In the following paragraphs, we examine some of the physiological, cultural, individual, and relational factors that can contribute to sexual difficulties. Significant interaction among these factors also occurs. For example, any degree of physiological impairment can make a person’s sexual response and functioning more vulnerable to disruption by negative emotions or situations. Thus a man with moderate diabetes may have no dif­ficulty achieving an erection when he is rested and feeling comfortable with his partner, but he may be unable to do so when he is under stress—after a hard day at work or after an argument with his partner. It is also important to keep in mind that it is usu­ally difficult to identify a consistent cause of a specific sexual difficulty because the same type of sexual problem will be caused by different factors in different individuals (Vardi et al., 2008; Waldinger, 2008).