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Research on cross-cultural influences on sexual disorders is lim-ited, owing to the lack of uniform descriptive methodology and to the fact that the major ethnic minorities in the USA do not seek medical treatment for this class of complaints (Davis and Herdt, 1997). Some cross-cultural studies have concluded that the paraphilias as currently characterized in the DSM-IV-TR are determined by specific features of the Western society, such as demographical size and complexity (whereby individuals may escape social sanction through anonymity), the nonavailability of partners, and the primacy of masturbatory activities as sexual outlets (Rooth, 1973; Gebhard, 1971). Despite a few small clini-cal studies that found similar rates of sexual dysfunctions among African-American populations (Fisher, 1980; Finkle and Finkle, 1978), most cross-cultural research suggests that sexual response is influenced by cultural and ethnic considerations. Racist stere-otypes, machismo, anxiety about infertility, and the tendency toward somatization of mood disorders as impotence have been cited as etiological factors of sexual dysfunction in African-American and Latino populations (Wyatt, 1982; Espín, 1984). In addition, the ethnographical literature shows that standards for sexual competence differ across the cultural spectrum and that many societies display a more flexible approach to issues of sexual orientation than is assumed by the diagnostic categories (Davis and Whitten, 1987; Herdt, 1990).
This cross-cultural diversity complicates the assessment of the sexual disorders. At present, it is unclear whether certain culture-bound syndromes involving sexual organs, such as koro among the Asians (characterized by the fear of genital retraction) or dhat in India (involving obsession or anxiety about semen loss), should be categorized among the sexual or the somatoform disorders (Davis and Herdt, 1997).
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