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updated 8/27/2008 2:40:03 PM ET 2008-08-27T18:40:03

Q. My wife, 48, and I, 50, do not have sex anymore. We haven’t for several years, and it was infrequent even then. She says she doesn’t want sex with me until we regain the intimacy we had earlier in our marriage. I stopped feeling close to her because she continually told me she was too tired to make love. (She works long hours.) She has never had an orgasm and won’t let me help and won’t do anything about it herself. Sex feels like something I do to her and she tolerates. I feel my only use to her is as caregiver to our children.

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I would like to be with someone who wants to spend her time with me emotionally and physically, but I love my children and don’t want to be separated from them. We see a marriage therapist. In therapy my wife reveals nothing personal about herself, while accusing me of being angry (which I am). I think she is a “hider” and cannot acknowledge mistakes. If she criticizes me she’s “trying to communicate,” but if I say anything negative to her I’m “angry” or “unsupportive.” Can you help?

A. You don’t feel close to your wife because she doesn’t want sex, and she doesn’t want sex because you are not close. You are trapped in a vicious cycle.

This is a common couple issue: Which came first, the chicken or the egg? Even though you can certainly understand the desire to figure out the riddle, the bottom line is that nobody is having sex and you are worried about divorce. Sadly, your wife doesn’t seem to understand that sex is, for you, a necessary way of being intimate and close.

Let's look first at the possibility she has a sexual dysfunction. Such dysfunction can have to do with her age and menopause, with psychological issues that are lifelong or with long-standing issues between you two.

Certainly, seeing a marriage therapist is the right thing to do. But you might also consider seeing a certified sex therapist. (Find out more at aasect.org, the Web site of the American Association of Sexuality Educators, Counselors and Therapists.)

If your wife has never had an orgasm, a condition called anorgasmia, this is absolutely treatable. It would in all likelihood make sex a whole lot more appealing for her.

But it does require being able to be emotionally intimate. Having an orgasm means relinquishing some control, so she must be willing to do this.

If emotional intimacy is the problem, much depends on the kind of progress your wife is willing to make. Remember the old joke, “How many shrinks does it take to change a lightbulb?” The answer is, “One, but the lightbulb has to really want to change.” Similarly, your wife has to really want to change.

Going through the rest of your life unable to have intimacy is very sad. You are denying yourself an entire wonderful arena of life.

So I say you should make every effort to stay together and work this out through therapy, as you are doing. But, at the end of the day, if you have tried to get help and your wife is unwilling to make the necessary changes, you have to decide for yourself whether you are willing to live with a loveless, sexless marriage or with sex that your spouse merely tolerates.

Dr. Gail’s Bottom Line: People are entitled to feel loved and desired by their spouse. For those who feel trapped in a marriage, only they can decide the risks and benefits of staying or leaving.


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.” 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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