Q: What are some things my husband and I can talk about to build intimacy without having sex?

A: Here are some ideas that I find work really well: You can discuss a vacation that you'd love to go on. Ask, "Where do you see yourself in 10 years?" Even if you've been with that person for 30 years, you may not have had that conversation since you were in your 20s. You could ask: "What are five things I do that make you feel loved? What are five things that you love about me?" Don't discuss the logistics of your life; don't bring up the kids. It might be awkward at first, but you can do a kissing exercise where you say, "I'm going to kiss you the way I most love to be kissed for a few minutes, and then you can kiss me the way you most love to be kissed." You'll learn something new about each other. Once that pressure to have sex is off the table, it makes room for the sensual energy to build.

Q: I have a husband who's quite good at oral sex, but I've had some uncomfortable experiences with it in my past. How can I be less nervous when he's down there?

A: I've done national research on genital self-image in women because this is such a huge issue. If you have negative genital self-image—concerns about odor, appearance and things like that—you're 6 to 10 times less likely to be able to reach orgasm or enjoy sex. The most significant predictor for that is some jerky partner in the past, who said something ridiculous. So one reason we're uncomfortable is that we're worried it's unpleasant for him or her when they're down there.

Another problem is that women have a really hard time lying back and receiving without doing something in return. Oral sex is the ultimate receiving. You start to worry, "It's taking a long time," and then it takes even longer because you're anxious about it. The reason he's pressuring you to do it is because he wants to give you a gift; this is a way that he's trying to express his love to you. When you're lying there and starting to have those negative thoughts, I encourage you to remember that he's there because he wants to be.

Q: I definitely want sex, but I am having problems being inspired by my spouse and wanting it from him. What can I do?

A: You know what you want, but you're not open to receiving it from him. Sometimes that's an issue with the delivery—he can't or won't give you what you want—but sometimes that's about something inside yourself that's closed to him. This isn't about sex. This is about something that's larger and outside the bedroom and keeping you from being open. That's a couple's issue that takes some soul-searching, some exploring and maybe some therapy to figure out. It certainly can be repaired, but until you feel that connection, you're not going to be open to receiving.

Next: Dr. Laura Berman's advice on marriage counseling


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