Kinda similar here. For me back in my raging hormones days sex and eventually climax was not too difficult. Climaxing did become more and more difficult over the years. ( TMI WARNING ) My best technique when I knew she was reaching the point of after this long we are rapidly approaching painful, was to allow myself to get into my fantasy of being the woman. In next to no time I climaxed. My wife, knowing of my GD used that to her advantage. Her on top was far better for her for various reasons as well as far easier for me to allow myself to sink into my fantasy. Plus other advantages for us both having two hands free

Due to a long distance marriage lasting 6 years plus her growing physical limitations before and still today we have not been intimate in a long time. Also add in a good dose of me having turned myself into a monster over years of Not handling being trans. A lot has changed in the past 8 years. For a few months now I've gotten the occassional "I really miss sex" remark though she is still mostly physically unable to. Plus me having a ton of anxieties now about it between being an old fart, having a unique ability to turn off any desire for sex, and many years of HRT.
Just last night the subject sort of came up again. I suspect in large part due to some positive events in restoring her health. This time I again opened up about how much I miss the intimacy we've had, the closeness, the touching and total sensuality. Even more so now that I am actually almost comfortable being in my own skin. Her response "Paper or plastic?"

Well actually real or rubber.
Over this past year of us under the same roof again and not just every other weekend for 1 1/2 days she is really seeing how much I have grown and changed for the better. The effort I expended between my TG group, HRT, and finally a for real gender therapist plus a lot of reading and working on myself is showing. She wasn't too thrilled at all when I dropped the T-Bomb 6 years ago. I cannot tell you how many times I heard "I did not marry a woman", etc.. Yeah, she still gets a bit freaked out at times seeing not just my big hips but also a pair of boobs on me. But not near as much as one minute seeing Joanne, followed by this almost bald headed guy.
It's all part of a long slow growing process, for us both. I have even less of a clear vision of my future now then 2 years ago. For now, my wife is getting more and more at ease around the real me. Once we get out of this toxic neighborhood, I'll have more freedom to be me which she is OK with the idea of. I practice we'll see, when or even if it happens.
Plenty of open honest painful and fear filled talks are sure to come, just as they have been around for a few years now. Keeping a relationship going through this takes work and compromise by both parties. Otherwise there is no relationship