I’m 38 and have been married for nine years. We are no longer having sex, for at least the past 12 to 18 months – not even the slightest touch.

He has always refused to even mention our sex life and made it clear I was not to come on to him; we could only have sex when and where he initiated it.

I had breast cancer in 2016 and although I am fully recovered he has no interest at all. This is not how I want to live; in a sexless marriage that’s draining the love it once had. I didn’t fight cancer for this.

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You have a right to ask for what you need, and you have a right to be able to fully discuss your frustration and despair – and to ask for change. The answer might be “no”, but at least you will have expressed your feelings and learned more about him; then you will be in a better position to make an informed decision about the future. Given your husband’s rigidity, I would imagine he might respond best to a very detailed request – such as asking for the exact frequency of sex you would like (once a week?) and requesting information about precisely what you might do to help put him in the mood. But the power imbalance in your sex life – he makes all the decisions, controls time, place and style – may reflect your overall relationship, and that is also a matter of concern. You feel powerless, which makes you miserable and resentful, and that’s simply not fair. I understand that sex is very important to you. Please recognise that your feelings and needs are valid and important. If you cannot break this impasse, seek help. Do also be aware that men can impose rigid rules regarding sex because they have a sexual disorder, such as an erectile challenge. If this is true for him, it would be very important for you to know this and help him to receive treatment. Once he feels more confident about his ability to achieve and maintain an erection, he may be more amenable to your initiating greater sexual frequency.

• Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders.

-The Guardian