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Sexual recovery is a significant indicator of healing for someone recovering from intimacy anorexia. Resistance to sexual growth can manifest in countless excuses, often reflecting an ongoing reluctance to be giving, loving, and emotionally mature within the marriage.

Establishing a sexual agreement is a fundamental boundary in intimacy anorexia recovery. A sexual agreement is straightforward: both partners mutually decide on a consistent frequency for sexual connection (e.g., once, twice, or three times a week), with once a week being the minimum standard for maintaining sobriety. Next, they agree on a system for scheduling—such as assigning specific days, alternating weeks, or rotating days—and commit to shared initiation.

If the anorexic partner has not regularly initiated sex for an extended period, it is reasonable and often necessary for them to take full responsibility for initiating during the initial phase of recovery. For the first 60 days, the anorexic should initiate 100% of the time. This encourages emotional growth and clarity about their commitment to healing before the spouse resumes initiating sexual intimacy.