Organisers of the upcoming Sex Cultural Festival are familiar with the prudish attitude towards sex that prevails in many corners. Last year, the event sought to break down taboos with its display of art, sex toys and with experts on hand to discuss sensitive issues.

However, some officials took issue with the art and attitudes - most notably the Food, Environ-mental Health and Hygiene Department, which demanded that a display of bras be removed from view.

Hong Kong University psychiatry professor Ng Man-lun, also chairman of the Sex Culture Society, isn't deterred. This year's event will go ahead in late May 'just to remind people of the importance of sex and talking about issues other than just sexually transmitted diseases'.

Attitudes are slowly changing. Sex therapy is gaining ground in private practice, and organisations such as the Family Planning Association (FPA) have recently added programmes offering sex coaching and sexual dysfunction therapy. People are also slightly less reticent about discussing their sexual problems, says Ng. 'The community is more open and counsellors are more skilful. A lot will depend on the counsellor,' he says.

A training course launched three years ago for sex therapists is also gradually taking effect. The Hong Kong Association of Sexuality Educators, Researchers and Therapists started offering the programme in 2004 in conjunction with the Florida Postgraduate Sex Therapy Institute.

This not only creates a wider pool of therapists, but has been a boost to public awareness, according to Francois Fong, medical director at the Hong Kong Sexual Health Centre. 'We're gradually seeing clients in Hong Kong coming in with their problems,' although Fong says that the city still lags countries such as Australia in terms of help for sexual-related issues.

Most of his clients attend the clinic for sexually transmitted disease (STD) tests and erectile dysfunction. The clinic also has a marriage counsellor and sex therapist on hand.

A few couples have started coming into the clinic. One in particular had been married for seven years, but hadn't yet been able to have intercourse. The husband and wife were both educated to tertiary level. Fong says this isn't uncommon in Hong Kong. Many patients come to the clinic with what seems to be a sexual dysfunction problem, but realise after a session with a therapist that there are more pervasive marital issues involved.

Although inroads are being made in terms of getting people to talk more about their sexual problems, it's against what many therapists see as a backdrop of an education system that's lagging and a lack of initiative from policy-makers to help break down taboos.

Little tangible evidence is available to pinpoint the level of sexual problems in the city, a step many doctors say is necessary in order to properly allocate resources.

There's no central database listing the number of visits to Hong Kong practitioners for sexual problems, but a 2002 Chinese University poll found that 50 per cent of men and 53 per cent of women surveyed had difficulties with sex for three consecutive months during the previous year.

The FPA estimates that 100 couples come to the organisation annually for sexual dysfunctional problems such as non-consummation, arousal disorder and relationship problems.

There's also the Durex survey, which takes the pulse of sexual appetite around the globe on an annual basis. The 2006 poll found that Hongkongers are having marginally more sex than before, but the dissatisfaction rate is relatively high. About 70 per cent say they're not satisfied with their sex lives.

Judith Mackay, author of the Penguin Atlas of Human Sexual Behaviour, Sexuality and Sexual Practices Around the World says she worries that such surveys give the impression that everyone is having lots of sex.

'The important message is that not everyone is having it off three times a night,' she says. 'The problem with these surveys is that people begin to feel dissatisfied. Even within western society, most people don't have that much sex.'

Her research seems to confirm the impression that there are significant differences in attitudes towards sex between the east and west, the former being more conservative. However, she sees a slight shift in sexual awareness in Hong Kong, albeit 'from very, very, very small to small'.

'Certainly there's a change,' Mackay says. 'It's gone from highly conservative to changing.'

Education is a key issue that Fong and Ng say needs to be addressed before people feel more confident about seeking help for sexual problems. Fong, in particular, says the quality and quantity of education are lacking.

The first point of call for many people with sexual problems is their family doctor . But Fong says they're 'often not comfortable talking about sexual issues and patients prefer the doctor ask them the questions first'. In a busy practice, it's also difficult to get enough time with a doctor. 'You need to spend a lot of time for each consultation,' he says. Forty-five minutes to an hour is a good benchmark.

However, government policy is the area he says needs to be tackled urgently. This means allocating more resources and taking a serious look at sex education.

What progress is being made helping couples open up about their sexual problems isn't reflected in key areas such as advertising for clinics.

'You can't use words like 'treatments for STDs' or 'premature ejaculation',' Fong says. Many ads for treatments wind up using confusing cartoons.