I’m 31 years old and I’ve been with my girlfriend for nearly three years now, but we’ve struggled with sex over the past 12-18 months. Ever since we started dating I’ve had a higher sex drive than her and a desire to be more experimental. I feel there was the constant hollow promise that we would try new things, but it never happened and now we’re only slept together twice in the past year, and even that was unfulfilling. I’m not sure I even have any desire to have sex with her any more, despite desperately wishing I did. How can I love and be in a relationship with someone I don’t want to sleep with?

You have asked a question to which there is no satisfactory answer – unless you decide to prioritise all other aspects of your relationship over sexuality. Trying so hard to reconcile the irreconcilable is making you very sad - and no wonder; such a gulf between thoughts and feelings commonly pitches a person into depression. This problem is not going to get better by itself, so it must be addressed urgently and directly. You need to have a very focused conversation with your girlfriend, in which you must share your true feelings without apportioning blame. Help her to see how unhappy this situation is making you, and ask her to describe her own feelings, while listening empathically.

It is also essential to ask her to try to help you understand the reason for her disinterest in sex. There are many possible causes of low libido, some of which require treatment. For example, perhaps she is suffering from anxiety, stress, depression, vaginismus or hormonal imbalance. Perhaps she needs you to change your style of initiation or your love-making technique.

But it is important that you start this conversation by reassuring her about the positive feelings you have towards her. Once you have a greater understanding about her reasons for avoiding sex you will be in a better position to make a decision about your future. Will you be able to work it out? Will you seek treatment together? Will you walk away?Feeling so hopeless about a relationship is far from a good sign. Many people unconsciously fall into unhealthy repetitive patterns, and if you suspect this may be true for you, seek help to move beyond such a hindrance to happiness. You deserve to have the ability to develop and maintain a happy, healthy, satisfying relationship in which problems can be aired and resolved.

• Pamela Stephenson Connolly is a US-based 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