Throwaway account because my husband's family knows my main.

My husband (40M) and I (38F) have been married for 5 years and have been together for almost 10 years. While our marriage has had our ups and downs (including one time I suspected he was cheating, but I never got proof), it is overall a happy marriage. Our sex life was amazing early on, but recently it has me feeling really unsatisfied and I feel extremely guilty about it.

He works a grueling job (he is a surgeon), frequently working 24 hour shifts and he is tired when he gets home. I am understanding of it as I remember what the days of residency were like. I work from home and take care of things that he can't do like house work, bills, etc.

I am generally been a high libido person, but he has been too. Even during residency we would have sex multiple times a week, sometimes multiple times a day. But recently over the past couple of years he has been more and more distant sexually and it is worrying me. Nowadays we only have sex once a month if that. When we do have sex it's because I initiate it. I have asked him what's going on and if it's anything I am doing but he denies it and he denies being depressed or anything like that.

The other day we had sex but afterwards I broke down crying because I felt like he wasn't into it. I was doing all the work: giving head, on top, etc. I also feel guilty using my vibrator next to him so I just do it in another room.

We've had multiple discussions about this but they usually go nowhere and it makes me feel so overbearing and needy. But it is how I feel and I need to express it to him.

We tried planning sex but it only happens 1/3 of the time. Out of ideas now, what should I do?