Psychiatry: disorder groups
Sexual dysfunctions & sexual health
This area covers sexual dysfunctions, the sexual side effects of psychiatric medicines, paraphilic disorders and the classification of gender incongruence. Psychiatrists need enough knowledge to ask sensitively, treat common problems and refer appropriately.
Depth by stage, Pre-U → Consultant (details)
What is it?
Sexual health is part of overall wellbeing. Problems such as low desire, erectile difficulties or pain are common, can be caused or worsened by depression, anxiety and relationship stress, and are a frequent side effect of antidepressants and antipsychotics. Patients often stop medication rather than mention these effects.
ICD-11 moved sexual dysfunctions and gender incongruence out of the mental disorders chapter into a new chapter on conditions related to sexual health. DSM-5-TR includes sexual dysfunctions and gender dysphoria. Paraphilic disorders — unusual sexual interests that cause distress or harm, or involve non-consenting people — remain mental disorders in both systems and are relevant in forensic work.
In Malaysia, discussing sexuality is often sensitive, and clinical approaches are shaped by law, religion and culture. Psychiatrists are expected to be respectful, non-judgemental and to follow professional and legal guidance.
Why does a psychiatrist need it?
Psychiatrists must ask about sexual side effects to keep patients on treatment, recognise when sexual problems signal depression or relationship difficulties, and manage paraphilic disorders in forensic settings. They need to understand current classifications and their ethical and cultural context.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns reproductive physiology and human sexual development.
- ClinicalAwareAware of common sexual dysfunctions and how to take a sensitive sexual history.
- HousemanshipAwareAsks about medication side effects including sexual ones when appropriate.
- Medical officerUnderstandsManages medication-related sexual side effects in psychiatric patients.
- Psych traineeAppliesAssesses sexual dysfunctions and paraphilic disorders; understands classification and ethics.
- Specialist / consultantAppliesHandles complex cases and teaches; forensic subspecialists manage paraphilic disorders in offenders.
What are the key topics?
Sexual dysfunctions
- Hypoactive sexual desire dysfunction
- Erectile dysfunction and arousal problems
- Orgasmic and ejaculatory dysfunctions
- Sexual pain disorders
- Physical causes: diabetes, cardiovascular disease, hormonal problems
- Psychological and relationship factors
Medication effects
- SSRIs and SNRIs: delayed orgasm, reduced desire
- Antipsychotics: hyperprolactinaemia and its effects
- Management: dose adjustment, switching, timing strategies
- Asking routinely to support adherence
Paraphilic disorders
- Definition: distress, impairment or harm to others
- Types relevant to forensic practice
- Assessment and treatment in forensic settings
- Risk assessment
Classification and context
- ICD-11 chapter on conditions related to sexual health
- DSM-5-TR sexual dysfunctions and gender dysphoria
- Differences between classification systems
- Professional, legal and cultural considerations in Malaysia
How is it learned and assessed?
- Physiology and behavioural science in pre-clinical years
- Psychiatry and O&G postings
- MMed Part II; MRCPsych Paper A (classification) and Paper B
- Forensic and liaison rotations
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- Kaplan & Sadock's Synopsis of Psychiatry — Wolters Kluwer
- The Maudsley Prescribing Guidelines in Psychiatry — Wiley (sexual side effects)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Why would a psychiatrist ask about sexual problems?
Because many psychiatric medicines affect sexual function, and depression and anxiety often do too. Asking helps adjust treatment so patients can stay well without unwanted side effects.
Are sexual dysfunctions mental disorders?
In ICD-11 they are listed in a separate chapter on sexual health, recognising that causes are often both physical and psychological. DSM-5-TR still lists them among mental disorders.