The socio-cultural aspects of sexual medicine: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).

Female genital mutilation/cutting (FGM/C) is practiced across a wide geographic range and has significant health consequences.

• FGM/C is practiced in Africa, the Middle East, and Asia, and among diaspora communities in Western countries.
• The WHO classifies FGM/C into four types based on the extent of tissue removal or alteration.
• Health consequences include immediate complications such as bleeding and infection, and long-term complications including sexual dysfunction, pain, and obstetric complications.
• The practice is often rooted in cultural, social, and sometimes religious beliefs about gender, sexuality, and marriageability.
• The paper emphasizes the importance of patient empowerment and respect for self-determination when clinicians encounter patients who have undergone FGM/C.

Penile circumcision is a widely practiced procedure with both perceived benefits and harms that are culturally and medically debated.

• Penile circumcision is practiced for religious, cultural, and medical reasons across many populations worldwide.
• Perceived medical benefits include reduced risk of urinary tract infections, sexually transmitted infections including HIV, and penile cancer.
• Potential harms include surgical complications, possible effects on sexual sensitivity, and ethical concerns regarding non-consensual procedures performed on minors.
• The paper notes ongoing debate about the ethics of performing circumcision on non-consenting infants and children versus respecting cultural and religious traditions.
• The authors highlight the importance of balancing patient self-determination with cultural and familial practices.

Unconsummated marriages are often the result of culturally determined insufficient sex education, psychological factors, and lack of clinical resources.

• Unconsummated marriages can result from vaginismus, erectile dysfunction, fear, anxiety, and relationship factors, many of which are influenced by cultural context.
• Cultural norms that restrict premarital sex education and discussion of sexuality contribute to the prevalence of unconsummated marriages.
• The condition affects couples across many cultural backgrounds but may be underreported due to shame and stigma.
• Clinical resources and sex therapy approaches are described as effective interventions when available and culturally accessible.
• The authors note that religious and cultural expectations around virginity and sexual performance can exacerbate psychological barriers to consummation.

Clinicians' own cultural backgrounds, training, and attitudes influence the way they approach patients with sexual concerns.

• The paper states that 'clinicians are not always aware of the way in which their training, their own experiences and attitudes influence the way in which they approach patients.'
• Cultural humility is recommended as a core clinical competency when dealing with patients from diverse cultural backgrounds.
• The authors recommend that clinicians approach patients 'with both curiosity and cultural humility.'
• The intersection of 'culture, history, religion, traditions, laws, political trends, and evolving attitudes affects sexual expression and acceptance or rejection of sexual practices.'
• The paper used a narrative review methodology drawing on PubMed, Google, and global organizational websites including WHO and the United Nations.

The International Society for Sexual Medicine (ISSM) is recommended to adopt a strong ethical perspective as part of ongoing discourse on culturally influenced sexual practices.

• The recommendation emerged from the Fifth International Consultation on Sexual Medicine (ICSM 2024).
• The ethical framework is intended to guide clinicians navigating tension between cultural respect and potential harm prevention.
• The authors call for balancing respect for self-determination with protection from harmful practices.
• Content was reviewed by all 12 authors, with disagreements discussed and additional literature incorporated to reflect multiple perspectives.
• The paper frames the ISSM's role as contributing to 'ongoing discourse' rather than issuing prohibitive mandates.