My husband and I have been together for more than 10 years. I’m a very sexual person, but he never comes on to me. He swears it is not me, it’s him, although I don’t know what the problem is. (I wonder whether it is related to him having always been obese; he is now on medication for high blood pressure.) He is the only man I have ever had an orgasm with, but it is just not fun enough any more. Nothing has been the same sexually since we got married. He is very sensitive about everything I say about sex, because I am more experienced. What can I do? Your husband’s medication may have sexual side-effects, so please make sure this is discussed with his GP. People who are experiencing, say, lowered desire or erectile difficulties will often become sexually avoidant without understanding why; their partners can mistakenly think the attraction has been lost. Having a full physical examination would be a good plan, since loss of libido and other sexual difficulties can be linked to myriad medical conditions, such as diabetes. Your husband may respond best to you urging him to have a medical checkup that includes a re-evaluation of his medications; many men who wouldn’t agree to seeing a sex therapist, or even a couples counsellor, find a medical checkup more palatable. 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.