In this talk, anatomical factors are forwarded as one of the often neglected determinants of sexual problems in heterosexual couples. Anatomical differences between men and women make women more vulnerable than men to developing sexual problems. Many women don’t know what excites them or when they have reached ‘normal’ or high arousal. Unfortunately, unlike men, women have the capacity to ‘compromise their genitals’, driven by the mistaken belief that sex is equivalent to intercourse. This ‘capacity’ is hypothesized to be one of the determinants of the difficulties that heterosexual couples encounter in their bedrooms. Therefore, the author will argue that sexual arousal is not merely a ‘bonus’ but a necessary requirement for pain free and pleasurable sex.