In addition to the lifelong/ acquired and generalized/situational subtypes, a number
of factors must be considered during the asse ssment of sexual dysfunction, given that they
may be relevant to etiology and/or treatment, and that may contribute, to varying degrees,
across individuals: 1) partner factors (e.g., pa rtner’s sexual problems; partner’s health sta-
tus); 2) relationship factors (e.g., poor communication; disc repancies in desire for sexual
activity); 3) individual vulnerability factors (e .g., poor body image; history of sexual or emo-
tional abuse), psychiatric comorbidity (e.g., depr ession, anxiety), or stre ssors (e.g., job loss,
bereavement); 4) cultural or religious factors (e.g., inhibitions re lated to prohibitions against
sexual activity or pleasure; attitudes toward sexuality); and 5) medical factors relevant to
prognosis, course, or treatment.
Clinical judgment about the di agnosis of sexual dysfunction should take into consideration
cultural factors that may influe nce expectations or engender pr ohibitions about the experience
of sexual pleasure. Aging may be associated wi th a normative decrease in sexual response. 
Sexual response has a requisite biological underpinning, yet is usually experienced in
an intrapersonal, interpersonal, and cultural context. Thus, sexual fu nction involves a com-
plex interaction among biological, sociocultural, and psychological factors. In many clinical
contexts, a precise understanding of the etiolo gy of a sexual problem is unknown. Nonethe-
less, a sexual dysfunction diagnosis requires ruling out problems that are better explained
by a nonsexual mental disorder, by the effects of a substance (e.g., drug or medication), by