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As a consequence of the impact of Viagra on male sexual dysfunction, considerable attention is now being paid to sexual dysfunctions in women, which might respond to pharmacological treatment. Should women's sexual problems be conceptualized in the same way as men's? The objective of this study was to assess the prevalence of distress about sexuality among women, and examine the predictors of such distress, including aspects of the woman's sexual experience, as well as other aspects of her current situation. A telephone survey of women used Computer Assisted Telephone Interviewing and Telephone-Audio-Computer-Assisted Self-Interviewing methodology to investigate respondents' sexual experiences in the previous month. A national probability sample was used of 987 White or Black/African American women aged 20–65 years, with English as first language, living for at least 6 months in a heterosexual relationship. The participation rate was 53.1%. Weighting was applied to increase the representativeness of the sample. A total of 24.4% of women reported marked distress about their sexual relationship and/or their own sexuality. The best predictors of sexual distress were markers of general emotional well-being and emotional relationship with the partner during sexual activity. Physical aspects of sexual response in women, including arousal, vaginal lubrication, and orgasm, were poor predictors. In general, the predictors of distress about sex did not fit well with the DSM-IV criteria for the diagnosis of sexual dysfunction in women. These findings are compared with those from other studies involving representative samples of women, and the conceptual issues involved in the use of terms such as “sexual problem” and “sexual dysfunction” are discussed.