Hello Verity & Nic: I've been with my husband for 17 years and married for 8 years. I love him and am still very attracted to him. I'm 47 and he is 59. The issue is we have not had sex since December 2009, and despite couples counselling, hormone treatments (for both of us), sex therapist counselling (together and separately) nothing has changed. It's gone on for so long I truly believe it's beyond being a physical issue and is now psychological for him. He says he still desires me and, yes, companionship /friendship is important. However, I can't believe I will never experience sex with him again, although it's looking increasingly likely. My younger friends counsel me to leave and the older ones say stay. I'm in deep despair about this (as is my husband) and have left him once, only to return. Please help, I really don't know what else to do. - Melissa
We are sad to hear how much pain you are both in. We admire how invested you are in the relationship and how many different avenues you have both tried. Without knowing the details of what you have already tried, our suggestions can only be general; we hope something in here offers you a new way forward.
Our first thought is to wonder how affectionate you are? Often when sex has become problematic, all touch is avoided for fear that it might raise the painful, unresolved issue of sex. If this has happened, we encourage you to reclaim affectionate touch: hugs, strokes, cuddles, kisses, massages. Be clear that none of these things is about or intended to lead to sex. To avoid any doubt about the intent of your touch, make a pact that nothing will get sexual without you talking about it first.
In terms of getting sexual, it's essential to have realistic expectations of how sex works. Anxiety activates the sympathetic nervous system, which inhibits arousal. If you are full of concern about how sex will go, it's tough to get turned on. This anxiety leads to avoidance, which breeds further anxiety until restoring your sex life feels like climbing Mt Everest. Focusing on achievable small steps will help encourage you. It will be helpful to think of going forward to a new place sexually, not recapturing what you used to have.
In most situations, the "problem" is not actually "I lost my erection" or "I take too long to orgasm". The real problem is how you emotionally collapse into shame and start shutting down, giving up, or getting upset. Given your situation, it will probably take some time and effort to work through the anxiety to get to feeling sexual.
Do you know that it's not necessary that you "feel like" sex (i.e. feel horny or turned on) to be sexual? If you decide that you want to be sexual, it is possible to make a start and have your body join the party later.
A majority of women and a minority of men experience "responsive desire", that is, sexual desire that emerges in response to, rather than in anticipation of, sexual arousal. If either of you is like this, you may be very confused because this pattern of desire and arousal is different from the "spontaneous desire" we are taught to expect. Even if that was not his or your original pattern, this is likely to be part of the journey back to being sexual for both of you.
If you are not restricted by mistaken beliefs that sex should be "spontaneous", then you are free to talk and, especially, to plan to try being sexually intimate. Think about and discuss what conditions you each think would make you feel more like being sexual (e.g., well-rested, sober, private, no unresolved conflicts, what location, naked or clothed to start etc.).
In our experience, desire and passion flow from a solid intimate connection. Focus on the "intimacy" part rather than the "sex". Ensure that you are intimate with what you say and do. Remember, intimacy can feel uncomfortable as it involves learning about yourself, struggling with your anxieties and your dilemmas in the presence of your partner.
You have to start from where you are. If you are having many thoughts that are "getting in the way of sex", that are making you disappear inside yourself, try and bring yourself back into the moment. If you can't, briefly share your concerns with your partner rather than risk becoming disconnected. Tell your partner if you feel anxious about your functioning, what they are thinking or feeling, etc. That's intimacy.
Remember to talk in terms of what is going on in you, especially how your anxieties and insecurities are operating, not in terms of what your partner is or isn't doing. This kind of radical honesty will likely draw your partner towards you, even if what you are saying seems negative.
Make sure your tone and manner are warm and caring. If you "just want to get on with it", consider that you might be avoiding your insecurities and need to connect with and talk about what's going on inside you.
Adopt a "can do" team approach with lots of positive determination to rebuild your sex life. If your partner says he's on board with this, but you don't believe it, look at which of your anxieties makes this hard for you to accept. Keep your focus on that goal and calmly deal with obstacles that crop up. Persevere, showing who you are and how you feel towards your partner through touch, talk, gaze and sex.
The same rules apply throughout the encounter. If you are caught up in your head worrying: talk about it! Talking will probably mean you need to stop being actively sexual and explain. Keep the talk as brief as possible; the goal is to get back into the moment and sexual connection.
Take the pressure off both of you to conform to notions of how sex "should" go. Try thinking of sexual touch as a way to communicate, to give and receive pleasure. Accept that things like erections, lubrication, intercourse, or orgasms may or may not happen. You can have enjoyable sex without any of them.
Keep your focus on sensual pleasure and connection with your partner. Give yourselves permission for things not to be romantic, "natural", smooth or easy. Don't be fooled by the movies; intimacy is often challenging, awkward and imperfect.
If sex doesn't go how you want, don't panic. Afterwards, have a good think about where it went wrong – particularly how your anxieties and insecurities contributed. Then have an intimate team talk with your partner about that and what you could do differently next time. And arrange a next time...
Verity & Nic are psychologists and family therapists who have specialised in relationship and sex therapy for over 25 years. They have been working on their own relationship for more than 40 years and have two adult children.