For women particularly the emotional context and the relationship between the partners may be the most important factors in sexual pleasure and satisfaction. Menopausal and aging women have numerous emotional challenges to deal with and the impact of these on both the emotional climate and the relationship is almost inevitable, so it is not surprising that the incidence of all sexual problems increases in this age group. The following summarises the broad range of causes outlines by the Working Party for a New View of Women's Sexual Problems.

Sexual problems due to socio-cultural, political or economic factors, which include,

a) ignorance and anxiety due to inadequate sex education, poor access to health services, and lack of language,
b) sexual avoidance or distress due to perceived inability to meet cultural norms, shame about one’s body, sexual attractiveness, or sexual identity,
c) inhibitions due to conflict between the sexual norms of one’s subculture and those of the dominant culture,
d) lack of interest, fatigue, or lack of time due to family and work obligations.

Sexual problems relating to partner and relationship, including

a) inhibition, avoidance, or distress arising from betrayal, dislike, or fear of partner, partner’s abuse, power imbalance, poor communication,
b) discrepancies in desire for sexual activity or preferences,
c) difficulty in communicating preferences or initiating, pacing or shaping activities,
d) loss of sexual interest as a result of conflicts, or traumatic experiences, e.g. infertility or the death of a child,
e) inhibitions in arousal or spontaneity due to partner’s health or sexual problems.

Sexual problems due to psychological factors, such as

a) sexual aversion, mistrust, or inhibition of sexual pleasure due to past abuse, problems with attachment, depression or anxiety,
b) sexual inhibition due to fear of sexual acts or their consequences, e.g. pain during intercourse, pregnancy, STD, loss of partner, loss of reputation.

Sexual problems due to medical factors, such as pain or lack of physical response despite a good relationship, adequate knowledge, and positive attitudes. Such problems arise from

a) medical conditions affecting neurological, neurovascular, circulatory, endocrine or other systems of the body,
b) pregnancy, sexually transmitted diseases, or other sex related conditions,
c) side effects of drugs, medications, or medical treatments, d) iatrogenic conditions.

Any life changing events such as losses, abuses and life style changes may give rise to sexual difficulties, at any age, not only during the menopausal years.