Your sex life, your way

Learn how Hims can help

When to Walk Away From a Sexless Marriage

Mike Bohl, MD, MBA, MPH, MS, ALM

Reviewed by Mike Bohl, MD

Written by Erica Garza

Published 03/02/2025

Updated 02/18/2025

For Deb Castaldo, PhD, LCSW, MS, a couples therapist in New York, being in a sexless marriage isn’t just a common topic with her patients—it’s personal. She was in a sexless relationship for 16 years, and she says it nearly “destroyed” her.

At 22, she married her first boyfriend—and first sexual partner—whom she met at age 19. “I will never know the reasons why my marriage was sexless, however I can tell you the impact was devastating,” she says.

Over time, she heard about the active sex lives of her friends, who were also newlyweds in their early 20s. She became more aware that something was wrong with her own marriage, which lacked a sexual connection. But, she remained for many years.

“At age 35, I woke up to confront the dysfunction that was slowly crushing my soul, and I did divorce. The damage to my sense of self and my lovability still reverberates in me today, although, thankfully, post-divorce, I have since had a very vibrant, fulfilling sex life for many years with a long-term partner.”

Dr. Castaldo now works with patients facing the same issues of sexlessness in their relationships. We asked her why sexless marriages happen, what partners in them can do about it, and when they should consider walking away.

Dr. Castaldo says there are four possible reasons why sexless marriages occur:

  • Medical conditions

  • Mismatched libidos

  • Confusion over sexual identity

  • Unhealthy power dynamics

Health Issues

According to Dr. Castaldo, the first question someone in a sexless marriage should consider is whether there are any physical reasons for a lack of sexual activity or desire.

She urges all her patients to get medical checkups to determine if there are any underlying health issues that may be contributing to the problem. “This is important because it would be a mistake to consider this dynamic an emotional or relationship issue if there are medical issues at the core that need to be addressed,” she says.

Some medical conditions that may be associated with a lack of physical intimacy include:

Mismatched Libidos

Dr. Castaldo says that differing sex drives can cause a severe mismatch or incompatibility that can stress out the couple emotionally and cause withdrawal.

Findings of a small 2018 study suggest that for many people in long-term relationships, higher levels of emotional intimacy are associated with higher sexual desire, which increases the odds of partnered sex occurring.

But, interventions like therapy can help couples with mismatched desire levels find common ground. “Couples therapy can be very effective in unraveling the complexity of differing needs,” says Dr. Castaldo. “[It can help teach] the couple communication strategies and help them make agreements about their sexual needs and how they can make it work for both partners to feel fulfilled.”

Confusion About Sexual Identity

Dr. Castaldo says that in a sexless marriage, partners must also ask themselves if they’re living their truth regarding sexual identity and orientation. She explains that not doing so can cause a severe disconnect that surfaces as the symptom of a sexless marriage.

One such orientation is asexuality.

“One must take into consideration that there are people who are asexual, who simply have very little interest in their own sexuality or sharing in pleasure with any partner,” says Dr. Castaldo.

Unhealthy Power Dynamics

Finally, a sexless relationship may be the result of underlying emotional dysfunction, or imbalanced power dynamics between the couple.

“If there are ongoing imbalances of power and power struggles, hostility, and high conflict, withholding sex can become a very powerful weapon,” says Dr. Castaldo. “Similar to silent treatment, withholding sex can be a wounding tool used to control and punish.”

She says that if these power dynamics fester over time, it can grow into deeper emotional neglect or even abuse.

Living in a sexless marriage can damage feelings of love and cause tremendous emotional harm and resentment from which it can be difficult to recover. Dr. Castaldo says she has heard many gut-wrenching stories from patients who feel unwanted, demeaned, and impoverished of love, while living in a sexless marriage.

Nonetheless, she doesn’t think all sexless marriages are doomed. She points again to interventions of couples therapy and intimacy coaching, both of which may help revive a dwindling sex life. But, she notes, for these strategies to work, there must be a strong commitment from the couple.

“I always recommend that couples give therapy a very good try for at least three to six months before making any major decisions,” she advises.

The decision of whether to stay in a sexless marriage shouldn’t be taken lightly. And it’s important to remember that a dry spell here and there doesn’t necessarily mean the end of sexual intercourse in your marriage, either.

However, suppose you’ve exhausted your options of investigating possible underlying causes, seeking therapy, and—of course—communicating with your partner about how you feel, and you still don’t see any changes. In that case, you may want to consider whether ending the relationship would be the healthiest choice for you.

Dr. Castaldo says that although some couples are fulfilled in platonic companionship, she has seen many more partners in therapy who feel completely demoralized, exhausted, and emotionally empty from their experience of a sexless marriage.

“My guideline is when someone feels their marriage is more harmful than helpful, and their most basic human needs for passion, being desired, and healthy expression of affection and sexuality are not being met, then it may be time to walk away,” she says.

It’s unclear how many sexless marriages end in divorce because there is not enough data to know for sure. But, according to one Pew Research Center survey, 61 percent of married people said having a satisfying sexual relationship was the key to a good marriage.

If being in a sexless marriage is a deal-breaker for you, it’s essential to seek support sooner rather than later. Many married couples can bounce back if both partners are willing to talk openly about their sexual interests, maintain their emotional connection, and address issues early on.

Being in a sexless romantic relationship can be frustrating and unfulfilling, but it doesn’t necessarily mean your relationship is doomed.

Remember:

  • There are many potential causes of a sexless marriage. Medical conditions, mental health issues, incompatibility, and unhealthy power dynamics can all contribute to a sexless marriage.

  • Leaving a sexless marriage isn’t a decision to take lightly. Talk to a sex therapist or couples counselor, treat sexual dysfunctions like erectile dysfunction or hormonal imbalances, and make sure you’ve communicated your needs to your partner before you walk away.

  • Having a healthy sex life is an important part of a romantic relationship. You shouldn’t have to accept a sexless marriage if you’ve tried everything you could and still don’t see any changes. Sometimes, the best option is to walk away like Dr. Castaldo did.

Think you’re experiencing low libido or sexual dysfunction? Talk to a healthcare provider to see what options are available.

2 Sources

  1. Geiger A. (2015). Sharing chores a key to good marriage, say majority of married adults. https://www.pewresearch.org/short-reads/2016/11/30/sharing-chores-a-key-to-good-marriage-say-majority-of-married-adults/
  2. Van Lankveld JA, et al. (2018). The associations of intimacy and sexuality in daily life. https://pmc.ncbi.nlm.nih.gov/articles/PMC5987853/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, the Director of Medical Content & Authority at Hims & Hers, and a member of the Obesity Medicine Association. Prior to joining Hims & Hers, Dr. Bohl worked in digital health at Ro, focusing on patient education, and as the Director of Scientific & Medical Content at a stealth biotech PBC, working on pharmaceutical drug development. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare, and he is a Medical Expert Board Member at Eat This, Not That!.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Business Administration and Master of Science in Healthcare Leadership from Cornell University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health, and he has earned a Certificate of Advanced Education in Obesity Medicine from the Obesity Medicine Association.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopaedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

Read more

Related Articles

Put yourself in good hands

Hims connects you with doctor-trusted products so you can have your best sex ever