Katherine has three children under six and works full time. She is three stone heavier than when she first met her husband. ‘I feel repulsed by my own body and even though my husband insists he still fancies me, I just don’t believe him,’ she says.

So many of us are trapped in self-criticism and the isolation it engenders. Let’s face it, our culture makes sure we never meet our ideal so that we can stay hostage to the pressures and consume the myriad products and services promising us perfection. In my travels across the world I’ve seen so many women who, by Western standards, would be considered overweight. And these women moved with amazing grace, they danced, their hips swirled, and no weight could stop them. Radiance defies weight.

But Katherine doesn’t feel radiant. ‘When I go out with my husband, I feel ashamed of how I look. I do make an effort but I just can’t get beyond feeling awful about how much I weigh,’ she says.

I wonder if this is just a weight issue. Katherine has become a mother in the last few years, and I see her struggling to retrieve the woman from behind the mother. Author Dalma Heyn calls this ‘the erotic silence’ of women – the numbing of your sensuality, desires, feelings, your sense of self. Throughout history motherhood has equated with selflessness, chastity, and sacrifice. I suggest it’s not just the weight that inhibits Katherine but her shutting herself off.

So what – if she’s skinnier, then she deserves to be a sexual woman? I wonder if she allowed herself to be woman, to let her husband touch her, caress her, desire her and make love to her, if the weight may well come off by itself. Dieting is a form of deprivation for a reward that may come in the future. But what she needs now is not deprivation, but love, support, appreciation, tenderness and pleasure.

Weight, in reality, is just a number, it’s all of the feelings and judgment that Katherine is attaching to it that are actively turning herself off. She hears her husband say he fancies her and yet because of her own negative body image, she can’t properly understand that he really ’sees’ her differently.

‘It’s madness, I know,’ she says. ‘There’s so much about my life that’s great. I love my children and my husband, but I deliberately find ways to disconnect so we don’t have to have sex. I realise this is starting to corrode our relationship. My husband feels rejected. I’ve been on a diet for a year but all I seem to do is lose and then put back on the same 10 pounds and I go back into a spiral of self-loathing.’

I can give Katherine many tricks to play with the body she has, but none of them will work if her judgments are so loud, she can’t hear anything else. So, first she needs to change her mindset. Beauty is a state of mind, feeling sexual is a permission you grant yourself. What would it be like for Katherine to feel she deserves to feel good, deserves to be pleasured by herself and by her man? Men are attracted to women who feel attractive more than by their specific looks. What turns them on is to see you turned on. A big turn-off for men, in fact, is a woman who is self-critical.

If she doesn’t like looking at the ‘dimples’, she can always cover them, lower the lights, wear nice clothes, or sexy underwear. Katherine must allow herself to sexualise her body, to eroticise herself. This is beyond the repertoire of moves and techniques of sex – this is about vitality, pleasure, self-care.

Katherine also needs to understand that sexual intimacy and activity is a range. If she doesn’t feel like having a fully naked sexual encounter with intercourse then there are other forms of sexual stimulation. If she doesn’t feel like sex, then she could stimulate her husband sexually (and she doesn’t need to be naked for the most of these activities…).

One thing that I see in couples a lot is that as soon as they feel they don’t want to have intercourse for one reason or another, they completely shut down other opportunities to be sexual – or even physical – with one another, and this is when things can deteriorate. 

I suggest that Katherine could blindfold herself, so she can’t see. Or blindfold her husband? Then he can’t see. And perhaps then they can both delight in what they see inside: two loving people who share a life, a family, and bliss.

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Photograph: Esther Perel by Christopher Lane