Proposal to Establish a Distinct ICD-11 Diagnostic Code for Seminal Vesicle Secretory Failure (SVSF)

 Submitted to:

National Center for Health Statistics (NCHS)
Centers for Disease Control and Prevention

Related Classification Authority:
World Health Organization – ICD-11 Maintenance Platform

Proposed by:
David Behar, MD
(Physician; policy and classification proposal)

Date: 2025

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I. Executive Summary

This proposal recommends creation of a distinct ICD-11 diagnostic entity for Seminal Vesicle Secretory Failure (SVSF)—a clinically meaningful, currently uncodable condition characterized by absent or markedly reduced seminal vesicle contribution to ejaculate volume, despite preserved ejaculation mechanics and patent outflow.

At present, ICD-11 forces clinicians to misclassify SVSF under:

• Male sexual dysfunction,

• Obstructive genital tract disorders,

• Endocrine hypogonadism, or

• Residual “other specified” categories.

This obscures epidemiology, impairs research on infertility and post-treatment sequelae, and undermines accurate clinical documentation.

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II. Clinical Rationale

A. Medical Significance

Seminal vesicles contribute 60–70% of ejaculate volume and are essential for:

• Sperm motility (fructose, prostaglandins),

• Semen alkalinity and coagulation,

• Fertility outcomes and assisted reproduction planning.

Loss of seminal vesicle secretory function is clinically distinct from:

• Anejaculation (neurogenic or psychogenic),

• Ejaculatory duct obstruction,

• Testicular failure or hypogonadism.

B. Common Clinical Scenarios Currently Misclassified

• Post-pelvic radiation or surgery (including prostate, bladder, colorectal)

• Congenital seminal vesicle agenesis or hypoplasia

• Post-infectious or inflammatory vesicle damage

• Medication-induced secretory suppression

• Autonomic denervation with preserved emission reflex

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III. Current ICD-11 Gap

ICD-11 contains no organ-specific functional diagnosis for the seminal vesicles.

Existing codes are etiologically or anatomically incomplete, forcing inaccurate substitutions:

Clinical Reality	Current ICD-11 Outcome	Deficiency
Absent semen volume with intact ejaculation	Male sexual dysfunction	Mislabels reproductive pathology as sexual
Vesicle secretory failure without obstruction	Obstruction codes	Factually incorrect
Post-radiation loss of seminal fluid	Neoplasm aftercare codes	Non-specific, non-trackable
Congenital absence	Congenital genital anomalies	No functional classification

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IV. Proposed ICD-11 Structure (Defensible & Minimal)

Primary New Code

GB0X.Y – Seminal vesicle secretory failure
(Chapter: Diseases of the genitourinary system → Diseases of male genital organs)

Definition:

Failure of the seminal vesicles to produce or contribute normal secretions to ejaculate volume, resulting in absent or markedly reduced semen volume, not attributable to ejaculatory obstruction or primary testicular failure.

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V. Proposed Subcodes (Etiology-Specific, Non-Redundant)

GB0X.Y0 – Congenital seminal vesicle secretory failure

• Agenesis or hypoplasia

• Congenital developmental defects

GB0X.Y1 – Acquired seminal vesicle secretory failure

• Post-infectious

• Inflammatory

• Idiopathic

GB0X.Y2 – Iatrogenic seminal vesicle secretory failure

• Pelvic radiation

• Pelvic surgery (prostate, bladder, rectal)

• Androgen-deprivation sequelae

GB0X.Y3 – Neurogenic seminal vesicle secretory failure

• Autonomic denervation

• Spinal cord or pelvic nerve injury

GB0X.Y4 – Drug-induced seminal vesicle secretory failure

• SSRIs

• Antipsychotics

• Alpha-adrenergic blockers
  (with external cause coding retained)

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VI. Coding Guidance (Preventing Misuse)

Explicit Exclusions

• Ejaculatory duct obstruction → GB08

• Primary testicular hypofunction → 5A80 / 5A81

• Retrograde ejaculation → existing sexual dysfunction categories

• Psychogenic anejaculation → HA60

Diagnostic Criteria (Minimum One Required)

• Persistently low or absent ejaculate volume (<0.5 mL)

• Imaging evidence of vesicle damage or absence

• Biochemical semen analysis showing absent fructose

• Clinical correlation with known vesicle-damaging exposure

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VII. Public Health & Research Benefits

1. Accurate infertility epidemiology

2. Improved post-cancer survivorship tracking

3. Clearer differentiation between sexual dysfunction and reproductive organ failure

4. Better outcome studies in ART and fertility preservation

5. Reduced miscoding and payer disputes

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VIII. Compatibility & Implementation

• Backward-compatible with ICD-10-CM mapping (e.g., N53., N50. analogs)

• No impact on existing codes

• Minimal coder training burden

• Aligns with WHO’s organ-specific functional taxonomy principles

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IX. Requested Action

The CDC/NCHS is respectfully requested to:

1. Endorse this proposal for U.S. ICD-11-CM consideration

2. Submit the code family to the WHO ICD-11 Maintenance Platform

3. Permit interim national extension usage pending WHO ratification

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X. Conclusion

Seminal Vesicle Secretory Failure is a real, common, and clinically distinct condition that currently lacks an appropriate diagnostic identity. Recognizing it corrects a structural omission in ICD-11 and advances accuracy in urology, oncology survivorship, reproductive medicine, and public health surveillance.