I am in my mid-40s and have been married for 16 years. Our sexual life has been very underwhelming. I have tried everything I know but my wife seems to have little or no interest in sex. I do know that she was circumcised as a child. Could that have affected her sexuality?

A person’s sexuality is created through a complex combination of physical, psychological and physiological factors as well as the messages about sex they received from childhood onwards – religious beliefs, parental warnings, societal judgment and formative experiences. You have told me little, but the fact that she was circumcised suggests that she may have been raised in a society where the notion of female sexuality was not exactly appreciated. In many of the world’s societies – including our own – it is judged by some as inappropriate, and even feared, suppressed, or punished.

I cannot even try to guess your wife’s experience, or the motives of those who performed it, but I am sure it has had some effect on her conceptualisation of sex and her ability to experience pleasure. This would be particularly true if her clitoris was removed. Gently ask her if she could try to express what the circumcision was like for her, and how it might have affected her ability to enjoy sex. A gynaecologist could shed some light on how nerve loss or damage might have affected her ability to orgasm or even become aroused, and a psychosexual counsellor could suggest alternative sexual approaches. After 16 years, your wife and you deserve some understanding and hope.

• Pamela Stephenson Connolly is a US-based psychotherapist specialising in sexual disorders.

• If you would like advice from Pamela Stephenson Connolly on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com (please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online and in print. She regrets that she cannot enter into personal correspondence.