Name of the Condition

• Sexual Masochism (ICD-10-CM: F65.51)

Summary

Sexual masochism is a condition characterized by the derivation of sexual gratification from experiencing pain, humiliation, or suffering. This behaviour is only considered a disorder when it causes significant distress or impairment in social, occupational, or other important areas of functioning.

Causes

The causes of sexual masochism are not fully understood but may involve a combination of psychological, biological, and environmental factors. It can be associated with past experiences, such as early sexual experiences involving pain or humiliation.

Risk Factors

• Family history of sexual masochism or related disorders
• Personal history of traumatic experiences, abuse, or neglect
• Presence of other paraphilic disorders

Symptoms

• Strong and recurrent sexual urges or fantasies involving being humiliated, beaten, bound, or otherwise made to suffer
• Engaging in masochistic behaviours as the primary means of achieving sexual gratification
• Distress or impairment in daily life due to masochistic urges or behaviours

Diagnosis

Diagnosis typically involves:

• A thorough psychological evaluation
• Assessing the pattern, intensity, and impact of behaviours
• Evaluating any associated distress or functional impairment

Treatment Options

• Psychotherapy: Cognitive-behavioral therapy (CBT) can help modify thoughts and behaviours associated with sexual masochism.
• Medication: Antidepressants or other psychotropic medications may be used to manage underlying issues like depression or anxiety.
• Sex therapy: To address sexual function issues and develop healthy sexual practices.

Prognosis and Follow-Up

• With appropriate treatment, individuals may experience a reduction in distress and improved functioning.
• Regular follow-up and support are essential to manage the condition effectively over time.

Complications

• Potential for physical injury due to masochistic activities
• Development of other mental health disorders, such as depression or anxiety

Lifestyle & Prevention

• Open communication in relationships about sexual preferences and boundaries
• Stress management and healthy coping strategies to reduce distress
• Prevention primarily involves awareness and early intervention for those experiencing distress or impairment.

When to Seek Professional Help

• If sexual masochism causes significant distress or impacts daily life
• When there is a risk of harm to oneself or others due to masochistic behaviours

Additional Resources

• American Psychiatric Association
• National Alliance on Mental Illness (NAMI)
• The Society for Sex Therapy and Research (SSTAR)

Tips for Medical Coders

• Ensure accurate documentation of the distress and impairment to determine the disorder status.
• Avoid confusing sexual masochism disorder with other paraphilic disorders—classification depends on distress and functional impact.