So it wasn't always like this. So can you pinpoint when he started to detach? Did something happen.
Rightly or wrongly when a man behaves like this it is invariably due to deep resentment. They may have tried to bring up what the issue is and you either wouldn't/couldn't respond, or didn't understand it. I know through experience and it is tough work to crack that shield they have put up. Badgering them to talk does not help, it only creates further distance. They know the distance hurts you, so will keep it up. Sex will not lead to closeness or become very mechanical. Breaking through takes time. Assuming you even want to. Can I ask what the health issue is, because it may explain some of your physical difficulties.
Here's what I would I do:
Keep in mind the rule for all relationships you can only be ultimately responsible and YOUR actions and those actions are not dependent on the other person or their reaction. Remembering this is the first stage to getting your power back.
So you put yourself first. You stop allowing him to set the tone. Stop being a puppet on his string. So when he says something nasty, REFUSE (at the very least) to let him see you upset about it. Do not respond in kind. It's tough but you fake it till you make it. You respond in kindness. If you were happy before you came home, you stay happy. Do not discuss anything negative with him. Do not let him see you appear hurt. Act as if you hadn't actually noticed that he's being a cold bastard. Do not let him bring you down.
Carry on within the house as if it were actually yours. Screw that he makes you feel it's not yours. You only get one life. Today may be your last. Make it look like whatever you want. If you're married you'll get some of the value anyway.
Immerse yourself in activities that make you happy, go out with colleagues amd friends. Get a new wardrobe. I find following body positive accounts helpful if you're feeling insecure about your body (and who is ever 100% satisfied) I lost a relative to a nasty illness and I no longer reserve nice clothes for special occasions.
Take control. Go gym FOR YOU. Or walks. Or swimming. Whatever floats your boat. Take up a new activity!
Cook nice meals for yourself and kids and if he's being mean grit your teeth and still leave him some
Men respond to happy women. It's the biggest irony when they do everything to make you miserable but trust me, through experience this works 100% although it may take time. The trick is to create an invisible safe happy haven around yourself, BUT you must not bring him into it. It must be only for you. Don't share things that can really leave you vulnerable. Keep sex off the table, take your hot self outside with your friends.
You will then eventually win the upper hand. Then YOU can choose to leave the bastard (I mean you can leave him now, but tis satisfying to leave whilst your self esteem is high, you're prepared and he's on a loss) or work it out. It's your choice by then.