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Barb DePree, MD, NCMP,MMM

Director of the Women's Midlife Services at Holland Hospital

Holland, MI

Dr. Barb DePree, a gynecologist in practice for over 30 years, specializes in midlife women's health. She is certified through the North American Menopause Society as a provider, and was named the 2013 NAMS Certified Menopause Provider of the year. Dr. DePree currently serves as the director of the Women’s Midlife Services at Holland Hospital, Holland, Michigan. In 2018, she completed a certification in Genetic Cancer Risk Assessment.

A member of NAMS, ACOG and ISSWSH, Dr. DePree has been a presenter for the ACOG CME audio program. She has served as a key opinion leader for Shionogi, AMAG, Duchesnay, Valeant, Wyeth and Astellas leading physician education, and participating in research projects and advisory panels.

Finding that products helpful to her patients’ sexual health were not readily available, Dr. DePree founded MiddlesexMD.com that shares practice-tested, clinically sound information and products, including guidance for working with partners and caregivers. Dr. DePree publishes regularly on her own blog, providing updates on research in women’s sexual health, as well as observations and advice based on her work with women in her practice. Sharecare named her as a Top 10 Social Healthmaker for Menopause in September of 2013. In 2017, she was named among the “Top 10 Best Menopause Blogs” by Medical News Today. Dr. DePree also publishes podcast interviews on women in midlife, exploring the ways they have made the transition in their lives and careers.

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sexless marriage
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Don't Settle for a Sexless Marriage

When one partner wants sex and the other one doesn't, it can cause deep, relationship-destroying pain. Find out how to change a sexless marriage.

Sexual Dysfunction

Sexual partnerships are as variable as snowflakes. Each couple dances to a unique harmony. For some, sex remains a vibrant and fundamental part of the love and intimacy between them. But for many others, sex fades into a boring and infrequent routine or it just doesn't happen at all. And that's not a happy place to be.

For many couples, sex—or the lack of it—becomes the white elephant in the room. They ignore; they avoid; they work around it. But generally, it's an underlying irritation and cause of increasing anger, frustration, and dissatisfaction. Whether lack of sex is the cause of these emotions or is collateral damage caused by other problems becomes hard to tease out. Just the fact that the darned elephant is sitting there on the couch takes a lot of energy to ignore.

Relationships without sex are common—it's estimated that from 20 percent to 30 percent of marriages are sexless, which is roughly defined as having sex 10 times per year or less. Even though women tend to struggle more with libido during menopause, "women don't have a corner on low libido," says Michele Weiner-Davis, therapist and author of The Sex-Starved Marriage in this very worthwhile Ted talk.

The number of times couples "do it" per year isn't the point. Really, who's counting? It's the level of contentment and connection between them that counts.

"If a couple is OK with their pattern, whether it's infrequent or not at all, there isn't a problem," says clinical sexologist Judith Steinhart in this article. "It's not a lack of sex that's the issue, it's a discordant level of desire."

And that discordant level of desire—when one partner wants sex and the other doesn't—can cause deep, relationship-destroying pain.

We're hard-wired for connection. We crave intimacy and emotional safety within our committed relationships. And sex is a powerful intimacy-builder.

But when it becomes the sole task of one partner to ask for sex, and when he or she is frequently rejected, a hurtful dynamic is set in motion. More is at stake than a roll in the hay. One's self-worth and sense of being attractive to, connected to, and cared for by a lover is on the line. In research studies, that kind of rejection activates the same parts of the brain as physical pain.

Over time, repeated rejection morphs into anger, frustration and contempt—or withdraws into boredom. Communication and connection on other levels shut down. Intimacy flattens like stale beer. We all know couples who don't touch or make eye contact or share a joke.

With discordant levels of desire, the person with less need for intimacy controls the relationship, says Weiner-Davis in this article. The bargain goes like this: "I am not into sex. You are. But I don't have to care about your sexual needs. Furthermore, I expect you to be monogamous."

Besides being unfair, the fatal flaw of this unspoken agreement is that relationships are built on mutual caretaking, and when that falters, the essential contract begins to crumble. Sex in a loving relationship is a reaffirmation of that mutual caring—a giving and receiving of pleasure, intimacy and trust. That's what we all deeply long for, and if it goes away, we deeply grieve its loss.

So, whether you're the withholder or the seeker in your relationship, there's good news. Even couples in long-term relationships can reignite the flame. "It's never too late to have a passion-filled marriage," says Weiner-Davis.

That doesn't necessarily mean shades of gray, sex on the kitchen table kind of passion, but it does mean a renaissance of sexy touch, playfulness, cuddling and general "canoodling," says Foley.

For starters:

  • Explain how you feel. Often, the partner with a lower libido doesn't understand the hurt caused by rejection and lack of physical intimacy. Explain how much you miss the physical expression of love in your relationship. That it's painful to feel he or she isn't interested in being close to you. That you don't want to settle for parallel, unconnected lives. That sex is important.
  • Just do it. If you're the low-libido partner, sometimes, you just have to get started in order to feel desire. If your partner clearly needs a little cuddle time, seize the opportunity to please and affirm your partner, whether you feel like it or not. If you can't get into the mood, you can touch, kiss and pleasure your partner in other ways—masturbation or oral sex, for example.
  • Get creative. Familiarity and routine can be a serious buzz kill in a long-term relationship. Sometimes, mixing it up a little reignites the spark. Maybe recall the moves that used to turn you on or maybe take a midwinter break for a rejuvenation weekend. Be new lovers for each other.
  • Get a physical. We all slow down with age. This isn't problematic in itself, but if the slowing is one-sided or if either or both of you want more action between the sheets, then a complete physical workup should be one of your first steps—for men and women. Sexual functioning is linked to so many physical and emotional variables—medication, stress, depression, illness—that teasing out the possible intersections is a job for the professionals. Once they're diagnosed, sexual issues can usually be treated or improved.
  • Get counseling. Maybe you need a few sessions to jump-start communication. Maybe you need a deeper dive to unearth ingrained bad habits. Counseling, group therapy, a marriage retreat or some other reset might help address blind spots and self-defeating behavior. If your partner doesn't want to go, you should go alone. "Counseling can help you figure out strategies to help yourself," says Sallie Foley, director of the Center for Sexual Health at the University of Michigan.

Tackling a sexless marriage isn't easy. Even if the status quo is unsatisfactory, changing it is risky and uncomfortable. If you're continually gnawing on irritation, if you feel rejected and unattractive to your partner, if you've shut down and settled for boredom, it's time to rattle that cage, express your feelings in a loving way, and actively seek out help.

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.

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