Having trouble in the bedroom? Here’s help

Dr. Gail Saltz TODAY Contributor • Profile • E-mail

Q. My husband isn’t interested in sex — at least not as much as I am. He has endless excuses to avoid sex. I feel unattractive and unwanted, and I think this could ruin our marriage. What can I do?

A. Increasingly, I am hearing from women like yourself who have a husband with a sex drive lower than theirs. Women are often too embarrassed to speak up about it.

You are entitled to a satisfying sex life with your husband. How to create (or recapture) this depends largely on whether it is an old or a new problem.

If, since the beginning, your sex drives have always been mismatched, it might be that your husband merely has a lower libido than you do. Not all men have enormous sex drives. In some cases, this has to do with low testosterone levels. This should be checked out by a doctor. If this is the problem, it can be remedied fairly easily with testosterone replacement.

If it’s not the result of a hormonal problem, which is more likely, the goal is to raise his level of desire. You can do this by figuring out what things are sexually stimulating to him and adding more of them.

In trying to ascertain this, throw out different ideas. These might include reading erotica to each other, watching porn together, wearing outfits he finds particularly appealing, going dancing, visiting the sex store for new toys or having sex in new places.

You might think you already know what he likes. But, as is often the case when it comes to men with low libido, you actually don’t. So ask. (But don’t ask when you’re in the bedroom arguing about this. Do so when you’re in the car, raking leaves, cooking dinner or doing something else ordinary, where he will not feel so vulnerable.) The idea is to introduce exciting activities that will whet his appetite and increase his desire.

To an extent, you will likely have to compromise. If your sex drives are out of balance, your aim is to meet in the middle, having sex a bit more than one partner likes but probably a bit less than the other likes. There is nothing wrong with self-satisfaction to help make up some of what you might miss from your partner. This kind of compromise is what healthy couples do.

If this is a newer problem, that raises the red flag of a possible medical issue. Health conditions such as diabetes or cardiovascular disease, and new use of medications such as antidepressants or antihypertensives can cause erectile dysfunction. Your husband might choose to avoid sex altogether rather than feel he is embarrassing himself in the bedroom.

His lack of desire might also stem from something you are not aware of — stresses over work, finances or something else. It is important to have a discussion about this — again, not in the bedroom. Allowing him to share his anxieties and helping him brainstorm solutions may make him feel more comfortable in the bedroom.

Your husband might be less inclined to work on the problem if he doesn’t perceive it as a problem. But if he knows how vital it is to you, it is something you can work on together. As you know, this kind of problem can seriously erode a marriage. Without sex and romance, you might as well be roommates.

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In many cases, mismatched desire could benefit from seeing a certified sex therapist, who can lay out specific and concrete treatment.

Dr. Gail’s Bottom Line: If you want more sex than your husband does, first rule out medical issues and then work on boosting his desire.

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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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