WEDNESDAY, Feb. 22, 2023 (HealthDay News) -- A lot can happen in a marriage to end the sexual part of the relationship.

Maybe a sexless marriage is OK, if both partners agree on the diminished role of physical and emotional intimacy.

But if there’s a difference of opinion about having a sexless marriage or a lack of communication about sex, that can be a problem.

“What I see most often is a desire discrepancy of one partner that's interested in having sex every night and then you have one partner that would be interested in having sex once a month,” said Laura Heck, an Oregon-based certified sex and couples therapist. “And when there's that big of a discrepancy and they don't find agreement, it's really challenging.”

What is a sexless marriage?

Heck said she would describe a sexless marriage as one in which a couple is not having intercourse or is having very infrequent sexual activity, including other types of physical touch.

Common reasons can begin with having children, Chris Kraft, director of clinical services at the Sex and Gender Clinic at Johns Hopkins Medicine in Baltimore, said about marital intimacy.

“It’s natural for a couple’s sex life to decline after having a baby because of the exhaustion and lack of private time,” Kraft said. “But many couples’ sex lives don’t recover after they get out of the baby zone. Priorities shift to raising kids and juggling careers and household responsibilities.”

It may also happen as relationships age and sex becomes routine, Kraft added.

A sexless marriage may come to be when one partner criticizes or disappoints the other around sexuality, sex therapist Aline Zoldbrod, who advocates for sexual intimacy in a marriage, said in a story on the American Psychological Association website.

The person who is hurt retreats rather than communicating, Zoldbrod said.

About 10% of women experience a decrease in sex drive at some point, according to Johns Hopkins Medicine.

Major life changes such as pregnancy or menopause may also contribute to lack of interest in sex, according to the Mayo Clinic. Medications for mood disorders, illness or surgery can also affect sex drive or interest.

Lack of connection, unresolved conflicts, poor communication about sexual needs and trust issues are some additional reasons.

Intimacy can involve a lot more than sex, Heck said, citing another expert’s definition that includes sexual, physical, spiritual, intellectual and emotional types of intimacy.

What is the role of sex in a marriage?

It varies depending on the couple, Heck said. It’s very important for each partner to be very clear on what that role is for them.

“For some people it can be a way to connect. For other people, it's a way to play with their partner and express joy and it's intimacy,” Heck said. “It's really different for everybody. So, I think the most important piece is being able to talk about it with each other, about what the role is or what your expectations are.”

For most, it’s something shared between the two of them and not with others in their lives. The role of it in a relationship may also evolve over time, Heck said.

Partners can agree that they’re not interested in having intercourse, but instead can be intimate by holding hands, snuggling, kissing, hugging and sharing emotional intimacy, Heck said. What’s important is the agreement, she said.

A study published recently in the Journals of Gerontology found that, in older adults, being sexually active, having sex more frequently, feeling OK with sexual frequency and reporting better sexual quality were all related to better mental health outcomes.

How to talk about sex with your partner

The experts offer some tips:

• Approach your partner gently in a space where they can actually hear you and aren’t distracted, Heck said. Taking a walk would be a good approach.
• “Do not address sexual concerns before or after any sort of a sexual encounter. And don't do it in the bedroom,” Heck said.
• Talk about your needs, but without blaming. Be specific about whether it’s the frequency or type of sex you’re struggling with and what changes you’re hoping will happen.
• Make time and effort. Kraft suggests scheduling a date night; doing things that make you feel sexy; or engaging in “outercourse,” types of touching that aren’t intercourse.

Seek outside support

Most couples wait an average of six years from the point of noticing a problem to seeking outside help, Heck said.

“That’s not helpful, because by that point often there's a lot of deeply ingrained pattern and hurt and resentment,” Heck said.

Heck suggests finding a therapist who specializes in sex online through the American Association of Sexuality Educators, Counselors and Therapists.

Seeing a certified therapist “helps to create a safe space where they're leading the conversation, they're asking the questions that oftentimes partners are too timid to ask,” Heck said.