The causes of sexual problems are as varied and complex as the human race. Some problems stem from a simple, reversible physical problem. Others can stem from more serious medical conditions, difficult life situations, or emotional problems. Still others have a combination of causes. Any of the following can contribute to sexual problems:

Relationship problems - Discord in other aspects of the relationship, such as distribution of labor, childrearing, or money, can cause sexual problems. Issues of control or even abuse in the relationship are especially harmful to sexual harmony. Such problems can prevent a woman from communicating her sexual wants and needs to her partner.
Emotional problems - Depression, anxiety (about sex or other things), stress, resentment, and guilt can all affect a woman's sexual function.
Insufficient stimulation - A woman's (or her partner's) lack of knowledge about sexual stimulation and response may prevent a woman from achieving a satisfactory experience. Poor communication between partners can also be a culprit here.
Gynecologic problems - A number of pelvic disorders can cause pain in intercourse and thus decrease satisfaction.
- Vaginal dryness - The most common reason for this in younger women is insufficient stimulation. In older women, the decrease in estrogen that occurs in menopause is the cause of vaginal dryness. Poor lubrication can also be linked to hormone imbalances and other illnesses and to certain medications. It can inhibit arousal or make intercourse uncomfortable.
- Vaginismus - This is a painful spasm of the muscles surrounding the vaginal opening that causes the vaginal opening to "tighten." It can prevent penetration or make penetration extremely painful. Vaginismus can be caused by injuries or scars from surgery, abuse, or childbirth, by infection, or by irritation from douches, spermicides, or condoms. It can also be caused by fear.
- Sexually transmitted diseases - Gonorrhea, herpes, genital warts, chlamydia, and syphilis are infectious diseases spread by sexual contact. They can cause changes in the genitals that make sex uncomfortable or even painful.
- Vaginitis - Inflammation and irritation of vaginal tissues due to infection or other causes can make intercourse uncomfortable or painful.
- Endometriosis, pelvic mass, ovarian cyst, surgical scars - Any of these can cause an obstruction that prevents intercourse or makes it difficult or painful.
- Pelvic inflammatory disease - This is an infection of the vagina that moves up into the cervix, uterus, and ovaries. It can be very painful on its own and make intercourse extremely painful.
- Nerve damage after surgery - Unavoidable cutting of small nerves during pelvic surgery (such as hysterectomy) may decrease sensation and response.
Physical conditions - Many physical or medical conditions can decrease a woman's satisfaction with her sex life.
- Tiredness (fatigue)
- Chronic diseases such as diabetes, heart disease, liver disease, kidney disease
- Cancer
- Neurologic disorders
- Vascular (blood flow) disorders
- Hormonal imbalances
- Menopause
- Pregnancy
- Alcohol or drug abuse
Medications - Certain medications can reduce desire or arousal. One well-known group of drugs that have this effect are the selective serotonin-reuptake inhibitor (SSRI) group of antidepressants, which includes drugs such as Prozac and Zoloft. Others include certain chemotherapy drugs, drugs for high blood pressure, and antipsychotic medications.
Other medical treatments - Treatments such as radiation therapy for certain types of cancer can reduce vaginal lubrication. They can also make skin and the membranes lining the genitals tender and sensitive.
History of abuse - A woman who has suffered sexual or other abuse may have trouble trusting her partner enough to relax and become aroused. She may have feelings of fear, guilt, or resentment that get in the way of a satisfactory experience, even if she cares deeply about her current partner.
Attitudes toward sex - Many people, either because of the way they were brought up or because of earlier bad experiences, don't view sex as a normal and enjoyable part of a couple's relationship. They may associate sex or sexual feelings with shame, guilt, fear, or anger. On the other hand are people who have unrealistic expectations about sex. Portrayals of sex in television and movies as always easy and fantastic mislead some people into believing that is how it is in real life. These people are disappointed or even distressed when sex is sometimes not earth-shattering or when a problem occurs.
Sexual problems of the partner - If a woman's partner has sexual problems, such as impotence or lack of desire, this can inhibit her own satisfaction.