Somewhere between 10 and 20 percent of married couples in the U.S. have sex fewer than 10 times a year, the most common threshold for what clinicians consider a “sexless” marriage. If you’re in one, you’re far from alone, and the situation is rarely about a single problem with a single fix. It usually involves a mix of physical health, emotional dynamics, and practical life pressures that have compounded over time. The good news: most of these factors are treatable or changeable once you identify them.
Rule Out Physical Causes First
Low desire often has a medical component that gets overlooked. Chronic conditions like diabetes, heart disease, thyroid disorders, high blood pressure, and chronic pain all suppress sex drive directly. For women, drops in estrogen during perimenopause and menopause reduce desire and can make intercourse uncomfortable. Conditions like endometriosis and polycystic ovary syndrome also interfere. For men, low testosterone is a common culprit, and it can decline with age, smoking, or underlying health problems. Erectile difficulties create a feedback loop: the physical problem causes anxiety, and the anxiety makes the physical problem worse.
Medications deserve their own hard look. Antidepressants (especially SSRIs like fluoxetine and sertraline) are well-known for dampening desire and making orgasm difficult. Blood pressure medications, particularly thiazide diuretics and beta-blockers, frequently cause sexual side effects. Hormonal birth control methods, including the pill, the patch, the ring, the implant, and the injection, can lower libido. Even some antihistamines and heartburn medications have been linked to sexual dysfunction. If the timing of your dry spell lines up with starting a new medication, that connection is worth raising with your doctor. Alternative drugs in the same class often carry fewer sexual side effects.
Understand the Emotional Cycle
In most sexless marriages, one partner wants more intimacy and the other pulls away. Therapists call this the pursuer-distancer dynamic, and it’s one of the most common patterns in couples therapy. The partner who wants more closeness starts initiating more often, sometimes with frustration or criticism attached. The other partner, feeling pressured, withdraws further. The withdrawal triggers more pursuit, which triggers more withdrawal. Neither person gets what they need, and resentment builds on both sides.
Sex therapist Laurie Watson, author of “Wanting Sex Again,” describes this as the core interpersonal struggle behind most sexual concerns in marriage. Research from the Gottman Institute found that men tend to be the ones who withdraw and women tend to pursue, though these roles can easily be reversed. The critical thing to recognize is that both positions are driven by unmet needs. The pursuer needs connection and reassurance. The distancer needs space and a sense of safety. Neither person is the villain.
Breaking this cycle starts with naming it out loud together. When both partners can see the pattern as the problem, rather than seeing each other as the problem, the dynamic begins to loosen. The pursuer practices pulling back without withdrawing emotionally. The distancer practices moving toward their partner in small, low-pressure ways.
Talk About It Without Making It a Crisis
The conversation itself is often the hardest part. Many couples go months or years without directly addressing the lack of sex because the topic feels too loaded. When it finally comes up, it tends to arrive during a fight or as an accusation, which guarantees defensiveness.
A better approach is to frame the conversation around what you miss rather than what’s wrong. “I miss feeling close to you” lands differently than “We never have sex anymore.” Choose a calm, private moment, not bedtime and not during an argument. Be specific about what you’re feeling without assigning blame. If your partner shuts down, don’t escalate. Let them sit with it and come back to the conversation later. The goal of the first talk isn’t to solve anything. It’s to establish that this is a topic you can both discuss without someone getting attacked.
Rebuild Physical Intimacy Gradually
Jumping straight from no physical contact to sex rarely works. The gap feels too wide, and the pressure makes it worse. Sex therapists have used a structured technique called Sensate Focus for decades to help couples rebuild touch from the ground up. It works in stages, and each stage removes a specific source of pressure.
In the first stage, you take turns touching each other’s bodies with genitals and breasts completely off limits. One person touches while the other simply notices the sensations without analyzing or evaluating them. There’s no goal, no performance, and no expectation of arousal. The point is to relearn what non-pressured physical contact feels like. In the second stage, genital and breast touching is added, but kissing and intercourse are still off the table. The third stage introduces lotion or oil to change the quality of sensation. The fourth stage removes the turn-taking structure so both partners touch and receive simultaneously. Only in the fifth and final stage does intercourse enter the picture, and even then, the focus stays on sensory awareness rather than performance or orgasm.
This progression can take weeks. That’s intentional. It rebuilds a foundation of safe, pleasurable touch that many sexless couples lost long ago. You can work through these stages on your own, though a sex therapist can guide the process and troubleshoot when you get stuck.
Consider Professional Help
Couples therapy and sex therapy are different specialties, and sexless marriages often benefit from both. A couples therapist helps you work on communication patterns, resentment, trust, and the pursuer-distancer cycle. A sex therapist focuses specifically on desire, arousal, and the physical mechanics of your sexual relationship. Many therapists are trained in both areas.
Cognitive-behavioral approaches have the strongest track record in sex therapy research. For specific conditions like difficulty reaching orgasm, success rates in studies run as high as 88 to 90 percent. Desire mismatches and more complex relationship-driven problems don’t have such tidy numbers, but structured therapy gives couples a framework they almost never find on their own. If one partner is resistant to therapy, the other can still go alone. Individual work on attachment patterns, communication skills, or your own relationship with desire often shifts the dynamic even when your partner isn’t in the room.
Address the Lifestyle Factors
Some of the most effective changes are also the least dramatic. Sleep deprivation tanks desire. So does chronic stress, whether from work, parenting, finances, or caregiving. Couples with young children are especially vulnerable because exhaustion, being constantly touched by small humans, and zero privacy combine into a perfect storm.
Protecting time and energy for your relationship isn’t selfish. It’s structural. That might mean hiring a babysitter on a regular schedule, going to bed at the same time, reducing alcohol (which suppresses arousal despite lowering inhibitions), or simply creating pockets of the day where you’re in the same room without screens. Physical intimacy doesn’t start in the bedroom. It starts in the dozens of small moments of connection, or disconnection, that fill a typical day.
When Desire Gaps Won’t Close
Some couples discover that their difference in desire isn’t situational. It’s fundamental. One partner may identify as asexual or simply have a naturally low baseline for sexual interest that no therapy or lifestyle change will shift. In these cases, the path forward requires honest negotiation about what the relationship can realistically look like.
Options range from accepting a low-sex marriage with other forms of intimacy taking center stage, to exploring ethical non-monogamy if both partners genuinely agree, to recognizing that sexual incompatibility may be a dealbreaker. None of these options is inherently right or wrong. What causes the most damage is avoiding the conversation entirely and letting years of silent frustration erode the relationship from the inside.