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Peter Banos / Alamy
Return to page one of Lazy Sex

I know that a lot of women will be thinking to themselves, Yeah, right, how do I get my husband to the doctor? One of the tips I give women is that if your husband agrees, even mildly, to your suggestion to go to a doctor, use that as license to pick up the phone, schedule the appointment yourself and, when it comes time, get him in the car. You need to be the proactive one.

Very often the problem can be emotional. For example, depression is rampant. With the economy being what it is, companies are being downsized and men are losing their jobs. Women really do not understand the full impact it has on men's self-esteem when they are let go from their positions. Obviously the last thing they would be interested in is making love.

Other personal issues could be impacting on his desire to be physical: if he has a childhood history of sexual abuse, or if he grew up in a dysfunctional family and has low self-esteem. Or maybe he has a lack of knowledge about being a good lover. We're not born knowing that stuff. So education, therapy, talking about and addressing issues so that he feels better about himself these are the steps he needs to take in order to feel like he's got something to give in the relationship.

What about relationship issues?

One myth I'd like to debunk is that if a man isn't interested in sex, it means there's some sort of sexual dysfunction. While sexual dysfunction undoubtedly contributes to a drop in desire, what I've found in working with couples is that the reasons men don't want to have sex are very similar to the reasons that women don't want to have sex. There could be underlying, unresolved relationship problems. Or one of the biggest complaints I hear from men is that their wives are critical or nagging. Trust me on this one, criticism and nagging are not aphrodisiacs. So, many men just go into a cave. You'll never be surprised to hear a woman say, If I don't feel close to my husband emotionally, I don't want to have sex. But you think men want to have sex regardless of the circumstances, even if the roof were caving in. It's not true. Some men may be like that, but many men really need to feel emotionally connected to their wives in order for them to want to be sexual.

You also talk about sexual confusion in the book.

Yes, there are many, many men who get married, have children and then, somewhere along the line, like in Brokeback Mountain, discover that they are either bisexual or homosexual. Needless to say, there's a time when they just don't want to have sex with their wives. [But] the man's drop in desire doesn't have anything to do with the wife, the woman. I point this out because one of the things that is so characteristic of sex-starved wives is that when their husbands aren't interested in sex, they immediately internalize it. They think there's something wrong with them that they're not attractive, they're not lovable. They feel badly about themselves. And many times it has absolutely nothing to do with them and has everything to do with just the man himself.

But many women blame it on their physical appearance. Is that an issue?

Yes, and no. As I said before, sometimes guys are just overwhelmed, or they're fatigued, or they're drinking alcohol, which might lower their libido and their ability to function. So the "no" part is that it could have absolutely nothing to do with their wives.

But there's a "yes" part, too, that I don't want to overlook. I've gotten tons of e-mails and heard this many times from men in my practice, who say, "I love my wife. I want to stay married, but, I have to tell you, she has totally let herself go. She doesn't eat well. She doesn't exercise. All she ever wears is sweatpants. It makes me feel that she feels that the relationship isn't important. I've just lost my attraction for her." If [those wives] think there's any chance at all that their looks may have something to do with the problem, rather than bemoan the fact that they think their husbands are shallow I agree they should also understand that attraction is a very basic, animalistic thing especially for men. Men are more visually oriented when it comes to arousal. So women can debate that, but the truth is, if they really want their husbands be more interested in them, they should pay more attention to how they're taking care of themselves physically.

Have you seen a lot of couples succeed in working out these types of problems?

You bet. I certainly wouldn't be doing what I do if I didn't see success, because it would be pretty depressing. I've already started to hear from women, based on this book, saying, I got my husband to read part of the book and for the first time he's willing to address this issue. That's the first step. In the same way that Bob Dole made "erectile dysfunction" a household word and took the sting out of having a sexual dysfunction, I think people need to feel it's okay. We know so much about how to help people, whether it's sexual dysfunction or biological problems, or emotional or relationship-oriented problems. There are so many resources available that anyone wanting a more robust sex life can have it. It's never too late to have a great sex life.