Which came first the chicken or the egg? Various depressive and anxiety disorders co-occur with sexual dysfunctions and vice versa. While one patient may be exhibiting symptoms of depression which lead to medication related sexual dysfunctions. Another patient may have a sexual disorder which lead to chronic depression. Likewise, anxieties may appear situationally with sexual relationships or be part of an underlying, chronic anxiety disorder which appears to influence sexual function. The DSM-5 is built progressively upon an emerging framework for understanding the classification of mental disorders. Such comorbidities as sexual dysfunctions manifest as underlying dimensions of psychopathology. Diagnostics for psychopathology within this empirical taxonomy show sexual dysfunctions are part of the internalizing spectrum. The internalizing spectrum of conditions are characterized by negative emotions. They are what accounts for comorbidity among the depressive and anxiety disorders. Whether a sexual dysfunction is a comorbidity or not, it is categorized into 4 categories of syndromes, with distinct symptoms such as desire disorders, or lack of sexual desire or interest in sex. Arousal disorders, the inability to become physically aroused or excited during sexual activity. Orgasm disorders when there is a delay or absence of orgasm, and pain disorders, pain during intercourse. So, what do these syndromes, symptoms, and disorders mean for your diagnosis of a patient? The spectrum of internalizing conditions includes sexual problems, fear, distress-based concerns, and eating pathology. The various syndromes that fall under each class are conceptually linked and with each syndrome interacting with and influencing other syndromes. This makes diagnosis of a sexual disorders all that much more complicated. Using interview instruments directly with the client and their partners may help. It is also appropriate to consult with their diagnostician, specialist, or medical doctor for records. When interviewing the patient directly, a short easy to answer yes-no questionnaire may be appropriate. We’ll look at some examples and apply one to our case study of Allen. An oral interview may be done as well with the patient and/or their partner. This would be beyond the intake interview of demographics data and include suspected disorder related criteria. Regardless of the type of instrument used, it must adhere to the DSM-5 and APA standards set forth for best practice reliability and validity measures. The Ethical Principles of Psychologists and Code of Conduct can be found on any APA related website or books and will include a section on assessment. For example, on the APA website there is a list of ethics for Bases for Assessments. Psychologists base the opinions contained in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings. It is completely appropriate to ask for a patient’s medical records if the patient has completed a recent physical exam which led to a diagnosed or suspected sexual dysfunction which is now influencing their mental health. It is also appropriate to recommend a patient who is experiencing sexual dysfunction to visit a medical practitioner or specialist to receive a diagnosis to aid with their therapy goal. Mental health therapists are not medical doctors, and we need a special certification to utilize sex therapy. It is not within our scope of practice to diagnose physiological conditions. We may however treat the resulting mental health disorders related to the functional deficits related sexual disorders. Sex therapists have much greater than average knowledge about the physiological processes of sexuality. Working collaboratively with physicians, we can address the entirety of the causes of sexual concerns. Without a sex therapy certification, a licensed professional counselor can still treat a patient with sexual dysfunctions by helping address any emotional or mental issues that are causing a patient sexual problem.