Q:

I am 53 and have been married for 13 years, but my husband and I have not had sex in four years. I have told him that I long for the intimacy and sexual pleasure we once shared. He says that he has found "peace within" and no longer feels the need for sex. I really love him, but I feel abandoned, unloved and insecure. He does not want us to seek counseling. What can I do?

A:

I can sense the pain you're feeling. The first thing I recommend is that you get your husband in to see his doctor for a complete physical examination. Numerous medical conditions and medications can affect a man's sex drive and ability to experience an erection, including depression, hypertension and diabetes. These become more common as men age.

Although your husband says he "no longer feels the need for sex," the reality may be that he is having trouble with erections and so has cut himself off from sex to avoid embarrassment. As you're no doubt aware, there are numerous treatments for erectile dysfunction, ranging from medications like Viagra, Levitra and Cialis to injections, pumps and inserts.

Next—or at the same time—find yourself a good sex therapist certified by the American Association of Sexuality Educators, Counselors and Therapists (go to www.aasect.org and click on your state). Just because your husband doesn't want to go to counseling doesn't mean you can't. You need to talk to someone about your feelings of abandonment and insecurity, and why you have learned to equate sex with love. You also need to explore other options if it turns out that there is no physical problem with your husband, but his sexual drive remains missing. Will you stay in the marriage? Seek sexual intimacy outside the marriage?

During this investigative phase, do whatever you can to bring intimacy into your life with your husband without sexual intercourse. For instance, the two of you could shower together, take long walks while holding hands and give each other massages. Make sure you give your husband long, lingering kisses several times a day, reach out to give him hugs and tell him how you feel about him.

At the same time, take good care of yourself by eating right and exercising. And treat yourself as special with long baths, imported dark chocolate or a facial or pedicure at a local day spa. And don't forget the emotional and physical benefits of masturbation—with or without a vibrator.

Most important, keep talking to your husband about your feelings. Your therapist can advise you on how to start and hold such conversations, but at the very least, make sure your husband understands how unloved and insecure you're feeling. No one needs to spend years without sexual intimacy—and it obviously means a lot to you.