Can a sexless marriage ever survive?

Many couples I see in my practice used to enjoy good sex lives - but now they rarely have sex any more.

It is difficult enough to talk about your sex life, but admitting you don't have one at all can be embarrassing. And often couples believe they are the only ones with this problem.

When I ask them when they last had sex, they can't remember and it's not unusual for them to tell me they haven't had sex for at least six months or sometimes several years.

But they did have satisfying sex lives in the past. They can remember it being so much fun in the early years of their relationship when they met, fell in love and had sex as often as possible. But the intensity of this period, called 'limerence', can be difficult to maintain. Things gradually change and they are left wondering what happened to the desire and passion they once had.

A sexless relationship is defined as having sex fewer than 10 times a year. In most relationships, sexual satisfaction is a measure of the entire relationship. If a once-satisfying sex life becomes one in which sex is infrequent or non-existent, it's more than likely that other aspects of the relationship are unsatisfactory.

When I talk to clients who are in a relationship that is lacking sex, my advice is: start fixing the issues before it is too late. When couples don't sort out these problems, sooner or later resentment will surface and intimacy and sex will go on the back-burner. Problems should be discussed, otherwise couples will grow apart, leaving both frustrated, resentful and angry.

A good sex life takes time and effort to maintain. Couples need to try making sex more playful and fun to keep their relationships exciting. Forget the popular myth that sex is spontaneous - it's not. If you want to have good sex, you have to create the time and the space to get both of you in the mood and looking forward to it. Planning a date night once a week is a good start. Being more affectionate is another.

Simply kissing, hugging, holding hands or cuddling up on the sofa is easy to do - and physical affection is so important. Couples may find that increased intimacy can result in a more passionate and connected relationship.

I believe relationships can improve if people listen to each other more instead of telling each other what's wrong. Rather than complaining about what your partner doesn't do, tell him or her exactly what they can do to turn you on. When you talk about sex, focus on the positive.