I've heard of this being a concern in other marriages. What comes across, as in desire for better appearance, boils down to, wanting the other to take a serious interest in their physical health and well being.

Your mentioning of ACOA and childhood sexual abuse, do you also find yourself, walking on eggshells?

The dry spell, can go both ways, in interpretation. The physical description of her health, can be masking talk of other issues underlying within the relationship and this being a tangible one?

I could be wrong, but I'll lend you the benefit of the doubt, in what you are trying to reach out for in a support community.

Are you both in counseling?