Dear Dr. Andrea,
My husband and I have been married for 12 years and sex has always been a problem. He really cares nothing about it. I always have to initiate sex. He seems to enjoy it when we do have it, but once a month is just not getting it enough for me!

He's had a physical and he's okay, but he's not the typical male. He doesn't touch me outside of sex, and he doesn't look at me if I am naked. I'm not ugly. I'm attractive and weigh only 115 pounds. What am I doing wrong?
-- Can't Get No Satisfaction

Dear Can't Get No Satisfaction,
You are doing nothing wrong. Your libidos are mismatched. The problem, as you describe it, is that your husband has a much lower sex drive than you do. It is even possible that he lacks a sexual appetite altogether.

Although the sex drive (libido) is biologically determined, psychological issues may adversely affect it. If your husband is clinically depressed, his sexual appetite would be severely diminished, among other things.

Some of the other symptoms of depression are feelings of powerlessness, hopelessness, sadness, excessive guilt, or low self-esteem; lack of pleasure in all or almost all activities; loss of energy or fatigue; insomnia or hypersomnia; significant weight loss or weight gain; inability to think or concentrate or make decisions; and depressed mood most of the day.

If he has these symptoms, he should consult a psychologist. Ongoing therapy and treatment with anti-depressant medication may offer him some relief, as well as increase his sex drive, if it is depression-related.

I strongly recommend that dating couples assess the compatibility of their sex drives BEFORE they marry. Now you know why that is so important. If his lack of sexual interest is not depression-related, therapy can still help IF he is motivated to make changes and work in treatment toward self-improvement goals.

Have you talked with your husband about your needs for increased sexual frequency? When you discuss it, does he appreciate your desires? Would he be willing to increase his sexual frequency to keep you satisfied? If he is, get him to commit to a mutually agreeable frequency, perhaps once per week.

Come to a clear agreement together about how it will be initiated and by whom, whether it will be scheduled or spontaneous, and any other factors about which you need reassurance. When he starts to slide, remind him about his agreement to comply with the "Once-a-Week Rule."

This suggestion will NOT make him want sex more frequently, but it might help you get more satisfaction. Good luck!