My wife and I haven’t had sex for 18 months since the traumatic birth of our second child, following which she required minor vaginal surgery. She is healed now, but doesn’t want to talk about sex. I try to be understanding and supportive, but it’s getting me down. She won’t consider counselling.

Trauma is tricky. Your wife’s most recent childbirth and the associated surgery mean she avoids anything that might lead to a repetition of such painful experiences. That means she now connects lovemaking with unpleasant consequences. You must try to help her enjoy the things she previously associated with sex, such as a romantic dinner, a sensual massage or cheeky moments in the car.

After childbirth, some women acquire negative body images and a sense of themselves as mothers rather than lovers – struggling to combine both roles. Again, you can help by giving reassurances and compliments, and by trying to do things you did when you were courting that triggered an erotic response. There are probably other factors involved, such as hormonal changes and the fatigue that accompanies the reality of caring for two young children. If she senses your frustration at the wrong time, that pressure will make her feel that sex is just another chore. I understand your concern, but don’t panic; just help.

• 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). Submissions are subject to our terms and conditions: see gu.com/letters-terms