Beneath that question there are often several others. Am I asking too much? Is this just what happens in long-term relationships? Should companionship be enough? Am I selfish for wanting more? And if everything else is reasonably good is a lack of intimacy really a reason to leave?

There is no simple answer. But perhaps the first thing to say is that intimacy matters - and it means much more than sex.

What do we mean by intimacy?

When we hear the word intimacy we immediately think of physical or sexual connection. But intimacy is also simply the experience of being known.

It is that conversation when you feel your partner is genuinely interested in what is happening inside you. The hand that reaches for yours. The private joke. The random message in the middle of the day. The feeling that someone notices when you are struggling without you having to spell it out. It is being able to say ‘this is what I am frightened of’, or ‘this is what I need’ and trusting that the other person will stay emotionally present.

Sex can be part of that of course. For many couples it is a very important part. But I often meet people who are not simply grieving the absence of sex. They are grieving the absence of being reached for. And that can feel profoundly lonely.

Lonely in the same room

There is a particular kind of loneliness that can exist inside a relationship. From the outside everything may look perfectly intact. You share a home. You go on holiday. You attend family occasions together. You may be raising children, paying a mortgage, walking the dog and deciding what to have for supper. You are functioning perfectly well as a team.

But somewhere along the way you stopped being lovers, confidants or perhaps even close friends. This can happen so gradually that it is difficult to identify when things changed. Work becomes demanding. Children arrive. Bodies change. Menopause, illness, depression, anxiety, medication, exhaustion and grief can all affect desire and connection. Resentments accumulate. A rejection here and a withdrawal there gradually become a pattern.

Eventually one person stops reaching for the other because being rejected hurts too much. The other may experience that withdrawal as relief from pressure. And a painful, silent stalemate develops. Neither person necessarily intended to create it.

But everything else is good

This is where people can become particularly conflicted. Your partner may be kind, loyal, funny, dependable and a wonderful parent. You may have built a whole life together. There may be enormous amounts worth preserving. So it can feel almost shameful to admit ‘I still feel lonely’. We can be very quick to invalidate our own emotional needs when there is nothing obviously ‘wrong’ with a relationship. But relationships do not have to be terrible for something important to be missing.

Equally the absence of intimacy does not automatically mean a relationship is doomed. Some couples are genuinely comfortable with relatively little physical intimacy. The important question is whether both of you are comfortable with it. Difficulty only arises when one person is quietly starving while the other believes everything is fine or is looking the other way.

The conversation beneath the conversation

Couples can become stuck arguing about frequency. ‘We never have sex.’ ‘We had sex last month.’ ‘You never initiate.’ ‘Whenever you touch me I feel as though it has to lead somewhere.’ Very quickly the conversation becomes about evidence, numbers and who is responsible. But underneath are usually much more vulnerable feelings.

‘I miss you.’ ‘I don't feel wanted.’ ‘I'm frightened you don't desire me any more.’ ‘I'm frightened that if I touch you you'll expect something I can't give.’ ‘I feel rejected.’ ‘I feel pressured.’ ‘I don't know how we got here.’

These are very different conversations. In couples therapy it is enormously important to slow things down enough to discover what the absence of intimacy has come to mean to each partner. Because sex is rarely just sex. And not having sex is rarely just not having sex.

Can intimacy come back?

Often yes. But usually not through simply deciding to ‘have more sex’. For some couples physical intimacy needs to be rebuilt from much further back: affection without expectation, curiosity about one another, emotional safety, playfulness, time together and the experience of being a couple rather than simply two people running a household.

Sometimes resentment needs attention first. Sometimes there has been betrayal or repeated rejection. Sometimes one partner has felt criticised for so long that vulnerability no longer feels safe. And sometimes desire has become buried beneath exhaustion, parenthood, stress or years of feeling emotionally disconnected. Rebuilding intimacy can therefore mean beginning very gently.

Not ‘how often should we be having sex?’ But perhaps ‘When did we stop reaching for one another?’ ‘What happened between us?’ ‘What do you miss?’ ‘When do you feel closest to me?’ ‘What makes closeness feel difficult?’

And perhaps the most vulnerable question of all ‘Do we both want to find our way back?

So can I survive without intimacy?

Of course we can survive many things. But perhaps survival is not quite the question. The more useful question might be ‘What do I need in order to feel alive, connected and loved within my relationship?’

There is no universal amount of sex, affection or emotional closeness that makes a relationship ‘healthy’. Different people need different things. But if you are repeatedly telling yourself that something shouldn't matter when deep down it does it may be worth listening to that voice.

Wanting intimacy does not make you demanding. Equally struggling with intimacy does not make someone cold or uncaring. What matters is whether the absence can be spoken about - honestly, compassionately and without blame. Because sometimes the most important sign of hope is not that two people are already close. It is that they are both still willing to turn towards each other and ask:

‘How did we lose this - and can we find it again?’ And that’s where therapy may help.