Same as It Ever Was explores the elements of a relationship and marriage, including love and sexual desire. Although Julia and Mark consistently express love for one another throughout their relationship, their connection sometimes wanes. In these moments, sexual intimacy and physical affection often confirm and reinvigorate their love. However, Julia strays from their relationship with Nathaniel when she feels sexually disconnected from her husband.

The novel’s opening chapters establish the fluctuations in Julia and Mark’s physical intimacy over time and its relationship to the strength of their marriage. In the main timeline, when they’re middle-aged, on Mark’s birthday, he puts his “hand at the nape of her neck, kneading gently” (15). That evening, they engage in light bondage and have sex, falling asleep curled together. This establishes that in midlife their love for one another is strong despite their disagreements and arguments.

This dynamic contrasts with Julia and Mark’s lack of sexual intimacy and subsequent lack of communication 20 years earlier when Ben was a young child. Julia was bored, thinking to herself, “How dull their life had become […] Remember our honeymoon in Greece, she did not say. Remember when we had sex standing up in an alley in Corfu […] remember when we had sex in the bathroom of Frank’s Nursery & Crafts […]” (19).