My wife has let herself go

If I didn't run your update last week, I will.

There will be more updates around Christmas. And feel free to keep sending them.

Dear Meredith,

I have been married to my wife now for some time; we dated even longer before that. We joyfully have a family together and are saving up for a home. We are lucky to have all the comfortable trappings of a content All-American lifestyle. That being said, there’s no way around the point that our relationship has become much less romantic and physical as time has gone by.

My wife is in the beginning of a demanding fellowship, before that she was in a grueling medical residency and before that she was a student. Needless to say, it has been a very long ride for us.
I feel lucky for all that I have, including a good career for myself and a wonderful set of children. But at the physical level, the demands on her have taken a major toll on our intimacy, and what's most difficult is that attraction has become an issue. When we were first together, she took very good care of herself; she dressed very well, had an extensive and impressive beauty regimen that included regular trips to the salon and led a healthy lifestyle of regular exercise and proper diet (right along with me).

Now I certainly realize that as time goes by people mature and change. I know that I don't have many of the hairs on my head left and that I can't keep the physique I had as a younger man. But my wife has truly done a 180, going from a very high maintenance, well groomed and well-coiffed dazzler to a low maintenance, clog-wearing slave of the hospital. Even for special occasions or holidays she seems underdressed. She hasn't worn makeup or elegant nightwear in ages and hasn't had her hair colored, cut or styled equally as long.

I don't want to be a shallow man, but I am afraid that is exactly how I will come out as if I discuss it. But I can’t get past the abandonment of her efforts to maintain her feminine appeals -- up to and including ... hairy legs. I don't know what to do and worry about the repercussions of addressing the matter. I don't feel like I should have to pine over pictures of her from 6 years ago even though the "light at the end of the tunnel" for her is so close (a few years away).

– Needing More From My Wife in Massachusetts

It's all in the delivery, NMFMWIM. There are some incredibly romantic sentiments in your letter. You love your wife. You fantasize about her (as opposed to other women). Let her know that what you want more than anything else is her.

Tell her that you miss feeling like she's excited to have a date with you and that you dream about the days when you used to go out of your way to impress each other. Maybe buy her a spiffy outfit and a pair of earrings to match. Tell her you want her to put it on … and then eventually take it off. (Cue sexy music). Treat her to a day of beauty -- because it's worth the cost. Continue to tell her how much you love her and miss the romance. Frame this as a gift, not a criticism.

She's no dummy. She knows that she's wearing clogs. She knows that you guys are less intimate than you used to be.

If she won't work with you and is simply miserable about the idea of wearing something that you bought for her, tell her you're worried about her -- because you should be. If she can't focus on her marriage -- or feeling good about herself -- she might be depressed or overwhelmed, in general. She might need to talk to a professional.

Go shopping. Set a night for a date. Work on a speech that is honest but loving. Remember, you don't want anybody else. You want your wife. Make that clear.

Readers? How do you tell a partner that you want them to step it up? What's going on here? Should he wait a few years before bringing this up? Should he be more straightforward and just tell her he's fed up with her letting herself go? Medical students, want to weigh in? Help.

– Meredith