Q: My wife and I are both 28. We started dating in college and married 2 years ago. Our friendship and marriage have been perfect. Sex has always been great; we’d do it often, and even be adventurous sex in public places, photography, occasional flashing, etc. Recently she claims that she has completely lost her desire for sex. We still make love; it’s great once we get started, but I have to do all of the initiating. This is not an attraction problem, we are both fit and think each other is beautiful, although now she thinks she is “fat” (at 5’4″ and 115, she isn’t). In the past year she has been taking medication such as Voltaren and Relafen for her sciatica. Could this medication cause her lack of desire? She’s changed her brand of birth control pills several times, and that hasn’t helped. Other than sex, we have never been happier or closer. What can I do? I am currently trying to help her see her beauty and make her feel like a woman.
Dr. Klein: One of the great challenges of long-term relationships is dealing with the fluctuations of sexual desire of one or the other partner. You cite several possible causes for your wife’s decreasing desire. First, birth control pills do decrease desire in some women. You say she’s tried several brands, so this is not likely. On the other hand, there are three distinct types of oral contraceptives; she should speak to her physician about changing the type of pill, not just the brand. Second, the Voltarin and Relafin could affect her desire, particularly when taken with birth control pills. She should speak with a physician about this. Third, you mention sciatica. Pain and the fear of pain can reduce sexual desire dramatically. Speak with her about this possibility. Fourth, you don’t say anything about children; it can take as much as 18 months for a woman to regain her sexual desire after giving birth. Fifth, what else is going on in your wife’s life that might be undermining her self-esteem? Problems with work or family can make anyone feel unattractive. And low desire is a common symptom of depression. Sixth, is it possible she’s seeing someone else? Seventh, when was the last time your wife had a physical? A variety of hormonal, neurological, and vascular problems can affect sexual desire. Finally, how does your wife feel about this development? If sex has been an important part of her life and of this marriage, surely she has strong feelings about recent changes. If the two of you can’t come to some understanding about this, a few visits to a couples therapist are in order.