Among young couples, unconsummated marriages are commonly seen scenarios at infertility clinics. The clinical prevalence of unconsummated marriage is about 10 per cent of all sexual concerns. The term unconsummated marriage indicates that ‘sexual intercourse between a married man and woman has not taken place’.
Appropriate diagnosis of the causes for each couple’s unconsummated marriages is essential for the right intervention to be introduced. The causes may include psychological barriers influenced by conservative societal and cultural mindsets. There may also be misconceptions about sexuality, a strict upbringing, experiences of sexual abuse or trauma, gender issues, or a lack of knowledge about sexual matters. Sexologists can provide sex counselling and behavioural therapy. If needed, sex therapists may direct the couple to medical doctors to obtain a clinical diagnosis to treat specific medical conditions, if any.
Therapists in the field of sexual health generally involve in alleviating sexual difficulties of individuals and couples through appropriate sex counselling and assigning practical behavioral therapy as “homework” to overcome conditions such as performance anxiety, partner conflicts and unresolved sexual concerns and dysfunctions. In men, for example erectile dysfunction (ED) can be due to psychogenic causes (anxiety, depression, stress, misconception about sexuality etc.) or physical causes such as hypercholesterolemia, hypertension, diabetes, smoking, alcoholism, spinal cord injury, hormonal and ageing or secondary to certain prescription drugs. ED is by far, the most commonly encountered problem contributing to unconsummated marriages. Next most common problem in man is premature ejaculation. Other problems contributing to unconsummation could be related to low testosterone causing lack of interest for sexual intimacy. In women, conditions like vaginismus (involuntary tightening of vagina) and dyspareunia (painful intercourse) can prevent penetration. It can also cause psychogenic ED in the partner.
Let me take a typical scenario of a couple who have not consummated their marriage. This couple is in the average age range of 28 to 35 and have had 2 to 3 years of courtship with dating but have not ventured beyond just holding hands or an occasional hug; they are likely to be prudish with a mind set about ‘sex is supposed to be after marriage only’. In such cases, both partners are also likely to be sexually naïve and apprehensive of premarital sexual encounters. There will also be predisposing socio-cultural factors like lack of common sexual knowledge, misconceptions, strict up-bringing, strong religious or spiritual interests, trauma/sexual abuse, gender issues and so on. They may have been “too busy with studies and career and might not have had sexual thoughts during youth”. For men, he may not have masturbated at all; the woman would not have touched her private parts and wouldn’t have a clue how the area is. All the above factors are likely to be essentially psychological, being dictated by societal, cultural, environmental or religious issues OR the background to the lack of interest / libido could simply be hormonal. Appropriate diagnosis of the causes for the difficulties is essential for the right interventions.
This couple is likely to be a 100% failure on their first night attempt after marriage. After several frustrating failures, they may even postpone such thoughts and may have an understanding that lack of sexual intimacy is not going to affect their love and feeling for each other. However, some couples may refrain from physical contacts altogether. Outwardly and for others they are indeed very affectionate and loving couple. They will come to the fertility clinic only after a heavy pressure from in-laws, relatives or friends regarding conception. After several months or years, frustration and displeasure will set in, together with misunderstanding which can lead to withdrawal of commitments to each other. With further drift in interpersonal relationship and cordiality, these changes in their marriage can even lead to a separation if the couple is not seeking appropriate professional support and help in time.
Sex therapists with expert knowledge in the area of evidence-based sexual medicine and years of experience can help patients in myriad of sexual health issues including unconsummated marriages to overcome their concerns.
This article was written by Professor P Ganesan Adaikan. He currently is one of the Clinical Sexologist / Sexual Medicine & Health Consultant at Sincere Health Care Group. Learn more about him here.
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