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updated 10/25/2007 11:37:14 PM ET 2007-10-26T03:37:14

Q. Menopause and hot flashes have taken my sex life away. My wife is 54 and started menopause at 46. For the past eight years it has been like I am married to my sister. My wife has no desire for sex and will not take hormones because they could cause cancer. I am not allowed to touch her because that would bring on a hot flash. There is no physical contact and what makes it worse is I love her so much.

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We have been together 27 years and I cannot imagine being with another woman, if you lined up all the women, I still would pick her. She is so beautiful and it is torture not being able to hold the one you love. I think about sex with her all the time and am frustrated and sad and feel unwanted.

I do not want a divorce and do not want to start my life over. I want my wife back. I have lost hope that will ever happen and do not know how to adjust. I do not think I can go the rest of my life without being able to hold and cuddle and make love to someone who will love me back the same way I want her too. What can I do?

A. Your note is very touching. Can you show this column to your wife? When a man feels frustrated, sad and unwanted, as you do, he can unwittingly come off to his wife as angry and abrupt. You may not be expressing your feelings to her as eloquently as you are to me.

So if you do come off as feeling annoyed rather than feeling abandoned, the misunderstood result is that your wife doesn’t perceive your love and tenderness at all. Instead, she retreats, feeling she is wanted only for sex. This will make a woman who is already not in the mood feel even less in the mood. An angry or importuning approach never feels like real intimacy, even if the desire for real intimacy is what's behind it.

Things have probably snowballed over time so that now, every time you approach your wife, she thinks it is for sex. This is why she always has an excuse — like if you touch her, that will bring on a hot flash.

Being touched does not trigger hot flashes. The bigger message from your wife is that sex, for whatever reason, is something she doesn’t want, so keep away.

It’s true that, for some women, their libido might be diminished by menopause, but that doesn’t mean her need for intimacy is. Many post-menopausal women have active romantic lives with their husbands, even though intercourse might take more effort than before.

Your non-sexual status has continued for eight years. If it keeps going, your love for your wife will start to diminish. Your quality of life already has. As you know, the answer is not to find someone else. I certainly understand your wish not to live the rest of your life without being able to hold and cuddle and make love to your wife. With many years ahead of you, you shouldn’t allow her to impose this celibate state upon you. So here are a few suggestions.

Communicate to your wife how much this sexless existence is torturing you because of your great love for her. And, to feel loved in return, you need to be sexual with each other. To start with, don’t coerce or insist. Rather, let her know that you crave intimacy with her and feel abandoned without it, which is why she must help you change this. If she could truly stand in your shoes, she would want to do something about this, unless she doesn’t love you, which sounds like it is not the case.

Studies on hormone replacement are conflicting. Unless your wife has a family history of cancer, it’s unclear what the best course of action is. Oral estrogen isn’t the only kind — there are creams and suppositories that can be used more locally. So one option is that your wife ask her gynecologist about hormone therapies that are not ingested. Testosterone is really the hormone of desire, and she should probably have her level checked to make sure that's not the culprit. Sometimes the answer is as simple as lots of lubricant.

Because so much time has passed, you might need to see a certified sex therapist. After eight years of no sexual contact, it will probably help to restart slowly.

One technique used by certified sex therapists is to start with physical interactions that are not sexual. A technique called "sensate focus” means that you massage and touch each other in a loving way, excluding the genitals altogether. There are no expectations and no pressure. This works because it diminishes the anxious partner's worries about having sex. You later move on to include genitals but you do not have intercourse. Only when the anxious partner is completely comfortable do you try intercourse.

Ultimately, though threats are not a good way to improve your love life with your wife, it's reasonable to let her know that you don't think you can stay forever in a sexless marriage.

Dr. Gail’s Bottom Line: When one partner has shut the door on sex in a marriage, it can have devastating effects, so it is imperative to work on this.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to TODAY. Her latest book is “Anatomy of a Secret Life: The Psychology of Living a Lie,” by Dr. Gail Saltz. She is also the author of “Amazing You! Getting Smart About Your Private Parts,” which helps parents deal with preschoolers’ questions about sex and reproduction. Her first book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” was published in 2004 by Riverhead Books. It is now available in a paperback version. For more information, you can visit her Web site, www.drgailsaltz.com.

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