Pillow Talk

"Is it that he can't or doesn't want to?" asks Scharff. "He may not know."

In the Chicago study, women reported more problems with sex than men, with almost half having experienced lack of desire. For some, that may have been for physical reasons such as pain during intercourse. They may be quite happy simply spending a quiet evening together watching a movie.

"I don't have a lot of these women saying, 'I want my husband to take Viagra,' " Washington social worker Gwen Pearl says.

Emotional reasons, particularly if tied to their relationship with their partner, can also diminish the quality of sex for women. Sex, Scharff says, is a true psychosomatic function for both sexes; if a woman is angry at her partner, that will show up in bed.

On the other hand, if she is happy with him, she may enjoy sex as much as, or more than, she would if she were receiving hormonal treatments, according to therapist Ogden.

"When you're having an amazing heart-to-heart connection, your oxytocin levels jump, your dopamine starts to pump, making you able to be sexual and enjoy being sexual," Ogden says.

This can hold true even if a partner is ill. Helen and Ronald, a Midwestern couple who asked that their last names not be used, learned how important conversation is when Helen developed breast cancer and had to have a breast removed.

"I just would not allow her to think herself into an asexual mode," Ronald recalls. "I knew that was not her nature. If I wasn't vigilant, she would say things like, 'Oh, my God, I am disfigured.' It was my job to say, 'What, you've noticed something I haven't?' "

For a while, says Helen, she had little desire for sex. "That was hard," she says. "I have a highly sexual nature." But Ronald had a soothing touch, a coaxing tone of voice and unlimited patience. "Those things really helped," Helen says.

Ronald says they also paid close attention to when certain techniques weren't working, "like the movie director who sees something he doesn't like and yells, 'Cut!' And then calls the cast together to talk."

Ah, yes, back to talking. Therapists say discussing sex is best pursued when both partners are relaxed -- not in bed, or after they've just come home from work or taken out the garbage or finally gotten a fussy child to sleep. Sex merits caution because talking about it can raise anxiety levels that inhibit the very thing partners are hoping to achieve.

"You have to find a neutral time," Pearl says. "In essence, make an appointment. Say something like, 'I've been thinking about our sexual relationship and I'd like to talk about it. Would you be willing, and when is a good time?' "