You Want Sex, He Doesn't--Or Vice Versa

Your kids are out of the house—or at least less likely to be barging into your room at all hours. You're no longer worried about pregnancy. Talk about perfect conditions for romance, right? Not necessarily. You and your partner may suffer from incompatible sex drives. Here are some steps to take:

1. Get a thorough checkup. "Make sure the drop in desire isn't related to something biological or medical," says marriage therapist Michele Weiner-Davis, M.S.W., author of The Sex-Starved Marriage: A Couple's Guide to Boosting Their Marriage Libido and The Sex-Starved Wife: What To Do When He's Lost Desire. A quick trip to the physician can reveal an underlying health condition. Alas, many women tell Weiner-Davis that their husbands will only go to the doctor "if they've lost a limb or they're bleeding to death," she says. "Pick up the phone and make the appointment yourself." Guys should get a doctor's OK for sex after heart disease, too.

2. Stop sniping. "I've had a lot of men say to me that their wives are very critical," says Weiner-Davis. "When wives are critical, the very last thing husbands feel like doing is making love to them."

3. Take erectile dysfunction seriously. "Whenever there's a drop in sex, you have to worry about health," says Dr. Harry Fisch, clinical professor of urology and reproductive medicine at Weill Cornell Medical College and author of Size Matters and The Male Biological Clock. "The penis is the dipstick of the body's health." (Erection problems precede heart disease by two to five years, he says.) With the help of your doctor, check that testicles are the size of walnuts. Smaller ones may be a sign of low testosterone—and a diminished interest in sex, says Fisch.

4. Check cholesterol. If your levels are high, you may experience erection trouble. "What gets clogged up before the heart is the penis," says Fisch. Then it can't easily fill with blood.

5. Hold hands. "There are all sorts of ways to be sexually satisfied, to be physically satisfied, that don't necessarily include intercourse," says Weiner-Davis.

6. Check your prescriptions. Some drugs, including beta blockers for high blood pressure, can contribute to erection problems. And selective serotonin reuptake inhibitors (SSRI's)—a popular class of antidepressants that includes Prozac, Paxil, Zoloft, and Celexa—can decrease libido. Even antihistamines can diminish sex drive. "The medications are often the cause of the drop in desire," says Weiner-Davis. "So often there are alternative medications that don't have the same negative impact."

7. Try lubricants. As women's estrogen levels decrease with age, they may experience vaginal dryness. Consider over-the-counter products or talk to your doctor about prescription estrogen creams.

8. Get treatment for depression. The mental illness is linked to lowered libido. Yet nearly half of Americans with major depression don't receive the treatment they need, according to the National Institute of Mental Health. Check with your doctor and on sites such as nimh.nih.gov and mayoclinic.com.

9. Ask your doctor about hormone replacement therapy. Estrogen in women and testosterone in men decreases with age (especially at menopause, around 50, for women, and beginning at 30 for men). Hormone replacement therapy remains controversial, but some doctors may think it's a good idea to boost levels of testosterone in male patients or of estrogen in female patients—and boost energy and libido in the process. "You're not going to be having sex if you have no drive," says Fisch. Hormone replacement therapy can also help with vaginal dryness and hot flashes in women. 

10. Consider erection-enhancing drugs. Men with impotence problems may want to ask their doctors about Viagra, Levitra, and Cialis. With these drugs, some men get flushing of the skin, nasal congestion and headaches. A doctor may also prescribe very low doses of SSRI's since they can delay orgasm—a benefit for men who suffer from premature ejaculation. (Viagra, which must be taken on an empty stomach, lasts eight hours. That makes it good for men on many other medications. Cialis can last for a few days.) A lower-tech option: condoms. They can make a man last longer since they decrease sensation. (Normally, an average man should be able to have intercourse for five to 10 minutes, says Fisch.)

11. Go easy on alcohol. Contrary to popular belief, booze is not an erection enhancer. Too much of it can diminish sex drive. And it may interact with other medications. (Some medications, such as cough syrup and laxatives, contain alcohol, too.) Do your homework with the help of sites for the National Institute on Alcohol Abuse and Alcoholism and the Mayo Clinic. Consuming more than two drinks a day can damage your blood vessels and worsen erectile dysfunction. With alcoholics, the liver makes more female hormones than male hormones. "That tends to poison things like erections," says Dr. Paul Turek, director of the Turek Clinic in San Francisco.

12. Kick the cigarette habit. Smoking constricts blood vessels—bad news for erections. It can also decrease levels of nitric oxide, which tells the body to let blood flow to the penis. To stop, get help from sites for the American Cancer Society, the National Institutes of Health, and the Mayo Clinic.

13. Exercise and eat right. Getting fit boosts everyone's mood—and improves body image. Take a (romantic) walk, join a health club together, and eat salads over candlelight. Fat converts testosterone to estrogen, and men with a waist circumference of more than 40 inches are more prone to erectile dysfunction. (Waist size should be half your height. So a man who is 70 inches tall should measure no more than 35 inches at his middle.) And men with type 2 diabetes, often associated with obesity, are at greater risk for low testosterone levels, which decreases desire.

14. Get more shut-eye. "If you want to have more sex, get more sleep," says Turek. Exhausted people aren't in the mood. For tips, visit the National Sleep Foundation's web site. And especially if you snore, ask your doctor whether you might suffer from sleep apnea.

15. Try new techniques. What worked when you met a couple decades ago may not today. "Compatibility is not the issue," says Turek. And health conditions, such as cancer, can also affect your ability to perform. Turek advises trying visual aids and even toys. Turn off the TV and the computer: they're distractions. And consider investing in a couple guidebooks, such as The New Joy of Sex.

16. Lower stress. It's easier said than done, especially in these economic times. But try. Stress is a desire and performance buster that elicits a "fight or flight" response—not a desire for intimacy, says Turek. "If you're a caveman being chased by a woolly mammoth, the last thing you want to do is relax and have sex."

For more about love, sex, and marriage, read:

Elizabeth Taylor and Her Many Marriages

Would You Take a Grenade for Your Partner?

Falling (Back) in Love

Falling Out of Love

Rekindled Romances

Say Goodbye to the Wandering Eye

Cheater Pants!