For a decade my wife has been suffering from poly-viral arthritis. She is exhausted and her sexual interest has dwindled. Now she uses orgasms to get to sleep rather than enjoyment. I don't know what arouses her any more. I feel neglected, unfulfilled and tired myself as I end up doing things alone we'd normally share. I've been told, when we argue about the issue, that I can look for a lover, which seems utterly wrong. I'm no longer sure what works for me sexually as I've been dependent on fantasy too long. The condition is taking over more of my wife's life and while we get on very well, I can't help but feel neglected and ill-used (which I know is irrational and unfair).

It's very hard when illness or disability means that a lover becomes a carer. You are both mourning the loss of your sexual relationship and the loss of her health. Depression and despair are common, and typically undermine sexuality. You need more support. Perhaps take more breaks or get extra household assistance – to help you feel less resentful. Your sexual response will improve when you are not giving so much. If she wishes, try timing love-making to when her pain level is lowest, and consult her doctor regarding using moist heat pads and strategically placed cushions. If the suggestion of outside sex is a true, loving offer, I have seen such an arrangement benefit both partners.

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