Sexual Dysfunction - Rating Tip of the Week

Impairment rating assignment for sexual dysfunction is often times based solely on self-report by the examinee. The Guides are clear in their directives for rating sexual dysfunction impairment ratings. Sexual dysfunction is discussed in the Guides in Chapter 7, The Urinary and Reproductive Systems, and Chapter 13, The Central and Peripheral Nervous System. Section 7.7 Male Reproductive Organs (5th ed., 156- 157) states:

• The male reproductive organs include the penis, scrotum, testicles, epididymides, spermatic cords, prostate, and seminal vesicles. See the following sections for impairment percentages for male reproductive organs for men between the ages of 40 to 65. Increase the percentages by 50% for men younger than 40, and decrease the percentages by 50% for men older than 65. For instance, class 3 impairment in a 35-year-old man would be rated at 30% (20% + 0.5[20%]). New treatments, when successful, may decrease the degree of impairment.

7.7a Penis

• The penis has the sexual functions of erection and ejaculation. The penis's urinary function is discussed in the first part of this chapter on the urethra (Section 7.6). Penile functional impairment symptoms and signs include erection and sensation abnormalities and partial or complete loss of the penis.

• When evaluating penis impairment, consider both sexual and urinary function impairment. Determine sexual function impairment according to the following classifications. To determine impairment of the whole person, combine this estimate with the appropriate percentage for estimated urinary function impairment. This classification also may be used to estimate penile implant use impairment (see the Combined Values Chart, p. 604).

• Objective techniques useful in evaluating penis function include (but are not limited to) penile tumescence studies, Doppler ultrasound penile blood flow evaluations, dynamic cavernosometry and cavernosography, and angiography.

7.7b Criteria for Rating Permanent Impairment Due to Penile Disease

• The impairment criteria for evaluating penile disease are given in Table 7-5.

Section 13.7d of Chapter 13, Sexual System Neurologic Impairments (5th ed., 342), states:

• Awareness and capability of having an orgasm are the criteria for evaluating permanent impairment of sexual functioning that may result from spinal cord or other neurologic system disorders (see Table 13-21). The individual's previous sexual functioning should be considered by the physician; age is only one criterion for evaluating previous sexual functioning. Adjust for age according to criteria outlined in Chapter 7, The Urinary and Reproductive Systems.

In rating impairment for sexual dysfunction using either Chapter 7 or Chapter 13 the individual must first be diagnosed or demonstrate injury to the reproductive system. Without objective evidence to support that the examinee has a medically verifiable sexual dysfunction, there can be no basis for rating impairment. Certain diagnostic testing which can be used to objectify the examinee's complaints are penile tumescence studies, Doppler ultrasound penile blood flow evaluations, dynamic cavernosometry and cavernosography and/or angiography. Impairment for sexual dysfunction is not to be based on the examinee's subjective complaints; there must be medical studies that support a verifiable sexual dysfunction that is reproducible in order to meet the standards of ratable impairment per the AMA Guides Fifth Edition. In most instances when the examinee's self report is not objectified the evaluator may consider the diminishment or loss of sexual function as an activity of daily living.