I should also have mentioned that I thought my idea of a same sex surrogate would in theory not complicate or compete with feeling that I have with my wife.

As a straight male I do not think I am predisposed to develop an adoration for a male that would compare to what I have with my wife.

I could be completely wrong about all of this.
Maybe there is no way to enjoy a sexual experience without developing feelings for the person that could complicate a marriage.

Maybe other people know more about the nature of sex than I do.

I think most women feel that for them the experience of sex is always about intimacy.

Maybe women need to have intense feelings of trust to allow themselves to be so vulnerable and not be self conscious about their body.

Maybe for many woman the whole nature of the act of sex with their spouse is that it brings them joy to do something that gives their husbands joy.

If that is the case then the desire will wain if she perceives that he is not worthy of it and feel he is not coming through on his part of the bargain.

Maybe most men need or at least want an affirmation that their wives feel the same physical attraction that they do. Maybe they will never get that from their spouse.

I have heard it said that women get the urge for sex if they think other women are attracted to their husband even if it is just the perception.
So when men take the initiative to be physically fit they will notice their wives take notice and have the desire back.
But if the man takes away the wrong lesson and thinks more working out equals more sex, he will squander away too much time on himself and then wonder what happened.

I am not that firm in my belief in evolution and natural selection but most of what seems to be true about human sexuality can be explained by it.
The rule of thumb is that men are aroused by visual cues.
Women take longer because they have an innate drive to consider the worthiness of a spouse.
If the drive is solely based on a mans ability to provide then they consider qualities that are genetically most likely to result in survival of the species.
Advancement in technology have out-paced the process of evolution of the species resulting in more variation in human behaviors.

Woman have to consider that the genetic material inherent in the biggest strongest male does not equate that they will be there to provide and protect during the period of gestation and nursing.
I am sorry that this developed into a lecture. You can tell that I enjoy analytical thinking.

Back to the initial problem of one physically ill spouse being unable or unwilling (for a number of complicated reasons) to have sex when the other spouse desires.
I think that this couple may be vulnerable to a lot of unfortunate and in my mind unnecessary pain and heartache.
Having not personally followed through with couples counseling, I do not know what kinds of suggestions they provide.

I have heard reports that people are having positive results from faith based programs.
It does make sense to me that there is a spiritual component.