Cultural factors and sexual dysfunction in clinical practice†

Although the word culture is used broadly, at its core it relates to the shared values and meanings of a particular group. Culture determines and defines our identity. For example, most psychiatrists carry multiple identities related to gender, religion, seniority, specialism and so on, which in clinical practice may manifest in different ways, depending on context. Culture can also be seen in material terms, in other words, as the sum of human productive activity in a given space, including habits, institutions and customs. In broad terms, definitions of culture may be divided into the ecological, referring to the sum of human artefacts of a group, and the cognitive, which refers to the gross network of meanings that link a people together (Barnard 2002). It is important to note the distance between ecological and cognitive theories of culture, which allows a space for what aspects of behaviour, including sexual behaviour, actually signify. Hofstede (2001) suggests that any given culture can be characterised in terms of five dimensions: individualism (egocentric or sociocentric); masculinity or femininity; power distance (the extent to which the less powerful expect and accept that power is distributed unequally); long-term orientation; and toleration of uncertainty. The influence of culture on the development of personality and maintenance of well-being is an important aspect of clinical work with disorders of behaviour, including sexual dysfunction. Medically, sexual dysfunction may be defined as a group of problems occurring in the domains of desire, arousal and orgasm, that may or may not involve pain (Bhugra 2013). We might also add that some sexual dysfunctions are genderspecific, for example vaginismus and ejaculatory and erectile dysfunction, whereas others, such as disorders of desire and orgasm, are diagnosed in both genders. On this basis, culture is particularly relevant in sexual function and dysfunction, where it is important to understand the way in which behaviour is perceived by the participants. It is inevitable that culture plays a complex role in the production of sexual activity, be it heterosexual, homosexual or alternative sexual minority behaviours. Attitudes to any sexual activity or behaviour are strongly influenced by culture.