Many couples go through long periods without having sex. The encouraging news is that if both partners are willing, you can revive sexual intimacy. Here are seven reasons why sex might be lacking in your marriage and how to turn it around. 

It is not uncommon to see couples in relationships that have not had sex in one month to even ten years. I am most often visited by individuals who have not had no sex with a spouse or partner for two or more years, and I am always fascinated by the fact that they wait so long to seek help. This is often due to embarrassment, not knowing who to ask, or simply accepting their new "norm." Let us look at some of the causes.

Painful Sex

One of the most common causes of no sex in a marriage occurs in menopausal women - PAINFUL SEX. Approximately50% of menopausal women who avoid sex do so because it is painful. This is often caused by vaginal dryness (atrophy) and leads to thin, non-elastic tissue with little blood flow. There are many ways to treat this, including topical estrogen creams, non-estrogen vaginal inserts, and other products for the vagina. This can restore at least 50% of the area's elasticity and lubrication. Note that lubricants will only wet the area and make it slippery, whereas the products mentioned above will actually restore the elasticity of the area to a more normal state. Although experienced by many women, painful sex should NOT be an accepted part of aging and menopause. Discuss this with your doctor and ask for management. If you are looking for a non-medicine approach, it is reported that having two penetrations a week or more will maintain the youthfulness of the vagina - so begin your homework!

Sexual Dysfunction

Another common reason for a sexless marriage is POORFUNCTION. This is generally the inability to achieve or maintain an erection suitable for penetration. Medical conditions, including cardiovascular disease and hypertension, often cause this. SMOKING and excessive alcohol consumption are HUGE risk factors for this, and we strongly advise you to stop smoking very early in life and keep alcohol consumption low. MEDICATIONS are also a big influence on the lack of function. Some are unavoidable, such as mood medications. Still, others are used to treat conditions that could be prevented with a healthy diet, maintaining a normal body mass, and participating in regular exercise. So, stay healthy, and this will prevent the need for excessive medications.

Resentment

In couples of any age, BITTERNESS and RESENTMENT present a huge barrier to sexual intimacy. It is no surprise that a person wants to be treated nicely if they are going to have sexual intimacy with their spouse. The daily drama in life with kids, work, and finances presents many aggravations that flatten dopamine and norepinephrine and interfere with sexual desire. I believe that mutual respect in ANY relationship can help avoid general conflicts whether or not you agree with each other. Avoid petty arguments when possible. Also, I would argue that having sexual intimacy may be a wonderful way to resolve conflict as it releases tension, "re-boots" the dopamine and norepinephrine, and makes you forget what you were arguing about! Try compartmentalizing conflicts and continue having sex regularly.

Boredom

We would be remiss if we did not mention BOREDOM! Although women and men rarely identify it as this, they are just bored of the same routine. EVEN IF the same routine ends in orgasm for both parties, the lack of excitement leads to reduced arousal (vaginal dryness and inadequate lubrication)and eventually low desire. So folks, just pursue each other andstop living like roommates. Spice things up a little! Read asexy book together, have sex in an unusual place (don't getarrested), women maybe dress up in sexy outfits, send flirtytext messages, get a couples massage, get in the bathtubtogether, give each other massages with oils. There are terrific books and videos out there to keep the heat in the bedroom!

Other causes of a sexless marriage include:

• Substance abuse by one or both partners, including alcohol and pain pills.
• In younger women, VAGINISMUS, which is an involuntary muscle spasm that does not allow penetration of a penis, a finger, or even a tampon, is generally an anxiety condition. This can be managed with couple’s therapy.
• A change in sexual orientation can become evident years after marriage.

The GOOD NEWS IS that in almost all willing couples, restoring sexual intimacy in the marriage IS POSSIBLE! It may seem awkward and challenging at first, but with persistent work, support from a certified sex therapist, and management of the medical aspects by your physician, it is possible to achieve GREAT SEX FOR A LIFETIME! So, let us start addressing it today!

Maureen Whelihan MD FACOG