A sexless marriage is conventionally defined as a marriage in which partners have sex fewer than 10 times per year. By this definition, research suggests approximately 15-20% of married couples in the United States are in sexless marriages. The actual number is likely higher, given how reliably people underreport sexual concerns.
This is not a niche problem. It is one of the most common presenting concerns in couples therapy, and one of the most treatable when the underlying causes are correctly identified.
Common Causes (and Why Misidentifying Them Matters)
The most important thing to understand about sexless marriages is that they are rarely caused by a single factor. More commonly, multiple causes interact, and treating only one while ignoring others produces incomplete results. The main categories:
Medical and Hormonal Factors
Hormonal changes (testosterone decline in men, estrogen shifts in perimenopause and menopause, thyroid dysfunction), chronic pain conditions, medication side effects (particularly SSRIs, antihypertensives, and hormonal contraceptives), and sexual pain disorders (dyspareunia, vaginismus) all affect sexual function and desire. These are medical issues requiring medical evaluation, not simply relational problems.
Psychological Factors
Depression, anxiety, body image concerns, unresolved trauma (including sexual trauma), and performance anxiety all significantly suppress sexual desire and function. These require psychological intervention, not just relational effort.
Relational Factors
Unresolved conflict, emotional distance, loss of attraction, mismatched desire levels, and communication patterns that prevent honest conversations about sex are relational issues that cannot be fixed by medical or individual psychological intervention alone.
Behavioral Entrenchment
Once the pattern of not having sex is established, avoidance becomes self-reinforcing. The longer the pattern continues, the more emotionally charged any attempt at reconnection becomes, increasing the likelihood that attempts will be awkward, pressure-filled, or unsuccessful, thereby further reinforcing avoidance.
The Effects of Long-Term Sexual Deprivation in Marriage
Research on sexless marriages documents a consistent set of secondary effects when the pattern persists:
- Decreased relationship satisfaction for both partners, even those who report low sexual desire
- Increased rates of depression and anxiety, with the non-initiating partner often experiencing the most significant mental health impact.
- Elevated relationship instability in sexless marriages has meaningfully higher divorce rates.
- Sense of rejection and unattractiveness for the higher-desire partner.
- Internalized shame and inadequacy for the lower-desire partner.
It is important to note that these effects are not inevitable. Couples who have explicit agreements about non-sexual relationships (due to medical conditions, asexuality, or mutual agreement) often report high relationship satisfaction. The negative effects are most pronounced when the sexlessness is unwanted by one or both partners.
What Actually Works
A 2021 review in the Archives of Sexual Behavior identified several approaches with the strongest evidence base for improving sexual frequency and satisfaction in long-term relationships:
- Sex therapy (particularly sensate focus, which removes performance pressure and rebuilds embodied connection)
- Couples therapy addressing the relational dynamics underlying avoidance
- Medical evaluation and treatment for contributing hormonal or physiological factors
- Mindfulness-based sex therapy for improving sexual awareness and reducing anxiety
- Psychoeducation about responsive desire, which changes how partners approach initiation and context
What does not work: waiting for desire to return on its own, attempting to increase frequency through pressure or guilt, and addressing physical intimacy without addressing emotional intimacy first.
How Relatio Can Help
Relatio offers dedicated programs for couples navigating sexless relationships, including guided exercises based on sensate focus, intimacy-rebuilding tools, and psychoeducation on desire dynamics. The program can be started by one partner or both, and is designed to create progress without pressure.
