At the top of the list is depression, he says. Depression can affect one's ability to enjoy anything. Next in line is interpersonal conflict. Problems in a relationship often manifest themselves in sexual problems, experts say. P.H., a certified nurse-midwife and sex therapist and professor in the School of Nursing at the University of Maryland in Baltimore.
Unexpressed anger is often part of the picture.
The problem often develops gradually, she says. It may begin with a lack of enthusiasm for sex that causes the woman to decline sexual overtures sporadically, she says. Then, often without deliberately planning it as a sexual avoidance maneuver, the woman may get involved in activities that keep her chronically busy, unavailable or tired, so the likelihood of sex is reduced. The partner is frustrated and angry and upset. The woman is puzzled and upset and feeling pressured by her partner or by her own expectations.