Dear Dr. G,

I am in my late 40s and has been more focused on the spiritual side of my life.

My wife and I have been married for nearly 20 years and we have a very fulfilling life.

We have two wonderful children, who are both doing so well.

Both my wife and I also have great careers and that gets us set for many years.

The fact is my wife and I have not had sex for at least two years, since she had the hysterectomy for a large fibroid.

Although she has recovered fully from the operation, my wife has not been interested in sex.

I also confess, my libido has also diminished over the years.

Don’t get me wrong, I really do not have any issues with erection or ejaculation.

My wife and I just think in our younger days, we had a very active sex life.

Now, we are more contented with embracing our spiritual side of life.

I sometimes think about my abstinence and am worried about the risk of a sexless life. Therefore, I would like to put Dr. G on the spot for some clarification.

Is sexless marriage common? How do couples manage with sexless relationship?

Will couples drift apart without sex?

I also read somewhere the risk of not ejaculating can be significant, some even describe association with infection and cancer of the prostate. Is that true?

I really hope you can sum up all the pros and cons of abstinence and active sex.

Yours truly,
Sexless Samuel

The frequency of sexual intercourse amongst couples is clearly multi-factorial. Physiologically, hormones such as testosterone and estrogen determine individuals’ sexual desire. As the levels of sex hormones diminish with age, this will in turn diminish the interests in intimacy, more obvious in menopausal women than aging men. Men who suffer from metabolic syndrome such as dyslipidemia, hypertension and diabetes may also encounter late onset hypogonadism and erectile dysfunction making regular sex impossible.

Apart from physical health, relationship and emotional dynamics between couples are also crucial when engaging in regular intimacy. This is clearly related to other issues such as work-life balance and the placement of sex amongst other priorities of life. In the modern urban lifestyle, it is not uncommon for couples to accept a sexless marriage due to busy lifestyle and different work schedule. Work and childcare can lead to stress and chronic fatigue. Lastly, cultural upbringing and spiritual influence in sexual relationship are also important factors in the frequency of sexual intercourse.

In the medical view point, the definition of a non-sexual marriage is broadened to sexual intimacy that is fewer than 10 times per year. A marital union, which a little or no sexual activities between the spouses is well documented in the western literatures. According to the United States National Health and Social Life Survey in 1994, complete sexless marriage is reported to be around 2%. The survey also identified around 20% of the married respondents had sex less than 10 times a year. This statistic is consistent with the Times report identifying 15-20% of American couples confessing to having sexless relationships. A more recent study from the National Institute of Health with 17,744 participants revealed 15.2% of men and 26.7% of women reported having no sex in the last 12 months, while 8.7% men and 17.5% women reported having no sex for five years or more.

Closer to home, several countries including Japan, Singapore and Hong Kong reported couples placing sexual relationship lower down in their life’s priorities. One study from Hong Kong conducted an anonymous population-based telephone survey on 2846 married couples between the ages of 25 and 59 years old. The study revealed around 5% of respondents, aged between 25 and 44, admitted to sexless marriages. The prevalence increases to 17% for couples between the ages of 45 and 59 years old.

The benefit of sex is well documented for both men and women; these include lowering of blood pressure and stress. The additional benefits of frequent ejaculations in men are also well reported to reduce the risk of prostate cancer and prostatitis. On the contrary, the health risks associated with sexless life is not as well studied. Although some experts in Taiwan have reported long-term lack of ejaculation in men can lead to adversity such as chronic prostatitis and cancer, however these reports are based on small anecdotal observations.

The benefits of abstinence is well documented in the medical literature. The risk of pregnancy and contracting sexually transmitted infection is clearly minimal without sex. In addition, the effort and risk of contraception such as oral contraceptive pills, hormonal IUD and used of condoms are minimised.

For some couples, a sexless relationship allows space to get to know one another better sans sexual intercourse.

This can help couples to further understand the differences between physical and emotional attractions. Of course, a sexless life may potentially free up more time to focus on career, religion, family and friendship.

Amongst Asian couples, sexual taboo and conservative upbringing bring negative perception of harmful impact of frequent sex. When such mentality persists into a marriage or relationship, sex may only serve the purpose of procreation. The fact is celibacy is a voluntary vow of sexual abstinence. As long as the decision is voluntary and willingly acceptable by both parties, then there is more to gain than lost in the relationship.

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