SEXUALITY and DIVERSITY
How Modern Sex Therapy Can Clash With Cultural Values
Cultural beliefs influence sexual practices, the perception of sexual problems, and modes of treatment. For example, in much of the Middle East the marital sexual relationship is based primarily on the two dimensions of male sexual potency and couple fertility. For both men and women, only when intercourse itself is impaired—not interest or pleasure—do couples seek treatment. Unconsummated marriage is a common complaint in conservative societies of the Middle East (Ghanem, 2011).
A study conducted in Saudi Arabia found that the most common problem leading a couple to sex therapy was erectile disorder. Women in Saudi Arabia, who are raised to inhibit their sexual desires, came to sex therapy only with problems of painful intercourse. Unlike their counterparts in Western countries, the women did not seek help for lack of desire, arousal, or orgasm (Osman & Al-Sawaf, 1995). A study of Islamic sex therapy centers found that 80% of female clients came for treatment of vaginismus (Aziz & Gurgen, 2009).
Many cultural traditions allow for little or no education or communication about sexual matters. Asians may consider it shameful to discuss sex, especially with someone outside the family. Muslims are often taught to avoid talking about sexuality with people of the other sex (including their spouses). Taking a sex history can be distressing for clients with these beliefs, especially when the husband and wife are interviewed together. In cultures in which women are expected to be innocent about sex, the sex-education component of therapy conflicts with the prevailing values. In Pakistan the lack of formal sex education leads to misinformation. For example, men who experience premature ejaculation usually believe that masturbation and ejaculation during sleep have damaged muscles and blood vessels in the penis, causing their sexual problem (Bhatti, 2005).
Western sex therapy techniques often contradict cultural values. For example, masturbation exercises to treat anorgasmia, erectile difficulties, or premature ejaculation conflict with religious prohibitions of Orthodox Jews and some fundamentalist Christians and Muslims (Sungur, 2007). The gender equality inherent in sensate focus exercises and the avoidance of intercourse in such exercises are also often objectionable to many religious and ethnic groups.
Sex therapy needs to take into account the clients’ cultural values and the implications they have for intimate behavior (Nasserzadeh, 2009). Therapists should attempt to adjust therapy to their clients’ well-integrated ethnic and religious perspectives (Richardson et al., 2006; Shtarkshall, 2005). This is likely to be more helpful than attempting to impose the cultural norms inherent in Western sex therapy (Ribner, 2009).
In the remainder of this chapter, we look at some strategies and sex therapy approaches that are used to deal with female and male sexual problems and sexual desire disorder.