To any practising clinician it will be apparent that taking into account an individual's cultural identity is an important aspect of assessment. It allows a mutual understanding of cultural factors that may be causing or contributing to the patient's problem and that can be used in planning and delivering appropriate and acceptable treatment. This is even more important in the arena of sexuality and psychosexual therapy, where cultures dictate models of explanation and help-seeking. Sexual expectations, practices and preferences are strongly shaped by culture, as well as by gender, class and ethnicity (Mahay et al, 2000). In our increasingly multicultural and globalised society, understanding the way in which our sexuality and relationships with one another develop is vital for the clinician.

Sex is one of the basic human instincts: over the centuries its function has vacillated between procreation and pleasure, and societies have fluctuated between sex-positive and sex-negative cultures. Sex and sexual behaviour have been viewed in different tones and shades, perhaps with fear or respect or as magico-religious experiences. Although historical data may be inaccurate (Bullough, 1972), it seems that attitudes to sex and sexual behaviour fluctuate and are strongly influenced by prevalent social norms (Gregersen, 1986; Segall et al, 1986). Inevitably, religion, state control and economic factors have at different times also profoundly shaped the way sex, sexuality and sexual practices are seen in a given culture.

Sexual function across cultures

Early literature was based on religious texts, which are a rich source of information on sexual behaviour (Bhugra & De Silva, 1995). The assumptions they contain about sex and its purpose have been greatly influential (Bullough, 1976); reinforced by centuries of religious observation, some remain deeply ingrained in many cultures.