Alexis on the Sexes: Turned off

Q: My wife and I have been together for 15 years. Over the last six years my wife has been dealing with menopause, and our intimate life has dwindled to next to nothing. She now wears a number of layers to bed (including a hooded sweatshirt with the hood up), which makes it difficult to initiate intimacy. Intimacy had always been initiated by me, and now I am finding it very difficult to even consider trying. Her sexual appetite has waned to next to nonexistent. We have been through couples and intimacy counseling with no changes. Can you help find new ideas?

A: Having zero experience in either a) being married for 15 years, or 2) going through menopause, I figured the best way to handle your question would be to ask a trusted source. Who better to trust than a loving mother? I wasn't too eager to ask my mom about menopause and marriage, as it would inevitably lead to the squicky subject of her sex life with my dad. No thanks. So I asked my friend's mom, Patricia Aletky, a licensed psychologist with a specialty in sexual health. Her primary concern is that you are effectively communicating what you're feeling.

"First of all, it sounds like they need to talk, and get specific about what is going on," says Aletky. "Since they have done some couple therapy, I would hope that they have learned some good communication skills, with good ground rules; e.g., 'I' statements, don't make assumptions, active listening." These are terms you probably heard during counseling, but it doesn't hurt to run your thoughts through these filters before sharing them with your wife.

Another thing is to be aware of the number that menopause is doing on her body. We all know about hot flashes, but migraines, back pain, vaginal discomfort and dryness, breast tenderness, incontinence, itchy skin, irritability, insomnia, depression and anxiety are all commonly associated with this time of transition. Perhaps the most common complaint during menopause is fatigue, a symptom of the physical and emotional stress of those other discomforts. "Women do want sex while in menopause and after," says Aletky. "Sometimes plain old fatigue is the problem, so perhaps her outfit [the hoodie in bed] is saying, 'Leave me alone.'"

There are ways to help ease symptoms that you and your wife should discuss. Dietary changes should be made to spotlight nutrients like calcium and vitamin E, which stimulates the body's natural production of estrogen and cools hot flashes. The herb dong quai is widely used to treat female hormone-related problems, and for centuries women in India and South America have consumed aloe vera juice to alleviate menopausal symptoms. Hormone replacement therapy is an option that she should discuss with her doctor.

"The starting point should be not in bed, but during day, for you to say, 'I would like to get our sex life going again, can we talk about this?'" Aletky says. I wholeheartedly agree. Approaching your wife outside the bedroom feels like less of an attack. Show tenderness so she doesn't feel like it's just about your sexual needs. Don't get angry; she doesn't have control over what's happening to her body, so that will just prompt her to put up a wall.

If this all sounds like a broken record after going through counseling, and you feel like you've exhausted all efforts and nothing has changed, it might be time for reality. Unless you can fathom it, tell your wife you don't plan on staying in a sexless marriage for the rest of your days. Sadly, if her spark for you is gone, there may be no point in trying to salvage what is lost.

• Alexis McKinnis is taking your questions about sex, dating and relationships. Send them to advice@vita.mn or submit anonymously at www.vita.mn/alexis. Don't leave out the juicy details!