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I think the setting should provide a fair representation of the different sexualities present in real-world society. This makes the setting easier to identify with. However, the real-world controversies and battles should be left out only because they would create a distraction. So, I suppose I'm advocating for a utopian representation - there are straight, gay, bi, etc. people and they are all treated fairly and equally, etc.
As for sex and sexual acts, I think Paizo has pushed a few boundaries, perhaps a bit too far, especially in the Adventure Paths. This hasn't created problems for me, but that is only because my gaming group is all older (30+) and it was easy to drop the parts that were too awkward.
Specifically, I'm thinking of Rise of the Runelords:
The female NPC that tries to seduce a PC. I had to drop this entirely as it was just too awkward to roleplay. Not from a maturity perspective, but from a that's not our game perspective.
Ogre-kin behavior. This shocked everyone and creeped them out a bit (as intended), but it was fine. Not sure what I would have done if I had a young teen or tween at the table.
I'm all for having sex being present in the setting. But I'd rather see it be presented as optional rather than "required". If the town has a prostitute - fine by me. Somebody has to hire the prostitute for the story to progress - sorry, no. And I don't want to ever be put in a situation where I have to explain to someone what a <insert adult topic> is.