I Do….Not! Consummating the Unconsummated Marriage

Document Type

Conference Proceeding

Publication Date


Publication Title

J Sex Med


Introduction: The Unconsummated Marriage, characterized by a failure to engage in penetrative sex, is a disorder of sexual function that impacts couples across a wide variety of. When the excitement of marriage and the anticipation of sexual intimacy is met with failed attempts at consummation, frustration, shame, and feelings of inadequacy can catapult clients into a host of other sexual dysfunctions. By the time individuals present for evaluation the disorder has often been intensified by unfair social comparison, cultural and religious dogma, and external and interpersonal pressures to engage and/or procreate. The use of a multidisciplinary approach at evaluation and management and an awareness of the collateral impairment on relationships is necessary to deal with and eventually resolve this roadblock to intimacy. Objective: The purpose of this case evaluation series was to review the characteristics of those who sought help for the inability to consummate their marriage, to investigate the impact of this problem on relationships, and to highlight key factors in successful resolution. Methods: The study population consisted of individuals and couples presenting to the Sexual Health Clinic between 2017 and 2018 with an inability to consummate their marriage. The parties where seen for initial assessment, a treatment strategy was devised, and follow up continued until achievement of identified desired goal. Interviews included demographics, duration and details of marriage, ethnicity, cultural and religious teachings about sex, detailed medical history. Treatment focused on 5 factors: 1)Goal Identification, 2)Biological Education 3)Screening and referrals for management of psychological or inter-relational conflict disorders 4)Dilator Therapy with Mindfulness 5)Couples assignments for non-sexual and sexual intimacy Results: During the study period, 20 couples were seen due to an inability to consummate their marriages. The primary presentation was pain and difficulty with penetration. The motivation for presentation was identified as a desire for pregnancy in 65% of the cases. Vaginismus was the primary cause identified. The most common negative impact of a failure to consummate on the marital relationship included pressure from family members, marital strain, and infidelity. Other sexual dysfunctions occurring as a result of, or in conjunction with, a failure to consummate included low libido, erectile dysfunction, premature ejaculation, and problematic pornography use. Ninety (90%)of couples reached their primary goal of consummation within 6 months. The remainder couples were referred for marriage and family therapy due to significant martial conflict and it is unclear if consummation was achieved. Conclusions: Although failure to consummate marriage is felt to be a problem primarily impacting those with strong cultural and religious convictions, couples from a diverse array of backgrounds are affected. Couples, and the providers who treat them, should be aware that this treatable condition responds well to a Bio-Psycho-Social approach that includes accurate education, individual and collective goals for consummation, and a respect for cultural and religious standards and beliefs. An approach to therapy that includes a multilayered, multidisciplinary approach can shorten the time between acknowledgement of the problem and the desired intimate engagement that individuals and couples seek. Disclosure: Work supported by industry: no, by n/a.





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