Sex File: My husband is too stressed to make love 

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My husband has developed an anxiety disorder and seems to have completely lost his sex drive. I'm doing what I can to support him but he doesn't even want to kiss or cuddle. He is worried that any physical intimacy will lead me on. I miss the closeness. I don't know what to do.

You know that your husband's low libido is related to his anxiety, so it will hardly come as a surprise to you to learn that your sex life won't get better until his anxiety does. Almost everyone experiences a degree of stress and anxiety during the course of their life, but your husband's condition is a different order of magnitude. Severe anxiety is an umbrella term that encompasses generalised anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder (or social phobia) and obsessive-compulsive disorder (OCD). These are serious mental health issues that can have a debilitating impact on a person's capacity to function as they usually would.

Although it may seem odd that your husband has turned away from an activity that could, theoretically, help him to feel more relaxed, low libido and sexual aversion are common side effects of severe anxiety. A study at the Federal University of Rio de Janeiro found that 75% of patients with a panic disorder had a sexual disorder. Most of the participants said they feared sexual intercourse because they were worried about having a panic attack during sex.

Although I realise that your husband's condition makes your life difficult, you are going to have to be patient. The good news is that anxiety disorders can be treated with a combination of medication, such as antidepressants, and cognitive behavioural therapy. The bad news is that getting better takes a lot of time, effort and commitment, and your husband is the one who has to do the work. You can't do it for him.

What you can do is keep talking to him and supporting him. Reassure him that you understand what he is going through. Tell him that you think you should both take a break from sex for now. Although your ultimate goal is to get your sex life back on track, giving your husband permission to avoid sex will take the pressure off and that will help to reduce his anxiety. The fear of you making sexual demands is causing him to withdraw from you. If you take sex off the table, you may be able to get him to relax enough to hold hands or have a cuddle. Any form of nonsexual affection will be enormously beneficial for him because it will reduce his levels of cortisol, the stress hormone, and help him to relax.

From there you may be able to progress to sensate focus, a therapeutic technique developed by the sex research team Masters and Johnson as a way of minimising sexual performance anxiety. It is designed to put people back into physical contact with one another without specific goals related to sex. You start with short sessions, and the aim is to use your curiosity to touch your partner's body in a nonsexual and non-goal-oriented way. Focus on being affectionate and exploratory rather than directly sexual. The next stage is to remove your clothes and repeat the process. Candlelight can be useful here to reduce self-consciousness. When you are comfortable at this stage, progress slowly to the next stage, which is more sexual contact. Don't rush - and enjoy the journey together.

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