Contextual causes (those specific to a woman's current situation) include the following: Intrapersonal context: Low sexual self-image (eg, due to infertility, premature menopause, or surgical removal of a breast, the uterus, or another body part associated with sex) Relationship context: Lack of trust, negative feelings, or reduced attraction toward a sex partner (eg, due to the partner's behavior or to a growing awareness of a change in sexual orientation) Sexual context: For example, surroundings that are not sufficiently erotic, private, or safe Cultural context: For example, cultural restrictions on sexual activity Distractions and emotional stress (eg, from family, work, or finances) can interfere with arousal.