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."
As important as launching those conversations, of course, is engaging in them with grace and understanding.
"Have empathy toward him and teach him to have empathy toward you," Friedman tells women. "Be sensitive to the pressure he's feeling. From the time he was 4 years old he's been told to be a superhero, and now he's in a place where he needs you to help him and be sensitive to him."
Which can be harder than it sounds when bruised egos are at play.
"I do encourage date nights and scheduling times to have sex during the week," Gilbert says. "If his wife is feeling frustrated and alone and shut out, and he's feeling guilty, having sex in the schedule can take pressure off both sides (to initiate it)."
"Humans are easily conditioned," he continues. "Once you do something regularly, it can quickly build momentum and fit into your life quite naturally."
Adapting to change
Friedman encourages couples to be optimistic as they grow into a marriage in which their bodies and appetites are changing. "This can be one of the best times of your life," she says. "Men with less testosterone may not be as quick to win the race, but they have more time to breathe, they're better fathers, better friends and better companions.
"Men and women both need to get comfortable with men's vulnerability," she said. "It's the antithesis of what we've grown to believe is masculine, but the irony is women love men who are a little vulnerable, who share more intimacy. We like them better that way."
"It's a complex issue," Gilbert says. "Certainly, the marriage is central, and it's important to look closely at the relationship itself and how each person in the relationship interprets what the other person brings to the table."
And schedule those date nights. And sex nights.
"Nothing replaces the behavioral changes," he says.
Debunking gender myths
As deeply entrenched as the stereotype of the oversexed male is that of the undersexed female. Neither stands up to research.
In the newly released "Don't Put That In There! And 69 Other Sex Myths Debunked" (St. Martin's Griffin), Indiana University School of Medicine associate professors Aaron Carroll and Rachel Vreeman aim to set the record straight on sexual appetites. In the chapter "Women Don't Really Want Sex," they write:
"Much of how women's sexual desire is described and understood is shaped by what is acceptable culturally and socially. When it comes to biology, there is plenty of research to suggest that women are also hard-wired to have a strong sex drive in and of itself."
In a later chapter, "Men Want It More. Way, Way More," the authors assess a 2010 Journal of Sexual Medicine report that found 57 percent of men age 18 to 24 had not had sex in the previous year, versus 51 percent of women.
"You read that correctly," they write. "More women had sex than men."
Furthermore: "Experts suggest that anatomy alone would indicate that women might even have more hard-wiring toward promiscuity than men. The presence of the clitoris, an organ functioning only for sensation, and the ability to have multiple orgasms without a refractory period are both unique to women.
"It's a myth to think that women don't want sex," the authors conclude. "We'd be thrilled if people would just show a little more equivocation and uncertainty about who has more or less sex or sexual thoughts."