Erectile dysfunction is a common medical condition. However, how it is viewed by individuals and couples is influenced by their cultural backgrounds. Culture shapes the norms, thresholds, and definitions of functioning, as well as how symptoms are reported and diagnosed. Understanding this complexity is a challenging task. Nevertheless, it is crucial for clinicians and patients.

Norms

The onset and the course of sexual dysfunctions are influenced by culture in many ways. It can influence the definition of symptoms, the threshold for seeking care and determine what type of care is sought. It can also influence how a disorder is understood and managed by clinicians and patients alike. Cultural factors may be either pathofacilitive or facilitating, but the overall impact of culture is significant.

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Normative models of manhood and masculinity influence the development of a person’s ability to participate in sexual activity. These factors include family upbringing, social and religious expectations, and individual beliefs. They are powerful determinants of sexual functioning and the onset of sexual dysfunctions, such as erectile dysfunction. Traditional male gender norms promote hypersexual behaviors to achieve a sense of manhood and to gain power and respect from other men. This can contribute to a person’s sexual risk-taking behavior and may lead to the development of sexual problems such as erectile dysfunction and pre-ejaculation.

These societal norms can be particularly difficult to challenge and have been linked with stigma and difficulty in finding appropriate treatment. However, clinicians must understand how culture influences sexual function and relates to the diagnosis of disorders such as erectile dysfunction.

While several epidemiological studies have attempted to compare the prevalence of sexual dysfunction in different cultures, the use of standardized case-finding instruments is often problematic, as they fail to take into account local culture and language. Furthermore, the use of a single measure across multiple ethnicities can lead to bias.

Beliefs

Although there is a lack of epidemiological data on the prevalence of sexual dysfunction in different cultural groups, it seems likely that these variations will affect patterns of help-seeking and the types of symptoms deemed to be disordered. For example, a culture may have a strong emphasis on procreation and this can influence perceptions of what is healthy or unhealthy in terms of sex. It can also modify the threshold for presenting with sexual problems and shape beliefs about what is somatic or psychological. It can even impact the way symptoms are presented in the clinical setting.

For example, a young man with an Islamic background who presents to the clinic with erectile dysfunction may articulate his problem using a medical model. This might lead to an overemphasis on the need for drug intervention. This is in contrast to the way Western men might describe their problem, for instance referring to anatomical causes of their dysfunction. This is likely because the culture of an individual is a powerful influence on what he or she believes about the body and the mind-body relationship.

Another potential factor is a culture’s level of permissiveness about sex. A culture that is more permissive in this way might be less concerned with defining what is abnormal, a phenomenon that has been called pathofacilitative, whereas one that is more restrictive of sexual behavior might be more interested in identifying and labeling disorders. It may also alter the definitions of a disorder by determining its degree of seriousness.

Socialization

Culture is a major influence on the behavior and experiences of all individuals, including those who present with sexual dysfunction. Attitudes towards sex and relationships between different genders, definitions of what constitutes deviance, and the sources from which help is sought are shaped by culture. It is therefore important for clinicians to be aware of these influences and to incorporate cultural factors into formulations.

The impact of culture on sex and sexual dysfunction is complex. Sexual behaviors, as with all aspects of human activity, are influenced by a variety of factors, from biological processes to social structures and beliefs about what should be possible. In this way, cultures influence not only individuals’ perceptions of what is normal and acceptable but also their sensitivity to sexual problems (Fatusi et al 2003).

A common framework for understanding sexual dysfunction includes the concept of an individual’s locus of control, first described by Rotter in the 1950s. An individual’s belief that they have internal control over their situation or circumstances is a significant factor in determining whether or not they seek help for a problem. Individuals who feel that they have an externalized locus of control may be less inclined to discuss their sexual experiences with others or to engage in therapeutic interventions.

Emotions

In cultures that are prone to a high risk of erectile dysfunction, clinicians need to understand how emotions play an influential role. It can shape how individuals perceive their symptoms and how they respond to treatment. It can also influence how couples seek help and the ways they communicate about sexual problems.

For example, the belief in some cultures that it takes 40 drops of food to produce one drop of semen or the African culture that encourages a discussion about sex and sexuality to be done in low tunes and with reverence, can alter how men feel about their problem and the way they present their complaint to medical professionals.

In Western biomedicine, we tend to think about illnesses and their etiology as largely a matter of the individual. However, this view can lead to misunderstandings when it comes to patients from non-Western cultures. These patients are often not egocentric and may have detailed interpersonal family contexts for their sexual issues which can make them difficult to formulate as single cases.

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