Can a man feeling sexually inadequate go silent for months? I can't figure this out. My husband stopped talking to me four months ago—no response to my advances, no sex whatsoever. He avoids eye contact and, when sleeping, he faces the other way. He won't tell me what's wrong. He used to be fun and charismatic, but his sex drive went down after his prostate gland was removed surgically. Even still, it was all good up until four months ago. I am so confused. We are both in our forties. Please help!

As sexologists, we can only offer our opinion on the issues you’ve presented here, but are very sympathetic to your situation and are grateful that you had the courage to come forth and share your story, as this is something that affects many married couples. We believe that at age 40, you should be having sex several times a week. Personally, we have found many reasons that you should have orgasmic sex every 24-36 hours for physical health, including helping with prostate issues.

What you’ve asked actually encompasses several issues that must be addressed simultaneously. However, we believe the primary issues are:

* Communication.

* Medical issues and working as a team with your physician.

* How to reconnect sexually.

First, let’s talk about communication.

One of the amazing things about our culture is that we are surrounded and inundated with media images of sexuality, yet most of us still have a huge problem talking about sex. The question above presents, at its core, what troubles us all: something’s wrong and one or both of us don’t want to talk about it. Silence can kill a marriage, allowing whatever the "800-pound gorilla in the room" issue is to fester and grow, and it can result in a rift so deep and wide that one day it may separate you permanently. It’s uncomfortable to address it, but it’s important to remember that the discomfort is temporary and it’s time to face the fear and do it anyway.

There are a possible host of reasons behind his silence. After prostate surgery, many men may worry about:

* Sexual inadequacy.

* Continued medical issues, including a foreboding concern over mortality.

* Rejection from their partner if they can’t perform the way they used to.

Overcoming his resistance to talking about what is behind his withdrawal is vital to discovering what the true problem is and how to overcome it.

We know that is easier said than done. A plan of action is required to get everyone on the same page and to open up your lines of communication. The first thing you need to do as the concerned, shut out spouse is to express how you feel while remaining kind and compassionate. This conversation needs to take place in a completely non-sexual situation, like over a cup of coffee or a glass of wine.

Communicate to your spouse that you are concerned about the fact you haven’t been sexual since the surgery. Have you told him that you miss being physical, including non-sexual physical affection like hugging and massage? Tell him now. Explain to him that you are also concerned about his health, and that you have noticed the changes in behavior that you mentioned in your question (not initiating sex, turning away from you, etc.) and that you are worried these behaviors may be symptoms of larger health concerns.

To determine whether his lack of sexual interest and willingness is related to a medical issue, you have to talk about it. That may take a little pressure off of him if his silence reflects a fear of inadequacy, not a medical concern. Explain to him that being sexual is a very important part of your marriage and that you are willing to do whatever it takes to revitalize the passion you share. Let him know you would like to set up an appointment to go to his prostate doctor together to talk about the progress and resume sexual activity.

Once you become comfortable talking about sexuality together, the next step is sharing your concerns with the doctor. (In part two, we will discuss what type of questions you should ask and what general items you, as a couple, should target when you see your doctor).

After prostate surgery, it's not uncommon for men to have concerns over their ability to perform as they had before. This is natural and can be the root cause of a tailspin of depression because they feel their masculinity has been compromised. There are many ways to get around this in most cases, and "getting back in the saddle" is one of the best ways to do it!

In the meantime, try to reconnect in small physical ways, like holding hands, kissing and massage if he is willing. It will make you feel closer to each other, and give him a safer space to feel physical again.

We also have a piece of advice for you: while he is uninterested in being sexual, you owe it to yourself to make sure your sexual needs are met, so take yourself on a date! Masturbation is a wonderful stress reliever and it will give you all the wonderful sex hormones we need to stay healthy and sane. Masturbation would be a great idea for him too, but he may not be ready to try it yet. (That’s a suggestion the doctor might make.)

Keep in mind, too, that many men post surgery need more direct genital stimulation to become aroused. They also may need more time to get in the mood, so fantasy can play a great role in dialing up the temperature in your bedroom. Our third installment on this topic will be about the things you can do sexually to revitalize your relationship. As we age, sex changes and what worked to turn us on 10 or 20 years ago may not work so well now, especially after surgery for men and during or after menopause for women.

In the meantime, spend an afternoon together and reconnect. We’ll be back shortly with your next step.

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Part 2: Reconnecting Sexually After Prostate Surgery

Dr. Joni Frater & Esther Lastique are the founders of www.SexEdBootcamp.com and the authors of "Love Her Right: The Married Man’s Guide to Lesbian Secrets for Great Sex!"