libido.

The ejaculatory disorders include premature ejaculation, delayed ejaculation, an-ejaculation (absence), and retro-grade ejaculation, painful ejaculation/post ejaculatory pain.

Male Hypoactive Sexual Desire Disorder

Equivalent terms for this type of Male Sexual Dysfunction include: Sexual Aversion Disorder, Male Sexual Interest/Arousal Disorder.

Male Hypoactive Sexual Desire Disorder is a lack of, or significantly reduced, sexual interest/arousal, that may be manifested by:

  • Absent/reduced interest in sexual activity;
  • Absent/reduced sexual/erotic thoughts or fantasies;
  • No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate;
  • Absent/reduced sexual excitement/pleasure during sexual activity;
  • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual);
  • Absent/reduced genital or non-genital sensations during sexual activity.

The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.

The diagnosis associated with these symptoms is determined by the treating qualified health professional.

A “desire discrepancy”, in which a male has lower desire for sexual activity than his partner, is not sufficient to diagnose Male Hypoactive Sexual Desire Disorder.

**Note: For VAC purposes loss of/decreased libido is considered a symptom often associated with other conditions. Loss of/decreased libido, is not considered an independent condition for entitlement if the medical information indicates that it is a symptom of, or due to the following:

  1. Mental health condition.
  2. Systemic condition - such as cancer, endocrine disorders including reduced estrogen levels, neurological disorders, renal failure, obesity and inability to exercise.
  3. Pain condition (local or generalized) - such as inflammatory arthritis, fibromyalgia, back conditions, hip conditions, etc.

As noted above loss of/decreased libido is a symptom. Therefore, loss of/decreased libido alone is insufficient to establish a diagnosis of Male Hypoactive Sexual Desire Disorder. If the information concerning the symptoms being experienced and/or the provided diagnosis is not clear or is contradictory, consultation with Medical Advisory is recommended.

Ejaculatory Disorder

The Ejaculatory Disorders include: Delayed Ejaculation, Premature (Early) Ejaculation, An-ejaculation /Anorgasmia (absence), Retrograde Ejaculation, Painful Ejaculation/Post Ejaculatory pain.

Premature (Early) Ejaculation means persistent or recurrent pattern of ejaculation that occurs prior to or within one minute following penetration during sexual activity and before the individual wishes it.

*Note: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in non-partnered sexual activities, specific duration criteria have not been established for these activities.

Delayed Ejaculation means marked delay in ejaculation or marked infrequency/absence of ejaculation.

An-ejaculation/anorgasmia means the persistent absence of, or the inability to achieve ejaculation/orgasm, despite stimulation during sexual activity.

Painful Ejaculation/Post Ejaculatory Pain means consistently experiencing genital area pain during ejaculation, or shortly after.

Retrograde Ejaculation occurs when semen(ejaculate) enters the bladder instead of emerging through the penis during orgasm. This is usually due to failure of the bladder neck muscle to tighten properly.

Erectile Disorder

Erectile Disorder is defined as the consistent or recurrent inability to obtain or maintain an erection of sufficient rigidity during sexual activity.

Erectile Disorder may manifest as:

  • Marked difficulty in obtaining an erection during sexual activity;
  • Marked difficulty in maintaining an erection until the completion of sexual activity;
  • Marked decrease in erectile rigidity.

Erectile Disorder is classified as:

  1. Organic (i.e., vasculogenic, neurogenic, local penile [cavernous] factors, hormonal, drug-induced),
  2. Psychogenic, or
  3. Mixed psychogenic and organic.

Entitlement Considerations

On this page

A. Causes And / Or Aggravation

Male Sexual Dysfunction may be classified as:

  • Organic (i.e., vasculogenic, neurogenic, local genitalia/perineal factors, hormonal, drug-induced);
  • Psychogenic; or
  • Mixed psychogenic and organic.

The timelines cited below are not binding. Each case should be adjudicated on the evidence provided and its own merits.

Note: The factors listed in Section A of the Entitlement Considerations include specific timelines for the clinical onset or aggravation of Male Sexual Dysfunction condition(s). The timelines are not binding. Each case should be adjudicated on the evidence provided and its own merits. If the medical evidence indicates an alternate timeline, consultation with Medical Advisory is recommended.

Note: The following list of factors is not all inclusive. Factors, other than those listed in Section A, may be claimed to cause or aggravate Male Sexual Dysfunction condition(s). Other factors may be considered based upon the individual merits and medical evidence provided for each case. Consultation with Medical Advisory is recommended.

  1. For psychogenic sexual dysfunction, suffering from a clinically significant psychiatric disorder at the time of clinical onset. Note: The symptom, loss of libido, is included in psychiatric conditions.
  2. Experiencing sexual trauma related to service, prior to the time of clinical onset.
  3. Taking a medication from the specified list of drugs that is supported by the timelines/time of clinical onset. See Appendix B.
  4. Undergoing a course of therapeutic radiation for cancer where the lower abdomen, pelvis or perineal region was in the field of radiation, before the clinical onset.
  5. Experiencing blunt or penetrating trauma to the penis, scrotum, prostate, perineum or pelvis (includes pelvic fracture), including surgical trauma.
  6. Malignancy of the perineum, penis, scrotal area, prostate, or testes.
  7. Having Peyronie’s Disease at the time of clinical onset.

In general, sexual dysfunction(s) resulting from:

  • Constitutional symptoms (such as weakness, fatigue, loss of interest, loss of libido, etc) associated with systemic conditions such as cancer, endocrine disorders, neurological disorders, renal failure, obesity and inability to exercise, etc. are considered to be included in the primary entitled condition. If the medical evidence suggests a possible relationship, consultation with Medical Advisory is recommended;
  • Pain due to local or more generalized conditions such as inflammatory arthritis, fibromyalgia, back conditions or hip conditions, etc are considered to be included in the primary entitled condition causing the pain. If the medical evidence suggests a possible relationship, consultation with Medical Advisory is recommended.

This excludes #4, #5 and #6 above.

B. Medical Conditions Which Are to Be Included in Entitlement / Assessment.

  • Male Sexual Dysfunction
  • Male Hypoactive Sexual Desire Disorder
  • Ejaculatory Disorder
  • Erectile Disorder

C. Common Medical Conditions Which May Result in Whole or In Part from Male Sexual Dysfunction And / Or Its Treatment.

No consequential medical conditions were identified at the time of publication of this EEG.

Medical conditions consequential to Male Sexual Dysfunction and/or it’s Treatment are only granted entitlement if the individual merits and medical evidence of the case determines a consequential relationship exists. Consultation with Medical Advisory is recommended.

Appendix B

The following medications may cause Male Sexual Dysfunction while on the medication. This list is not all inclusive. If the medical evidence suggests a medication not listed here in Appendix B may be contributing to the claimed Male Sexual Dysfunction Condition(s), consultation with Medical Advisory is recommended.

**Note: Cannabis for medical purposes is not considered a medication for the purposes of this EEG. Cannabis authorized for medical purposes does not meet the safety and efficacy standards required by the Food and Drug Regulations (FDR) and is not sold as a medication in Canada and does not have a DIN.

Male Hypoactive Sexual Desire Disorder and Ejaculatory Disorders

  • Citalopram / Celexa
  • Clomipramine / Anafranil
  • Desvenlafaxine / Pristiq
  • Escitalopram / Cipralex
  • Fluoxetine / Prozac
  • Fluvoxamine / Luvox
  • Paroxetine / (Paxil)
  • Sertraline / Zoloft
  • Venlafaxine / Effexor (XR)

Erectile Dysfunction

  • Citalopram / Celexa
  • Escitalopram / Cipralex
  • Clomipramine / Anafranil
  • Desvenlafaxine / Pristiq
  • Finasteride / Propecia, Proscar, Avodart
  • Fluoxetine / Prozac
  • Fluvoxamine / Luvox
  • Methyldopa / Aldomet
  • Paroxetine / (Paxil)
  • Sertraline / Zoloft
  • Venlafaxine / Effexor (XR)

4. References for Sexual Dysfunction

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th edition (DSM-5) Washington.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV) Washington: 2000.
  3. Burnett AL, Nehra A, Breau RH et al: Erectile dysfunction: AUA guideline. J Urol 2018; 200: 633.
  4. Australian Government Repatriation Medical Authority, Statement of Principles: Erectile Dysfunction (2013); Female Sexual Dysfunction (2016).
  5. Compendium of Pharmaceuticals and Specialties online access https://www.e-therapeutics.ca/welcome
  6. DynaMed. Erectile Dysfunction. EBSCO Information Services. Accessed June 28, 2021. https://www.dynamed.com/condition/erectile-dysfunction
  7. DynaMed. Female Sexual Dysfunction. EBSCO Information Services. Accessed June 27, 2021. https://www.dynamed.com/condition/female-sexual-dysfunction
  8. Equity & Inclusion Office. Positive Space Language. Vancouver, The University of British Columbia, [no date] https://equity.ubc.ca/resources/positive-space/positive-space-language/ Accessed September 7, 2021.
  9. Government of Canada Translation Bureau. Gender and Sexual Diversity Glossary https://www.btb.termiumplus.gc.ca/publications/diversite-diversity-eng.html. Accessed September 7, 2021
  10. Government of Canada Translation Bureau. Gender Inclusive Writing: Correspondence. https://www.noslangues-ourlanguages.gc.ca/en/writing-tips-plus/gender-inclusive-writing-correspondence Accessed September 7, 2021
  11. Government of Canada Treasury Board Secretariat. Gender – Based Analysis. https://www.canada.ca/en/treasury-board-secretariat/services/treasury-board-submissions/gender-based-analysis-plus.html#gba1
  12. Government of Canada – Department of National Defence. Sexual Misconduct Response Centre. 2019-2020 Annual Report. https://www.canada.ca/en/department-national-defence/corporate/reports-publications/smrc-annual-report-2020.html
  13. Kerckhof M. E., Kreukels B. P. C., Nieder T. O., Becker-Hébly I., van de Grift T. C., Staphorsius A. S., Köhler A., Heylens G., & Elaut E. (2019). Prevalence of sexual dysfunctions in transgender persons: Results from the ENIGI follow-up study. The Journal of Sexual Medicine, 16(12), 2018-2029. https://doi.org/10.1016/j.jsxm.2019.09.003
  14. Kingsberg, S, Female sexual pain: Evaluation in UpToDate, Waltham, MA. (Accessed on 2021-06-27)
  15. Lexicomp Online, Lexi-Drugs Online: UpToDate, Inc.; 2021; Accessed July 2021.
  16. Mc-Call-Hosenfeld JS, Liebshutz JM, Spiro A, Seaver MR (2009). Sexual Assault in the military and its impact on sexual satisfaction in women veterans: a proposed model. J Womens Health; 18: 901-909. Accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727857/
  17. McIntyre-Smith, A., St. Cyr, K., King, L. (2015). Sexual functioning among a cohort of treatment-seeking Canadian military personnel and Veterans with psychiatric conditions. Mil Med 180(7): 817-24. https://doi.org/10.7205/milmed-d-14-00125
  18. Richardson, J. D., Ketcheson, F., King, L., Forchuk, C. A., Hunt, R., St. Cyr, K., Nazarov, A., Snaider, P., McIntyre-Smith, & Elhai, J. D. (2020). Sexual dysfunction in male Canadian Armed Forces members and Veterans seeking mental health treatment. Military medicine, 185(1-2), 68-74. https://doi.org/10.1093/milmed/usz163
  19. Rosebrock L, Carroll R. Sexual Function in Female Veterans: A Review. J Sex Marital Ther. 2017 Apr 3;43(3):228-245. USMT_A_1141822_O (researchgate.net)
  20. Rosen, R. Epidemiology and etiologies of male sexual dysfunction in UpToDate, Waltham, MA. (Accessed on 2021-06-28)
  21. Shepardson, R. L., Mitzel, L. D., Trabold, N., Crane, C. A., Crasta, D., & Funderburk, J. S. (2021). Sexual dysfunction and preferences for discussing sexual health concerns among Veteran primary care patients. The Journal of the American Board of Family Medicine, 34(2), 357-367. JM-JABF210001 357..367 (jabfm.org)
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