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UNCONSUMMATED MARRIAGESRupin Shah
Consultant Andrologist and Microsurgeon, Bhatia GeneralHospital, Mumbai 400 007.
INTRODUCTION
One of the pleasures that a newly married couples most looks forward to is a happy and mutually satisfying sexual life. Failure to achieve this satisfaction, and worse, being unable to have intercourse at all, can have a shattering effect on the marriage, resulting in marked stress, frustration hostility, and even divorce.
In our traditional society, most of the couples entering into an arranged marriage are virgins with no sexual experience and little sexual knowledge. As a result, inability to consummate the marriage is quite common (many sexologists report that every third patient they see has this problem!). Unfortunately, due to the secrecy surrounding this subject, the matter is rarely discussed and doctors and laypersons alike remain ignorant of the prevalence, causes and cures. The problem persists as a hidden epidemic leading to broken marriages and ruined lives. The sad irony is that most of these problems can be treated very effectively and the sorrow and suffering that the two young lives undergo can be avoided. The purpose of this brief overview is to sensitize doctors to this problem so that they may be prompt in recognizing it and in providing appropriate guidance and therapy.
Aetiology
- Ignorance : many young couples, despite being well educated, are surprisingly ignorant about sexual matters. False expectations or incorrect technique can lead to failure and start off a negative cycle of performance anxiety and further failures.
- Fear of pain : many women approach their first sexual encounter with a preconditioned notion that sex is very painful. As a result, they experience severe vaginismus, and intercourse becomes impossible.
- Performance anxiety : similarly, many men are prey to numerous myths and misconceptions (masturbation guilt, "dhat syndrome", etc.) as a result of which they fear that they are sexually inadequate and will be unable to have intercourse. Thus, their first sexual encounter with their wife is accompanied by severe performance anxiety, which leads to erectile failure.
- Personality disorders : some men and women have severe personality disorders characterized by phobias, deep rooted fears, depression and impaired social skills which affect not only their sexual response but also all aspects of their relationship. In these cases, the sexual disturbance is just one facet of a very disturbed marriage.
- Physical defects : sometimes the failure to achieve intercourse may be due to an actual physical problem that prevents intercourse. The woman may have dyspareunia due to a local inflammatory pathology. Rarely, the hymen may be very tough and would need dilatation. Similarly, a man may have phimosis or severe penile curvature that makes penetration painful or difficult. Sometimes a man may have a congenital defect in the penile arteries or the veno-occlusive mechanism, resulting in inadequate erections. These men appear normal externally and only a detailed evaluation will reveal that the problem is a physical one.
- Social factors : Family pressures, lack of privacy, job stress, can sometimes generate so much stress within a marriage that sexual intimacy is not possible.
Treatment
It is very important that therapy be initiated as soon as possible. We often have couples coming to us only after one or two years have elapsed because when they went to their doctor initially they were told to wait and be patient and "things will work out". By the time they come to us there is so much frustration and hostility that therapy becomes very difficult. Hence, it is very important not to waste time and the couple should be referred for therapy as soon as possible. Non-consummation of the marriage should be treated as a semi-emergency.
In many cases all that is required is basic sex counseling to correct misconceptions, allay fears, and teach the right techniques. When fear is the main problem, then, in addition to counseling the woman must be taught vaginal self-dilatation : when she realizes that even a large diameter dilator can be accommodated in the vagina without pain, her fear of penetration diminishes and she allows intercourse. Vaginal self-dilatation will also work in women with a tough hymen - surgical hymenectomy is usually not required.
Often, social counseling is also required to correct excessive interference by the in-laws, create privacy, minimize stress and improve interpersonal communication between husband and wife.
When the man’s performance anxiety is very severe, counseling alone is often inadequate. These men need temporary medical support (sildenafil or intra-penile injections) to obtain adequate erections; once they succeed in having intercourse a few times with the help of the medicine, they gain confidence and are soon able to get a full erection naturally and have intercourse without the help of any medication.
If a man has a physical defect then surgical correction is required. This may involve circumcision, correction of penile curvature, penile revascularization to bring more blood into the penis, or, in severe cases, implantation of a penile prosthesis.
While almost any kind of physical defect can be corrected, deep-rooted psychopathology is often extremely difficult to treat, and these are the cases that frequently fail.
CONCLUSION
Failure to consummate a marriage is a fairly common problem in our society. Most cases can be successfully treated if therapy is instituted early. Hence, physicians must be aware of this problem, should be alert about detecting it, and should be prompt in referring such couples for therapy. By doing so they will save many marriages and bring joy into the lives of many young men and women.
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