I have been married to my husband for nearly four years. He is 34 and I am 33, with no children. We have had problems with our sex life in the past, as I’ve wanted it more than my husband. We have had blazing rows about this and though I felt we had turned a corner recently it’s now been more than a month since we were intimate. I am tired of the effect this has on my self-confidence. He regularly stays up late and I often go to bed on my own as he loses track of time. I am becoming despondent in our marriage overall, especially with the duties I used to take pride in. He makes a lot of effort to keep up with his hobbies and friends, so I feel as though our sex life isn’t important enough to him. I don’t want sex to be a chore but unless I said something he would never raise the subject. What do I do?

I can certainly understand your frustration and despair. It is very important that you learn exactly what has caused him to withdraw sexually. This must be elicited without blame, so if you are unable to make him feel safe enough to share his feelings and thoughts with you, ask a therapist to help. There are many reasons why a partner might be exhibiting low desire for a spouse – including trying to hide a sexual disorder, an undiagnosed medical problem that causes erectile difficulties, a secret sexual interest such as a fetish he does not care to share, an obsessive attachment to pornography, or a psychological disorder such as depression, anxiety, a phobia or obsessive-compulsive disorder. It is not unusual to take this situation personally, but it is not necessarily about you. Seek clarity, then try to be a loving support to help fix whatever the problem might be.

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• Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders.

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