Eh, I inferred and implied that it's probably related to everyone being fat.   Snyder says many of his patients are men struggling with being sexually attracted to their spouses.  The author mentions the Madonna thing as a potential cause, but I think he's overlooking the obvious: fat people aren't sexually attractive, and many married people (or even people in committed relationships) let themselves get fat.  Feel free to call in the mods if you think this is too diluted. Happy to be corrected if I've done something wrong. Edit: here's some data on married people getting fatter faster than they would otherwise: NYT Article