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Are you not getting any? If you aren't having sexual relations on a regular basis, you are not alone. Couples actually have less time for sex than they did in the era of Lucy and Ricky and Ozzie and Harriet.

The need for both partners to work and the ever increasing demands of preparing children for success leave married couples with less time for intimacy than the 1950's. Experts estimate that up to 40 million couples in the United States alone have an essentially sexless marriage, engaging in sexual relations less than ten times a year.

A dry spell of a few weeks can become a dry spell of a few decades if the reasons couples don't have sex aren't addressed, but sometimes the problem isn't fundamentally romantic. It can be as simple as replacing a lumpy mattress. Here are the top ten reasons heterosexual couples don't have sex, which give you the top ten tips for keeping your sex life alive.

1. You're insanely busy

Or at least it seems that way. Despite the fact that the aforementioned Lucy Ricardo and Harriet Nelson didn't have Cusinarts, microwaves, or even frozen food, they had plenty of time for sex. (Well, we think they did. In the 1950's, television decency standards required couples to be depicted as sleeping in twin beds.) In the twenty-first century, everybody is constantly connected, our iPhones, iPads, email, and cell phones demanding constant attention.

Sex Rx: Turn your communication devices off once a week. Email your spouse it's time for an evening of romance, and then shut out the electronic world, at least for an hour or two, to get reconnected.

2. You're raring to go, but your partner's engine is stalled

If you have found the time to keep up your appearance, and hygiene, chances are it's not you, it's them. The underlying issue could be anything from childhood teaching about sexual relationships that crops up after a parent dies or becomes disabled, to a feeling that the two of you have done it all and there are no new sexual frontiers to conquer.

Sex Rx: Talk it out. Don't assume you know what your partner is thinking and feeling, but give them the space--especially if you are both stressed out in general--to think out and articulate their feelings in their own time. Don't wait forever, but allow the discussion to evolve over at least days or weeks. Don't assume your partner is cheating on you just because interest in sex has waned.

3. You've started taking medication

Or, if you are a woman, you've been taking the Pill for a very long time. Men's sex drives are affected by medications for high blood pressure and cholesterol. Women's sex drives are affected by these medications, as well as the contraceptive Pill. This particularly likely to be the case when the Pill is a brand that is high in estrogen.

Sex Rx: Be frank about your concerns with your doctor, especially if one of you became disinterested in sex shortly after beginning a new medication. If the problem is the Pill, you may want to consider condoms, an IUD, or the rhythm method. Just be sure you understand the method you choose.

4. Your mattress is lumpy

Sex isn't fun if you keep getting stabbed by a mattress spring. An old mattress can be a major impediment to your love life.

Sex Rx: Rotate your mattress at least once a year. Replace your mattress every seven years or more often.

5. Perimenopause or andropause

In the forties, many women experience perimenopause. Vaginal dryness can make sex extremely unappealing. About the same time, many men experience andropause. They really can be more interested in watching TV than in sex.

Sex Rx. The symptoms of perimenopause respond both to estrogen replacement therapy and to dietary changes--but men who are experiencing andropause may not respond well to the phytoestrogens their wives need in the diet. Lubricants may also help. Men can boost their testosterone levels just by losing a few pounds--fat cells make estrogen, and, in men, too much estrogen saps sex drive.

6. You don't like the way you look

This is usually more of a problem for women than for men (who are usually willing to have sex even if they don't think they look good). Women often have a way of feeling self-conscious about the features men find most attractive.

Sex Rx: Don't be afraid to ask what your man finds attractive about you. And don't underestimate the value of losing a few pounds, even 1 or 2 pounds, for your self-esteem and your hormonal balance. Losing weight sometimes balance hormones in ways that make you feel good about yourself again.

7. Women: You like your vibrator better

Some women prefer self-stimulation. But a vibrator can't reach all of a woman's erogenous zones.

Sex Rx: Consider using the vibrator together. Or, even better, learn how to have orgasms that aren't limited to the genitals. Both men and women can have orgasms, sometimes far more intense orgasms, throughout the whole body, not just in the sex organs.

8. You're sick. You're tired

Almost any hormonal imbalance, including hypothyroidism, and almost any condition involving chronic pain, including arthritis and fibromyalgia, can deflate one partner's sex drive.

Sex Rx: The traditional wedding vows included the promise "in sickness and in health." When your partner is sick, find ways of pleasuring each other that don't require penis-vagina contact, including ways of pleasuring each other that don't involve the genitals at all.

9. Viagra, Cialis, and Levitra

Ten years ago pills for erectile dysfunction were for the Medicare crowd. Now men as young as 25 are using them. While the new formulations make it possible for men to perform sexually whenever their partners are in the mood, the problem can be that the man is in the mood all the time.

Sex Rx: Before you get turned off to sex altogether, have a frank discussion about how many times a week, or day, sexual relations are really romantic.

10. You're never alone

The kids are partying. The boss is calling. Your bff, the one you're not married to, has a life issue requiring your attention at 1 a.m.

Sex Rx: Take a vacation from everyone and everything else in your life. As couples have more and more responsibilities, it can be a very long time before they find time for each other, but it's always important to invest the time in your relationship now, rather than later. You don't know what the future holds.

  • Nes RB, Røysamb E, Harris JR, Czajkowski N, Tambs K. Mates and marriage matter: genetic and environmental influences on subjective wellbeing across marital status. Twin Res Hum Genet. 2010 Aug,13(4):312-21.