Q: I find that my sex drive is decreased and my husband often does not understand that it is due mostly to fatigue and medication side effects.  Please help explain that it is not a lack of interest or attraction to him.

A: To your husband let me say that there are many factors which may play a role in your wife’s decreased sex drive including lupus, fatigue, medication, pain or depression.  Under any of these circumstances, her lack of sexual interest has nothing to do with her attraction to you.  Having said that, it is important that the two of you begin to explore the source of the decrease in desire.  Solutions will very depending upon whether the problem stems from fatigue, medication, depression or pain.  For example, if the problem stems from fatigue, rest and energy conservation may be useful.  If medication side effects seem to be the problem, medication adjustments may be possible (under your physician’s guidance).  If depression is the culprit, treatment for depression may be the solution.  If the problem is due to pain, new, gentle and creative techniques may need to be learned.  Exploring these issues honestly and directly will help you to identify where to focus your attention.  The two of you need to communicate openly by sharing your needs and feelings honestly and listening attentively so that you can begin to explore different methods of satisfying one another sensually and sexually.  Discuss the history of your sexual relationship and explore the nature of the change.  Open communication and mutual respect will go along way toward re-creating something new that will work for both of you.  If you need help, consider talking with your physician or another professional