There's a passage at the beginning of Michele Weiner Davis' 2008 book, "The Sex-Starved Wife: What to Do When He's Lost Desire" (Simon and Schuster), that underscores what experts say is a larger problem than our culture lets on.
"You ask yourself, 'What's wrong with me? Aren't I attractive?'" Weiner Davis writes. "How did you manage to hook up with the one man in the world who would prefer doing just about anything other than making love to you? Why isn't he like all the other guys?"
The one man in the world. All the other guys.
It's difficult to quantify how many women are in marriages with husbands who've lost the appetite for sex, in part because it's hard for women — who are surrounded by friends, sitcoms and magazines telling them all men want sex all the time — to speak up about the "one man in the world" who doesn't.
"It's a very real problem," says psychiatrist Andrew Gilbert, medical director at the Hallowell Center, a New York-based facility that treats cognitive and emotional problems. "It's not weird or unique. It's also very treatable."
While researching her book, "Manopause: Your Guide to Surviving His Changing Life" (Hay House), co-author Lisa Friedman spoke with women who struggled to reconcile their husbands' waning desire with the impressions they had always accepted about men's sex drives.
"It's hard for anyone to admit; let's start there," Friedman says. "Women are just as uncomfortable admitting they're not having sex as men are. They think, 'What's wrong with my man?' Because, after all, the ability to perform is at the core of his masculinity."
And therein lies much of the problem.
A man's lack of desire may have nothing to do with how attractive he finds his wife. It may not even be a lack of desire. But if he's feeling anxiety in another area of his life — marital or otherwise — the pressure to perform becomes just one more source of anxiety.
"There can be resentments or frustrations about things that aren't clearly expressed or communicated, and that can be misrepresented as sexual disinterest," Gilbert says. "Sometimes he's still engaging in a lot of masturbation, where he's more in control and there's less pressure to perform. It's not necessarily that his libido is lower. It's just that he's expressing it differently."
Whether a man's withdrawal from sex is a change in libido or how he expresses it can be partly sussed out by a physician.
Task No. 1, of course, is for men to get checked for underlying health conditions that may be contributing to a shift in desire: undiagnosed depression, pituitary or thyroid issues, diabetes, cardiac problems. "Anything that affects blood vessels and blood flow," Gilbert says.
Testosterone levels naturally lessen as men age, Friedman notes, which can lead to a decrease in libido.
Testosterone peaks during adolescence and early adulthood, according to the Mayo Clinic website: "As you get older, (a man's) testosterone level gradually declines — typically about 1 percent a year after age 30."
Often, says Friedman, men who've stopped having frequent sex turn to alcohol, food or another substance. Doctors need to know that too.
"They figure it will lessen the pain or they'll have fun in another way," she says. "And it actually causes more problems."
Talking it out
Once the physical symptoms have been addressed, couples need to move on to the communication, or lack thereof, in their relationship.
"It's so important for couples to feel comfortable expressing themselves and dealing directly with the things that may be misrepresented as less interest," Gilbert says. "It could be work pressures, parenting, less time with friends, less alone time, less time with your spouse."