My husband and I are in our 30s and have been together for nine years, with no children. I had severe anxiety and depression a couple of years ago, which I continue to struggle with. As a result I’ve always struggled with sex. I’ve never felt that sexual and although I love my husband very much – he’s a very kind, caring and patient man – I know sex is important to him. I enjoy intimacy such as kissing and cuddling, but we haven’t had sex for more than seven months and the last time we tried I had a panic attack. We’ve been communicating with each other about how to get through this and what could be the issue, but have no idea how to proceed. At the ages of 33 and 34 we are facing the prospect (I believe) of a sexless marriage. I know deep down this is torture for him and I would rather let him go than have him face the rest of his life in a sexless relationship. Anxiety and depression can significantly lower one’s sexual desire, and some of the medications used to treat them can negatively affect various aspects of one’s sexual response. It is vital that you speak about your sexual challenges to whoever is treating your mood disorder. Do not underestimate the seriousness of having a panic attack during attempted sex. You deserve to have the treatments that will help you become psychologically and sexually healthy, so advocate strongly for your own healing. Many people find it difficult to discuss sex with their doctors and think they have no right to enquire about the possibility of sexual side effects from their prescribed medications. Don’t be one of them. Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders. If you would like advice from Pamela on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com (please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online. She regrets that she cannot enter into personal correspondence. Submissions are subject to our terms and conditions. Comments on this piece are premoderated to ensure discussion remains on topics raised by the writer. Please be aware there may be a short delay in comments appearing on the site.