I think it was Tennessee Williams who said, "When the relationship is on the rocks, the rocks are usually in the bed". I use the term "marriage" in the title because of the unfortunate and incorrect belief that marriage kills romance. But this article can be applied to any long term committed relationship.

It is no surprise that most couples who come into my office because of difficulties in their relationship often have complaints about what is going on in the bedroom. Interestingly though, it's not usually something they will bring up on their own. In fact, they will talk around the subject endlessly but rarely address it head on unless I confront the topic directly.

After many years of working with couples I rarely get past the first session without asking a couple about their sex life. Typically the complaints range from one person not feeling satisfied by the frequency to neither party being particularly interested in being romantic. There are many reasons for sex to wane in a marriage. Among those reasons are the normal everyday stresses of life, financial burdens, demands of children and work, and sleep deprivation. There are also physiological factors involved in maintaining a healthy libido. For this reason, if I sense that there could be a medical cause for the lack of desire, I make a referral to a general practitioner or a gynecologist to rule out the possibility.

There are hormones involved in maintaining a healthy libido as we age. The primary ones are estrogen and testosterone and a medical doctor can determine through a simple blood test if they are a factor contributing to a low sex drive. Once a medical condition is ruled out we can begin to work from a behavioral model to improve the couple's physical intimacy. The first important step is communication and once the topic is brought out into the room it is hard to ignore -- which is one way couples deal (or don't deal) with the problem.

Unless a major injury or indiscretion has occurred between the two people, I encourage couples to get back on the horse so to speak. It is obviously easier to stay focused and be accountable when there is an outside person monitoring progress. But couples who just need to get the romance back into their marriage can do this without outside intervention. The lack of spontaneity may sound counter intuitive, but when sex is simply not happening then it is important to schedule it into your lives.

Couples should start out by writing down on a piece of paper, privately, how many times per week they would actually like to have sex and then reveal that number to each other. The compromise then begins as they negotiate a happy medium between those two numbers. Often when couples wait for sex to just happen spontaneously it somehow never gets to the top of the priority list. I hear everything from, "we were just too tired this week" to "we haven't really had the time." This is when scheduling sex becomes necessary because people tend to follow through with things on their calendar. Pick a time and day that make the most sense for both of you and as the Nike ad says, "just do it"!

There is a great deal more to say on this topic and in many cases it is much more complicated than I have just described. But in truth, in many cases it is not. Physical intimacy is a crucial part of a romantic relationship and of an individual's connection to their own physical being. This makes it something that should not be ignored in a relationship or relegated to a last priority. Sometimes it just takes a jump start, a fanning of the flames, to rekindle the romance and passion in a relationship. This connectedness can trickle into other areas of the relationship and may offer a couple just the motivation they need to help give their relationship a fresh start.