I’m 62, and my wife is 54. We have been married for nearly two years. Six months after we were married, she had a major prolapse of her bladder. At that point, her desire for sex greatly diminished. This went on for almost a year. Six months ago, she had a hysterectomy. Now she has no desire for sex at all, nor does she have any desire for intimacy. We even sleep in separate beds. I still very much want sex. I have really tried to be understanding, but it hurts and is very disappointing. I am afraid it will ruin our marriage. She loves me very much, and feels guilty that she has lost her once-strong sexual drive. To make matters worse, she is turned off by any hint of an advance on my part. I feel almost as if my sexual desire for her is perverted. I can’t take that. I love her dearly as well. But I don’t know what to do.

The sexual consequences and aftermath of such physical complications can be complex and multifaceted. First, there are the purely physiological factors, such as possible nerve damage, which can create partial or total interruption of the sexual response. Second, your wife will be experiencing radical hormonal changes that will affect her desire, arousal and orgasmic ability. And you have alluded to the psychological and relationship issues that frequently arise in your situation – for her, feelings of guilt, shame, even anger towards her own body; for you, frustration, disappointment, fear of hurting her and more.

The first strategy is for you to share your feelings with each other – being careful to avoid blame, but being frank about the complexity of the feelings. For example: “I feel sad, frustrated and miss our sexual connection, but I also feel afraid to hurt or upset you in expressing this.” Once there is true empathy for each other’s position it becomes easier to seek outside help as partners taking equal responsibility for change. Everyone has a right to healthy sexuality, and it is important to bear this in mind when approaching your doctors to ask for proper focus and help in restoring sexual function. You both deserve this help, so please do not allow your needs and wishes to be ignored or dismissed. Finally, two avenues of psychological healing are available – sex therapy and also some fine online groups and informational websites such as Dr Mitchell Tepper’s Sexual Health Network.

• Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders.

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