The way I see it, if you’re not having sex in your marriage anymore, there’s a problem. I know, not only because of the many patients who have told me about their issues, but because I have experienced it myself. I’ll say it again: Busy or not busy, when sex is gone from an intimate relationship, it’s a problem you’re either experiencing— or it’s one in the making.

Of course, there are real and important reasons why couples stop having sex, often temporarily: after the birth of a baby, while caring for aging or sick parents, acute job stress, or a diagnosis or treatment for cancer or another condition—anything that throws you off your rhythm. And that’s totally normal and should be expected. But when it continues to just not happen, and you find yourself looking for excuses to rationalize it rather than make a change, then it’s an issue you must face or risk damaging your marriage. And barring physical or medical causes, a sexless married life signals deep issues brewing.

I see women every day in my hormone practice who aren’t having sex with their husbands and they come to me desperately seeking answers for their low libido. First I run a full panel of hormone tests, and many times I do find that they’re suffering from an imbalance that would cause low sex drive— but even once we fix that, some of them still don’t feel desire for their mates. When I dig a bit deeper, they finally admit that they feel unhappy or unsettled in their relationships. Hidden resentments, one partner feeling rejected by the other, one partner bearing a lot of financial burden, or a lack of trust can all get in the way of hitting the sheets.

If you don’t address these issues head on, you can bet that the lack of sexual intimacy they set off will quickly become self-perpetuating. Research proves that the absence of touch and arousal creates both physical and emotional distance between you and your spouse. Couples who report having little to no sex have lower levels of marital satisfaction than those who get busy regularly.

As I said, I experienced this in my own relationship a few years ago, and I’ll be honest, I wasn’t sure my marriage would last. I was stressed, and felt anything but sexy, and the less intimate we were, the less connected we felt— and on and on. Together we turned it around, but not by waiting for the mood to strike, but by making sex a priority (and also by addressing my own lagging energy issues, which I’ll tell you about another time). Today, we’re committed to keeping the spark alive. Just last week when we realized we’d both been traveling on business a lot and hadn’t had any sex in weeks, we got right to it!

There are plenty of other reasons to focus on this, rather than brush it under the rug: Because a sexless and unsatisfying marriage leaves you or your partner open to getting your needs met elsewhere; because you want to model a positive, engaged relationship for your children if you have them; and because doing so truly is its own reward. You will feel better— trust me.

Where do you start? Right here:

1. Observe your daily habits. For example, do you binge on Netflix in the evenings instead of spending some time connecting to each other? You can’t change what you don’t see, so take some time to observe what it is you’re doing, what habits are in place, and what you may be avoiding in your daily life together.
2. Engage in non-sexual, loving touch more frequently. Get physically closer to your spouse by reaching out and holding his hand when you normally wouldn’t, or smiling and locking eyes with him before you head out for work in the morning. These subtle, affectionate cues will help re-establish your connection and set the stage for more earth shattering moments later on.
3. Recall sexier times. Did you once enjoy a particular kind of kiss, back rubs or bathing together? Let your partner know what you miss about your romantic past. Then take the pressure off by telling your mate that you want to initiate some physical contact again and thought you could do fill-in-the-blank tonight.
4. Flirt. Send your wife a text about how sexy she looks today, or shoot your hubby an e-mail about how impressed you were that he got the kids fed, dressed, and out the door this morning. Flirting can take many forms!
5. Talk to a pro. When and if you’ve tried everything, it may be high time to consult a qualified third party to intercede. Find a skilled marital therapist who can help you uncover and work through your issues. It will not only help bring buried issues standing in the way of sex to the surface; it will likely help save your marriage.

Dr. Jennifer Landa is Chief Medical Officer of BodyLogicMD, the nation's largest franchise of physicians specializing in bioidentical hormone therapy. Dr. Jen spent 10 years as a traditional OB-GYN, and then became board-certified in regenerative medicine, with an emphasis on bio-identical hormones, preventative medicine and nutrition. She is the author of "The Sex Drive Solution for Women."  Learn more about her programs at