I am 37 years old this year. My husband is 45. We have been married for 11 years.

My husband is impotent. He does not want to be intimate with me. He refuses to seek a second opinion from a doctor and I do not know the cause of his problem. In the earlier years of our marriage, his sexual performance was not very good, but I did not notice it until recently. We also do not have any children.

My mother and a few close friends have told me to stick with my husband and be patient. But I feel lost and depressed.

-Linda (name has been changed to protect writer's identity)

Dr Fong Yoke Fai, Assistant Professor, National University of Singapore and consultant at the National University Hospital replies:

I feel there are two issues here that needs attention. The medical issue is that of impotence, and is probably easier to address. There are many causes of impotence and therefore without further information we are unable to be more specific.

Broadly speaking, it depends on whether the impotence happened recently or if it began some time back. If it happened recently, then factors like stress, medical conditions such as hypertension, diabetes, renal, liver disease etc. need to be considered. Even age, accompanied by decreasing testosterone levels can affect sexual performance. If the problem started right from the beginning, meaning there is no consummation of marriage, then besides the above named factors, others such as psychological factors will come into play.

The other issue is a 'social' one and the couple will have to decide for themselves what they really want. It is impossible to help any couple if either one of them refuses to seek help. The couple should have a heart to heart talk to decide expectations of each other. If there is no frank communication, then dissatisfaction escalates and this can lead to a breakdown in the marriage.

In both instances, counselling may not be a bad idea, as it tends to open the communication between a couple. This can be in terms of marriage counselling or sex counselling.

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