QUESTION: I have been married for 18 years and my husband and I have not had sex in over a year. He refuses to talk about it, except to say that I'm going through menopause and that we have a small child. He never openly discusses his feelings. I have been seeing a counselor (he refuses to go) but am becoming increasingly worried the marriage may end. How can I get him to open up and talk about this problem and do you give us much hope for the future of our marriage?

ANSWER: We recently wrote a book about all of the various reasons a man in a committed relationship might stop being sexual ("He's Just Not Up for It Anymore. Why Men Stop Having Sex, and What You Can Do About It," William Morrow, 2008). We were intrigued by something rarely discussed –- when a marriage stops being intimate, about half the time it's the man's decision.

You say that after 17 years of marriage, your husband decided to stop having sex with you, and refuses to talk about it. Clearly, something happened a year ago that caused him to make this decision. Let's look at some of the possibilities.

There are few things that can make a man shut up and shut down faster than a problem with impotence (erectile dysfunction). You might think that in this age of Viagra, Cialis and Levitra men would see their doctors and get help, but you would be wrong. Only 20 percent of men who could be helped by medication ever get a prescription –- they are simply too ashamed to do so.

And speaking of prescriptions -- is your husband taking any medications that might either cause ED or lower his libido? Some examples are pills for high blood pressure, depression or diabetes. If so, he should speak to his doctor immediately. It is often possible to change prescriptions or decrease dosage. He should have his testosterone level checked as well.

Does your husband seem depressed, but not on medication? Intimacy is never too high on a depressed person's to-do list. Again, he should see his doctor.

He seems to be tossing the problem back to you, by saying things like you are going through menopause and that you have a small child. You may, indeed, be perimenopausal, but from what you've written we don't quite understand what it has to do with this situation. Is he obliquely suggesting that you are causing the problem, perhaps because of "hormonal" issues? When he mentions your child, is he suggesting that she is taking up so much of your time and attention that he feels neglected? In other words, do you think that he is angry, but unable to express his anger? We surveyed more than 4,000 people for our book, and 44 percent of the men said that they stopped being sexual with their wives because they were angry at them. (Forty-five percent of the women thought that anger was the reason.)

You ask us how to get your husband to "open up." Was he previously willing to discuss personal things? If not, he may be so closed off to this type of conversation that you won't be able to. However, you can try. Don't be accusatory, don't get angry, listen carefully, and address this as a "we" problem, which it most certainly is. Prepare yourself with as much information as possible, so that you can have an intelligent and compassionate conversation. Perhaps begin by saying that you love him, and you miss the intimate part of your life together. You don't understand why he stopped being sexual and need him to communicate so that you can solve the problem together, because you can't read his mind. If it is something that you have done, or if he is angry about something either at home or at work, he must speak up so you can solve this together. You might add that it would be excellent if he joined you in therapy, so that you don't have to give his side of the story, which you may be reporting incorrectly. Also mention how important it is to you both that he visits a physician.

Is there "much hope" for the future of your marriage? We certainly hope so –- you have a lot of history and a young child. However, we don't have enough information to answer that question. We don't know, for example, how successful your marriage is in other ways. Are you supportive and respectful of one another? Do you share similar interests and beliefs? Do you have a good time together? Is he a loving and involved father? Is he faithful, and not an abuser of alcohol or drugs? If the answers are "yes," you may decide that a marriage good in so many ways is worth preserving in spite of a lack of intimacy. And if the answers are "no" you have other things to deal with that are just, if not more, important than a sexless relationship.

Visit Bob and Susan's Web site at www.bobandsusanberkowitz.com.

Bob and Susan's current book, "He's Just Not Up for It Anymore: Why Men Stop Having Sex and What Women Are Doing About It," was published by William Morrow on December 26, 2007. Click here to order from Amazon.com.

Have a question for Bob and Susan? Ask it here.

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