"I recently got back from a one week 25th anniversary celebration cruise - all very romantic and lovely. Spent loads of time with wife, lots of attention, lavished her with expensive gifts etc. "
This just makes my skin crawl. Sex is something that should be shared between to equal partners for the entirety of a marriage (or at least as long as all the gear works). The thought that I am going to have to buy a bunch of crap for my wife, make her dinner, take her on a cruise, blah, blah, blah, to get her to want to have sex with me REALLY PISSES ME OFF. She should want to be with you and meet your needs because you are you and your needs are important. If she can't see that....kick her to the curb where her narccisitic a$$ belongs. If this has been going on for a while, and you have expressed your needs in a healthy and loving way, and you have tried therapy, medicine and every other avenue you can try then just give up and either adjust or get out. If you have kids you should probably just accept that you are in it for the long haul. Accept that your wife is much more concerned with her needs than she is yours, stay together, but find yourself a girlfriend who actually does care for your needs, and have sex...lots of it (just don't stay overnight). Just make sure that your girlfriend understands the situation and that there is no possibility of it going anywhere. Just tell the wife that you ARE going to have a healthy and fulfilling sex life, you hope she will be part of it, but, if not, you will do her a favor and remove the sexual pressure by finding someone else. No healthy person should be forced to turn off their sex drive...it is part of who you are.
Meatpuppet = I used this moniker because that is pretty much my role in my marriage right now. Just a big old bag of meat walking around while my wife thinks she is pulling the strings.