Sexless Marriage

Many marriages and other long term relationships face the dilemma of a discrepancy in sexual frequency. Some are a little bit different and some are a lot different. Several of you are facing very large differences in desire.

You may have read the FAQ about "One of us wants sex more than the other." If you haven't, that would be good to do.

In the case of a male wanting considerably less, there are definite steps to take -- if the male is willing and wants to increase his desire and willingness to be more sexual.

There are also steps for the female. I'll cover them both here since both sides of the dilemma were raised in this discussion.

First things first. There must be some kind of communication between the people involved. This involves (as others have suggested) deciding whether this level of discrepancy is a deal breaker for the relationship. If you assert that it is, you need to follow through or you will be in a relationship in which your mate will not take you seriously.

This communication cannot be stymied by silence, changing the topic, or similar tactics. You need to say that this really matters to you.

Both males and females can supplement with testosterone topically. There will eventually be a patch for women (last I heard in the fall, the FDA were hoping to fast track the patch for women).

But, in the meantime, women can use a product designed for men, but use it in a much lower dose. A male would use a tube of Testim per day. A female would use one tube over a ten day period. Men generally apply it to the arms. Women can do the "Macarena method" -- applying it to the hips and calves.

Women and men should have some blood tests done before jumping in with supplementation. Both should have a prolactin test -- particularly a man with remarkably low sexual interest and particularly if he once had way more.

In very, very rare cases there can be a high level of prolactin for a male and there can be a brain tumor underlying that. In my 23 years doing this, I've had only one case, but he was glad I encouraged him to have the test. He was treated and last I knew was fine.

On the topic of prolactin for women -- when women give birth and breastfeed, their prolactin levels naturally go up. That's what permits breastfeeding. After a birth, not all women's hormones go back to "normal." And, they certainly won't really until breastfeeding is done (though this does not mean a woman should rush her child through it).

Women need a balance of estradial, progesterone, and testosterone -- to name the big three. When looking at testosterone levels for both males and females, the free testosterone and total testosterone should be measured. In cases of extremely low male interest and somewhat low interest for women, I would also recommend a blood test for SHBG (sex hormone binding globulin).

So, those are all the physiologic issues that relate to hormones. Of course, there may be other issues such as diabetes, thyroid conditions, medications that suppress sexual desire, life stress, and relationship issues (that may not all be on the table -- think extra-relationship sex or "affairs"). So, it's best to take a very large look at what could be causing what.

That's where a sex therapist comes in. A skillful one can help you assess and manage all the variables that can play a part in creating the discrepancy.

If you're up for an excellent and challenging book, consider David Schnarch's book "Passionate Marriage." It deals with many of the issues in an in-depth manner and you may find it quite helpful in your quest to decide what to do.

Related Links: Why We Cheat, Testosterone testing

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