Previous qualitative research on women's sexual problems has documented the ways in which they can impact psychological well-being as well as women's close interpersonal relationships. However, little attention has been paid to the ways that women with sexual problems negotiate sexual contact in the context of a relationship where sexual activity has a central role. This article draws on qualitative data from in-depth interviews with 23 heterosexual women who experienced sexual desire loss or vulvar pain. The data were analyzed within a material-discursive framework and this identified the centrality of relational and broader social factors in women's sexual negotiation. Key findings included: avoiding potentially intimate situations; engaging in intercourse when it was painful or the women had no desire to; and mentally planning and preparing themselves for sex. Other sexual activities were almost always regarded as a prelude to intercourse, yet around half of the sample had adapted their sexual repertoire to compensate for an absence of intercourse. The implications for future research and treatment in the area of women's sexual problems are discussed.