Struggling with Sex in Marriage? Here’s What To Do First.

I can’t tell you the number of times a spouse has contacted me to explain a challenge they’re going through with sex in their marriage and asked for insight on what to do. I don’t feel worthy of how vulnerable and trusting people have been with their stories to me over the years. And I feel the burden of wanting to give them true wisdom that results in hope, breakthroughs, and deep intimacy with their beloved.

But as often as I’m able to answer readers’ questions, I also end up referring and deferring to others with one particular recommendation occurring over and over. What is that slice of advice?

See a Healthcare Provider.​

It might be the spouse who writes me or the their mate who needs to see a healthcare provider, but this step is an important one. All too often, there’s a physiological component to sexual difficulties.

Any of the following can diminish or block sexual intimacy:

• Sexual pain or discomfort
• Low testosterone
• Hormonal imbalance
• Heart disease
• Stress
• Poor diet
• Diabetes
• Chronic Illness
• Depression or Anxiety

And there are treatment options to address all of them.

Treating the physiological issue might resolve the sexual difficulties in your marriage, or that aspect might be one of several issues. But even if it’s not the core or primary issue, it’s worth addressing those impediments to sexual interest, pleasure, and satisfaction. From a healthier place, you can then take on other challenges with greater energy and focus.

Make It a Habit.​

When’s the last time you had a physical? Ideally, you should have regular visits with your primary care provider to screen for issues and discuss any concerns you have. What constitutes “regular visits”?

• If you’re in your 20s or 30s and healthy, get a physical at least every 3 years.
• If you’re in your 40s and healthy, get a physical every other year.
• If you’re over 50, get a physical every year.
• If you have a preexisting condition or need another issue tracked (e.g., contraception), see your doctor every six months.

Also, be sure to get screened for common problems. Unfortunately, I could tell you a few stories of folks who did not do this and ended up with symptomatic disease that couldn’t be treated nearly as well as if it had been caught early. What are those screenings?

Screening For	Type	Age Range	Frequency
Hepatitis C	blood test	18+	One time
Sexually Transmitted Infections & HIV	blood test	18+	as regularly as needed
Cervical Cancer	PAP Smear	21+	ages 21–30: every 3 years ages 30–65: every 5 years
Lipid Panel (cholesterol)	blood test	20+	regularly with physical
Diabetes	finger prick blood test	20+	regularly with physical
Breast Cancer	mammogram	40+	every 1–2 years
Colon Cancer	colonoscopy	45+	every 10 years, if normal
Prostate Cancer	physical exam / blood test	50+	regularly with physical and as determined by PCP given your risk
Lung Cancer	chest CT scan	50+	only if you smoked about a pack a day for more than 20 years; if yes, then once a year
Osteoporosis	Bone density scan	65+

Resources: Triffin, Molly. “How Often You Should Get a Physical Exam, According to Doctors | Livestrong.” LIVESTRONG.COM, April 18, 2022. https://www.livestrong.com/article/13763777-how-often-to-get-physical-exam/; “Preventative Health Screenings, by Age.” UCLA Health. Accessed November 12, 2024. https://www.uclahealth.org/sites/default/files/documents/NewPatientGuide-PrevHealth_FINAL_091721.pdf.

Mental Health Too.​

My current primary care provider does a depression/anxiety screening every time I visit. But not every healthcare provider assesses mental health. And mental health often has a physiological component.

Depression, anxiety, and other mental health disorders typically involve your brain’s chemistry, and thus affect your sexual desire and experience. If your PCP doesn’t conduct regular screenings, ask for one and/or check out an online assessment, such as the PHQ-9 or SCAARED.

Be especially aware that past or current trauma can impact sexual interest. If you’ve had adverse childhood experiences (ACEs) or adult trauma, seek help.

Your First Step Isn’t the Last.​

For some couples, discovering the physiological obstacles to regular and better sex is the key to sexual intimacy in marriage. But for many, it’s the first step. You may discover a physiological cause, but other factors influence your emotional and sexual health. And some may rule out physiological causes—meaning it’s time to consider other issues.

Regardless, seeing a healthcare provider likely isn’t the last step. Even if that’s the issue, you’ll be encouraged to follow up with treatment. Others need to seek additional reasons why sex isn’t happening as well as it should be in their marriage. That could be a long or a short trip, depending on your situation, but it’s worth embarking on the journey.

Many couples have sought help—medical or otherwise—and built beautiful intimacy in their marriage that both spouses desire, enjoy, and feel grateful to have.

Take that first step TODAY.

Beloved, I pray that all may go well with you and that you may be in good health, as it goes well with your soul.

3 John 1:2 (ESV)

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