How do culture and modesty shape sexual dysfunction presentation?

A patient’s ability to communicate with clinicians, a concept known as cultural health capital, influenced whether she received a diagnosis and treatment for sexual dysfunction, according to Sameena Rahman, MD, FACOG.¹

“People that can use the right phrases and the right words or have the right language, like English speakers versus non-English speakers, they have more success with getting diagnoses and treatments,” Rahman said.

Shame around the genital and pelvic region was nearly universal across cultures, Rahman said. She noted that the name of the pudendal nerve itself derived from the word for shame. Girls learned early that the genital region was shameful. In cultures where modesty further discouraged open discussion, patients were even less able to raise sexual health concerns.

That reticence was not intrinsic to every culture that now showed it. Several South Asian cultures were historically sex positive, Rahman said, citing the Kama Sutra and the erotic literature of Islamic civilizations. Within marriage, those traditions treated sexual concerns as matters to discuss openly. Colonization and Victorian-era philosophies disrupted that openness, a history Rahman addressed in her new book, Brown Girls’ Disease.²

Cultural identity alone did not predict an individual patient’s upbringing, and Rahman cautioned against assumptions based on background. One South Asian Muslim woman, for example, may have been raised very differently from another who shared those characteristics. Instead of assuming, Rahman asked patients directly how sex was discussed in their household and whether they felt able to talk about menstruation growing up. Many patients reported that they could not discuss menses with their mothers. That silence sometimes meant they did not know when their mothers went through menopause.

This history informed the clinical picture without defining it.

“Understanding how different people are raised within the cultural context of who they are is, again, part of the equation. It doesn’t make the diagnosis,” Rahman said. In her view, cultural background was context for the evaluation, not an explanation that ended it. Attributing sexual dysfunction to culture alone risked cutting the differential diagnosis short.²

Childhood experiences directly affected sexual health and overall health, Rahman said, pointing to adverse childhood experiences as a contributing factor. For ob-gyns, the practical implication was to explore how a patient’s upbringing, family communication, and early experiences interacted with her current symptoms. Clinicians could then help patients unpack how able they were to discuss sexual health at all. Understanding where a patient started, Rahman said, was necessary to move care forward.

Rahman is a board-certified ob-gyn and the founder of The GYN & Sexual Medicine.

References

1. Shim JK. Cultural health capital: a theoretical approach to understanding health care interactions and the dynamics of unequal treatment. J Health Soc Behav. 2010;51(1):1-15. doi:10.1177/0022146509361185
2. Rahman S. Sameena Rahman, MD, on bias, dismissed diagnoses, and the vulvar vestibule. Contemporary OB/GYN. September 23, 2026. https://www.contemporaryobgyn.net/view/sameena-rahman-md-on-bias-dismissed-diagnoses-and-the-vulvar-vestibule