One foundational step in recovery is creating a sexual agreement, which serves as a critical boundary. A sexual agreement is straightforward: you and your spouse mutually decide on a consistent frequency for sex—such as once, twice, or three times a week. Sobriety, in this context, would be defined as engaging in sex no less than once per week.

Next, determine a system for scheduling: whether it’s splitting the week, rotating specific days, or alternating weeks. Equally important is establishing mutual initiation, so both partners share responsibility for connection.

It’s vital that there are clear and serious consequences if the intimacy anorexic fails to initiate or says no without a valid medical reason. For a deeper understanding of how to implement a sexual agreement, refer to Chapter 11 in Intimacy: A 100 Day Guide to Lasting Relationships.