My wife has a diminishing sex drive and now continually making excuses as to why it is not a good time to be intimate. I am 69 and she is 61. She had breast cancer six years ago and this precludes her taking medication that may help. Do you have any advice – other than my taking on a discreet lover?

Breast cancer can sometimes lead to depression – which needs to be treated. It may also change a woman’s relationship with her own body to a more negative one; if this has occurred, you should help support her in coming to terms with her altered body, and in developing a more positive body image. If she truly feels attractive and desirable, she will be more desirous.

Would you be willing to change your established style of approach and lovemaking? Very often, women who have faced physical challenges and may also be suffering from a diminished level of hormones need an entirely different style of intimacy.

Let her know you want to understand what she truly needs now. Talk with her and show her that you are open to providing soothing and relaxing strokes or massages without placing any demands on her. Allow her to be in control for a while and encourage her to ask very specifically for what she needs. She may have a penchant for a non-demanding style of sex, and orgasm may not be that easy to achieve. Encourage the use of lubricants and always check that she is not putting up with pain caused by dryness – especially during intercourse.

• Pamela Stephenson Connolly is a psychotherapist who specialises in treating 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).