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A reader writes:

I’m 65 and my wife is 55. I love her, but I don’t feel loved by her. We have no sexual relationship. The last time we made love was about five years ago, and we haven’t had regular sex for more than a decade.

I realize she means I shouldn’t take her lack of interest in sex personally, but it hurts a lot.

My wife says she has no sex drive because of a total hysterectomy years ago and that even if Regé-Jean Page walked through the door, she wouldn’t want to have sex. I told her that Regé-Jean Page is unlikely to walk through her door, but I do walk through her door, frequently. I realize she means I shouldn’t take her lack of interest in sex personally, but it hurts a lot. I acknowledge that hormones and such are important, but our most important sex organs are our brains and our hearts. I have asked her many times to go with me to marital therapy, and she refuses and won’t give a reason.

A medical problem resulted in erectile dysfunction for me. We tried intercourse once or twice after that, and I felt like I was pushing a rope. I tried Viagra, which worked well, but she hated it and said it was painful. She saw a gynecologist about three years ago and had some kind of treatment for whatever caused pain during sex. We tried to have sex once then, but it didn’t go well.

I said I would enjoy just touching intimately and “making out” without penetration. She said that would make her want to have intercourse, which would be painful, and she didn’t want to get frustrated, so no. She tells me she hates her body. She says she doesn’t like it when I touch her intimately or playfully because she doesn’t like herself. She will often flinch, even recoil, when I touch her.

She gets anxious and angry when I try to discuss our sexual problems. I do my best to be gentle and sweet, but she’s not willing to talk about it. She often says she loves me, and she treats me well. She just shows no interest in sexual or physical intimacy, and when I take the initiative, she does not respond.

I would give anything for a healthy, loving, playful sex life together, where we can openly and freely discuss our concerns and joys. I don’t know what to do.

–  Wishing for Intimacy

Joan responds:

I am so sorry that you and your wife haven’t been able to agree on any kind of physical intimacy that both of you find pleasurable. Your email was filled with even more details of medical and family stresses that would be eased by the comfort of intimacy. You and your wife have endured great challenges, and I admire you for calmly trying over and over to find some resolution.

Your suggested solutions—marital counseling, sexual pleasure without penetration, candid discussions—are excellent and exactly what I would propose. Your wife is not open to any of them. I can’t know why. I only know that she told you no, no, and no. I think you must accept her “no.”

There are many ways to engage in fully satisfying, orgasm-filled sex other than intercourse. See “A Senior’s Guide to Sex Without Intercourse” and my webinar, “Great Sex Without Penetration.” I’m sorry that your wife rejected “making out” and intimate touching, because this would be a loving way to bring sensual pleasure into your relationship.

I’m struck by this: “She had some kind of treatment for whatever caused pain during sex.” Do you not know the cause and treatment because she wouldn’t discuss it, or you don’t remember?

You and our readers should know that sexual pain can have a variety of causes, and the treatment depends on the kind of pain and its cause. I wonder if she did not get a diagnosis, or if she did but didn’t want to discuss it with you. It would be worth asking her exactly what the gynecologist told her. It might not change anything, but you’d understand more.

The fact remains that your wife decided years ago that she doesn’t want to be sexual with you anymore. Some of her reasons are medical, others are psychological. If she hates her body, dislikes herself, and recoils when you touch her, the problem is bigger than not having a sex drive. If she had written to me, I’d advise her to seek out individual counseling for her own feelings of lack of self-worth as well as her issues with you. She may be giving you all she feels she has right now, and that is not likely to change without professional help.

If she won’t budge, you have to decide what you need. Do you want to ask her for a “hall pass” to seek a physical connection elsewhere? What resolution would comfort and satisfy you? It would be helpful to see a sex-positive therapist to help you figure that out for yourself and open the discussion of where to go from here. I’m sorry I don’t have a magic solution.

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Joan Price has been Senior Planet’s “Sex at Our Age” columnist since 2014. She is the author of four self-help books about senior sex, including her award winners: “Naked at Our Age: Talking Out Loud about Senior Sex” and “Sex after Grief: Navigating Your Sexuality after Losing Your Beloved.” Visit Joan’s website and blog for senior sex news, views, tips, and sex toy reviews from a senior perspective. Subscribe to Joan’s free, monthly newsletter.