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Background There are a paucity of studies that address women's own understandings of sexuality and sexual problems. Much of the research and theory which underpin current diagnostic criteria for sexual problems is based upon a set of sexual norms which are predicated upon male experience. Moreover, these dominant understandings, entrenched in a perspective that favours the material body, fail to take account of contextual factors of women's experiences. Objectives Within a diverse sample of women: to examine understandings of sexuality and sexual problems; explore the importance of sexual activity using their own definitions; and identify the influence of wider socio-cultural factors upon understandings of sexuality and sexual problems. Methods In-depth semi-structured interviews were conducted with thirteen women recruited from the general public and ten women recruited from a psychosexual clinic aged 23-72 years. Data analysis Data were analysed thematically using the conventions of template analysis within a material-discursive framework. Findings The findings of this study suggest that women's understandings of sexuality, sex and sexual problems should be understood as bodily 'experienced' and socially and psychologically mediated. Participants also appear to be influenced by the relational context of their experience and draw upon a patriarchal explanatory framework to make sense of their own sexual functioning and satisfaction. Conclusions This study poses a challenge to the recent drive to medicalise women's sexual problems via the Female Sexual Dysfunction (FSD) label. The findings dispute current diagnostic criteria for sexual problems which presuppose a highly individualized framework and take very little account of contextual factors. Consequently, this study concludes that such criteria need to consider biological, social, psychological as well as patriarchal and historical factors in determining the meaning and importance of sexuality, sex and sexual problems to women.