I am a 50-year-old woman who has been married for 20 years. My husband and I have not had sex for seven years now. I have gained about 70 pounds, and my husband told me that I was too fat for him to have sex with me. However, he gets on the Internet and looks at porno. What do you suggest I do? I do not want to go without sex for the rest of my life, and I do not want to look outside the marriage.

There could be several different things going on here, but I am going to offer you one possible scenario. At a certain age, a man loses his ability to have a psychogenic erection, which is an erection that happens without any physical stimulation. In other words, all a teen male has to do is think of something sexy or see an erotic visual image to become erect. As he ages, a man loses that ability, but it is a gradual process and your husband might be at the stage where he needs more and more visual stimulation to have an erection. Seeing your familiar naked body, no matter what you looked like, became insufficient to cause him to have an erection. It was not your fault but rather his aging body that caused this, and it happens to every man. But if he did not know that, he blamed it on your excess weight.

Now, at some point in time, the only thing that is going to get him erect is physical stimulation, something that you can give him. So your job is to let him know what is happening and tell him that if he wants you to help him down the line, he had better start giving you some sexual satisfaction now. Do not make it an ultimatum. Do it sweetly, but make sure he understands what the future holds for him. If your relationship is still in good shape, this lesson will sink in. If you feel you need some help with this, then make an appointment with a sex therapist to get some professional assistance.