I guess it depends what you mean by 'puritanical'. third gendered people have been accepted in India and China and the Middle East and I'd say they are less accepted in developed western nations (where intersex infants are often operated on such that they appear female).

But that is distinct from sexual preference (in some instances at any rate). I guess we could look at whether homosexual sex is illegal and what kinds of penalties there are (e.g., criminal conviction, fine, death penalty)...

Most puritanical... I'd put in a vote for Nazi Germany (extermination programs 'n all).