In sociology and cultural studies, the body is often treated only as a symbolic space, as a surface on which sexual meanings are written and from which they are read. Realist philosophy of science and philosophy of mind, however, do not treat discursive meaning as arbitrary and disconnected from the material universe. Using a realist framework, this paper examines areas of collision between values and beliefs about matters of fact concerning men's and women's sexual bodies and sexual pleasure and displeasure. Groups campaigning for and against male circumcision do not argue directly against each other. The first draw on health justifications, while the latter raise difficulties about human rights and loss of sexual sensitivity. Measuring penile sensitivity proves to be difficult. When sexual satisfaction is understood as traditional masculine role adequacy in reproductive coitus, there is no way of understanding complaints about loss of receptive sensuality. Debates about the structure and nomenclature of the clitoris, about the existence of female ejaculation and about the evolutionary function of the female orgasm similarly founder when the protagonists do not share a conceptual framework: macroscopic anatomic structures and physiological processes become invisible to observers and false assumptions are made, for example about when and how orgasm occurs. Most sexual difficulties are not physical dysfunctions, but failures to meet social rules of sexual behaviour. In conclusion, the paper draws attention to issues insufficiently addressed in contemporary sexuality studies and calls for practical engagement by social researchers with public health and policy.