After 20 Years, Our Sex Life Has Gone Cold 

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Dear Reverend,

My husband and I have been together for 20-plus years, and everything is great — except in the bedroom. While our pairing started out hot and heavy, over the last several years it's gone stone-cold. He deals with a constant amount of pain due to back issues. He offers to try if the circumstances are just right, but even if that happens, he says he's not in the mood. He's tried testosterone, but that didn't do anything except make his temper short. He's said no to an open marriage and even thinks online sexy chat is cheating. I'm at my wit's end and am desperate for some intimacy. What can I do?

Nada Gettinanni (female, 41)

Dear Nada Gettinanni,

It's practically impossible to be in the mood when your body hurts. The fact that you mention getting involved with another partner, virtual or otherwise, makes me wonder whether everything truly is "great" with your marriage. Sex does not equal intimacy, and maybe there's more lacking in your relationship than just the physical stuff. If you're certain that's got nothing to do with it, there are lots of options. Has he tried acupuncture or physical therapy? How about some yoga?

You can adapt your sexual positions to accommodate whatever posture makes his back feel better. He should also minimize his back movement by using his legs and hips to do the work, rather than his spine. Speaking of work, it might be best if you do most of it. So hop on top and ride him, cowgirl! (Gently, perhaps?)

Different settings could help, like the floor or a chair. He may be able to loosen up pregame by taking a hot shower or bath, getting a massage, or applying heat or ice. He should also take a pain reliever or apply a pain relief cream.

Don't forget that sex is more than just penetration. Would it be better for him to use his hands and/or mouth? Have you explored adult toys?

The best thing you can do is discuss the problem with his doctor together. I know nobody wants to talk about sex with their doctor. But there's no need to be embarrassed; they've heard everything.

Good luck and God bless,

The Reverend