I'm not certain how he can say he's self aware and interested in getting help, but acting toward the contrary and in such a blatantly disrespectful way toward you. I think it was good you confronted him and his embarrassment/defiance was understandable because he was caught, but I don't know how beneficial establishing a fake personality to flirt with him was. Me personally, I think this would have killed me. I would never have been able to carry it on as far as you did. Having medical issues and previous history with another woman is one thing, but your desires are valid and this man doesn't seem to be on the same page as you nor does he want to be. I don't know the reason he decided to change his lifestyle when he originally said he wouldn't but if I'm honest, if there's no real interest in resolving your personal interaction, I don't believe he wants to continue the marriage but does not want to move on maybe due to personal comfort. It's wrong for you to have to put up with that disrespect. You are worth more than this. I don't know if confrontations or ultimatums are your thing, but if I were you, I would consider your personal feelings and do what's in your heart. You don't have to stoop to his level and cheat. You're better than that. I leave your decision to you and send hugs.