ICD-11. Conditions Related to Sexual Health: Codes and Discussion of Innovations
Authors: Kocharyan Garnik 
Published: December 2024

The transition to ICD-11 was recommended by the WHO beginning from January 1, 2022. This classification went into effect on February 11, 2022. All sexual disorders, apart from paraphilias that in ICD-11are termed as paraphilic disorders and included into the Chapter “Mental, behavioural or neurodevelopmental disorders”, were removed from this class. But it should be noted that paraphilic disorders were also simultaneously included into the new ICD-11 rubric “Conditions related to sexual health”. All other sexual disorders have also been included in this chapter. The following fact served as one of impulses for separation of the above chapter. LGBT activists and organizations applied to the ICD-11 project demanding to exclude this pathology from the list of mental disorders, because its presence in the above list, in their opinion, broke human rights. That application was not ignored. In ICD-11 the block F64 “Gender identity disorders” from ICD-10 was replaced with “Gender incongruence”. Also, gender incongruence (transgenderism) in ICD-11 was transferred from “Mental and behavioural disorders” ICD-10 to “Conditions related to sexual health”. In this way mental pathology “was turned” into the norm by means of a “depathologizing” effect of social factors. But leaders of organizations of transgenders do not like even the terminology, which reflects in the ICD-11.
What do they think, the term “gender incongruence” is stigmatizing too, because it contains the word “incongruence” as one of its components. The problems, which compose the group “Conditions related to sexual health”, are present in Chapter 17 of ICD-11. These include (1) sexual dysfunctions; (2) sexual pain disorders; (3) gender incongruence; (4) changes in female genital anatomy; (5) changes in male genital anatomy; (6) paraphilic disorders; (7) adrenogenital disorders; (8) predominantly sexually transmitted infections; (9) contact with health services for contraceptive management.
The article discusses aspects associated with sexual dysfunctions: the required duration of their existence for making a proper diagnosis; the obligation of presence of the diagnostic criterion, according to which a sexual problem must cause clinically significant distress; the exclusion of sexual aversion from this category; the transfer of excessive sexual drive to the Chapter “Compulsive sexual behaviour disorder”; the discussion of the problem of a normal duration of a sexual intercourse, and others. The article contains the author’s table of comparisons of sexual dysfunctions as well as sexual pain disorders in ICD-10 and ICD-11. The author informs that Chapter F66 “Psychological and behavioural disorders associated with sexual development and orientation”, which also contained egodystonic sexual orientation, was completely excluded from ICD-11.
The discussion also involves partial depathologizing of paraphilias, which is based on the absence of a diagnostic criterion of the presence of distress caused by them, which is reflected in ICD-11. According to this approach, if such distress is absent and  a person fully accepts the direction of his sexual drive, then we are talking about a mentally healthy person who has paraphilia, and if paraphilia is not accepted and causes distress, then this is a paraphilic disorder, which refers to mental pathology. The above is fully applied to paedophilia too. What calls attention to itself is absence of masochism among the paraphilic disorders listed above. The author believes that, from a medical point of view, the partial depathologization of paraphilias, which is reflected in ICD-11, is scientifically unfounded, a consequence of the action of exclusively social factors. Therefore, when diagnosing these disorders, it is advisable to use the traditional approach to their diagnosis.