The Impact of Culture and Ethnicity on Sexuality and Sexual Function Joseph Heinemann, Sandrine Atallah & Talli Rosenbaum Current Sexual Health Reports ISSN 1548-3584 Volume 8 Number 3 Curr Sex Health Rep (2016) 8:144-150 DOI 10.1007/s11930-016-0088-8 1 23 Your article is protected by copyright and all rights are held exclusively by Springer Science+Business Media, LLC. This e-offprint is for personal use only and shall not be self- archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com”. 1 23 Author's personal copy Curr Sex Health Rep (2016) 8:144–150 DOI 10.1007/s11930-016-0088-8 FEMALE SEXUAL DYSFUNCTION AND DISORDERS (L BROTTO AND A BRADFORD, SECTION EDITORS) The Impact of Culture and Ethnicity on Sexuality and Sexual Function 1 2 3 Joseph Heinemann & Sandrine Atallah & Talli Rosenbaum Published online: 2 July 2016 # Springer Science+Business Media, LLC 2016 Abstract psychological factors are acknowledged and identified, and Introduction The biopsychosocial paradigm recognizes that have been extensively researched, the recognition of social sexual development and sexual difficulties may have multi- factors, which include cultural and religious identification, factorial etiologies related to physical, psychological, and media influence, and association with sexual and political social factors. While physical and psychological factors are sub-cultures, has not received the same degree of attention, acknowledged and identified, the influence of social factors yet may all influence sexual development, sexual relation- often receive less attention in clinical settings. ships, and sexual function. This chapter will review the Aim This study aims to determine how social, cultural, and most recent literature addressing social and cultural factors religious factors and media influence may influence sexual related to sexual disorders and will provide clinical development, sexual relationships, and sexual function. recommendations. Method Review of the most recent literature addressing social Aspects of sexuality that are influenced by culture include and cultural factors related to sexuality was conducted. values, such as decisions regarding appropriate sexual Conclusions The impact of culture should be recognized and behaviors, suitable partner or partners, appropriate age of addressed and clinical recommendations are provided. consent, as well as who is to decide what is appropriate. Sociocultural beliefs across the globe influence the answers Keywords Sociocultural . Culture . Ethnicity . Cultural to each of these questions and in many cases these charac- sensitivity . Sexual dysfunction . Sexual function . Sexuality . teristics are seen as integral to culture. In describing some Religious beliefs cases where culture has affected sexuality, specific cultural beliefs should not be used to create stereotypes regarding specific cultures, rather, to gain an appreciation for the affect Introduction culture can have on sexuality. The biopsychosocial paradigm recognizes that sexual difficul- A Changing World ties may have multifactorial etiologies related to physical, psychological, and social factors [1]. While physical and Characterizations of sexuality have traditionally been influ- enced by both religious and philosophical writings [2]. This article is part of the Topical Collection on Female Sexual However, in recent years, altering beliefs and a significant Dysfunction and Disorders change of attitude have been seen with regards toward same sex marriage (SSM). The legal status of same sex couples was * Talli Rosenbaum not even placed on the ballot to vote on in the USA only two [email protected] decades ago [3] while today SSM has been legalized in several countries. Additionally, consensual non-monogamy, swing- 1 Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel ing, and polyamory appear to have become more prevalent. 2 Levant Clinic, Fouad Chehab Street, Beirut, Lebanon In the 1970s, there was an estimated 1–2 % of married couples 3 Sexual Rehabilitation Clinic, Reuth Medical Center, Tel Aviv, Israel that had at one time been involved in swinging [4]. This Author's personal copy Curr Sex Health Rep (2016) 8:144–150 145 number has risen to as high as 8 million people currently [15]. Finally, the extent to which normative sexual behaviors involved in swinging in the USA [5–7]. Furthermore, may be considered pathological may be governed by religious Canada has legalized swinger clubs in 2005 [7]. A survey of and cultural beliefs, such that both men and women may re- 375 primarily female undergraduate participants from Poland port feelings of guilt due to masturbatory habits [16, 17]. and the UK found that even with more liberal beliefs toward sexuality, monogamy and polygamy are still seen as more favorable than open and swinging relationships. Culture Defines Sexuality Unauthorized infidelity was found to be viewed as significant- ly more negative [8]. It is important to be aware of the chang- Lo and Ko [18]assertthatwomeninAsiararelyconsid- ing perceptions toward sexuality even where they may con- er a lack of sexual desire to be abnormal because flict with one’s own beliefs. Asian women are not entitled to have sexual desire. Additionally, cultural beliefs such as the Hispanic Acculturation and Immigration American male’smachismoandfemale’s Bmarianismo^ [19•] as well as the Iranian women’smaintaininganex- Acculturation or the process of adaptation that occurs when an pected Bkhanoum-like^ image (maintenance of her immigrant raised in one culture arrives in another country with family’shonor)[20•]havebeenimplicatedinaffecting a different culture is another manner by which sociocultural sexual satisfaction. The concept of marianismo,rootedin influences can be examined. With more than 3 % of the cur- Catholicism, places the Latino woman in a role of sexual rent worldwide population being immigrants [9, 10], investi- morality, honor, self-sacrifice, passivity, and care-taking gation of acculturation has become a very powerful tool in while machismo defines a male’sroleofmasculinity examination of sexuality within cultural minorities and immi- [19•]. The Hispanic males role of machismo can be tem- grant population. porarily fulfilled by having intercourse but ultimately on- During the process of acculturation, a family may attempt ly pregnancy, either premarital or during marriage, is to retain their patriarchal traditions. This may include the authentic proof of his machismo or manliness [21]. idea of a Bvirtuous^ woman that may clash with the The idea of gender stereotypes within a culture can be Bhypersexualized^ media and culture to which they are seen with the Hijra of India. Chakraborty [22]describes exposed. Becoming westernized is synonymous with promis- the Hijra of North India as a world of the Bother^;the cuity in many communities. In some cases, the addition of a Bother^ being women or men who do not fit expected new language gives a woman a way to express issues that gender norms, such as women who fail to menstruate were taboo in her language of origin [11]. Evaluating the and transgender males. These individuals are seen as vul- client’s level of acculturation may be useful in determining gar in their culture and are forced to live in their own how best to discuss sexuality in context of culture of origin. isolated communities. The existence of the class defined as Hijra has the potential of causing undo stress to the Religious Beliefs Affect Sexuality Indian male, due to fear of possibly being perceived as Hijra, and subsequently being expected to undergo the An additional sociocultural factor that is intricately associated process of nirvana or rebirth as a women followed by with sexuality is religious beliefs and traditions. Values and possible castration by a Guru [22]. traditions regarding sexual meaning, ritual, and practice are In an interview with 50 Bangladeshi men, power over essential parts of many religions. Factors such as sexual guilt women was described as Bnatural^ and Bnormal.^ Sexual in- and shame have been reported in the literature in association tercourse, described as a Bgame^ (khela), is the only compe- with religious influences [12, 13]. However, the degree to tition of the sexes, and therefore, this is the only game a man which religious beliefs and observance affects sexual function may lose to a woman, a threat to his natural power over the is still unknown [13]. woman [23]. The shame of Blosing^ or ejaculating before the Traditional values that may restrict access to knowledge woman wants to stop threatensthemasculinesexuality. about sex or stress restricted and limited sexual behaviors Negativity toward premature ejaculation is also seen among may impact sexuality through their influence on emotions Muslims men in the UK, who describe premature ejaculation including guilt and anxiety [14••]. In the presentation of guilt, as a punishment [24]. shame, or anxiety, discussion of religious beliefs may expose A clinician can examine underlying cultural beliefs