According to the International Society for Sexual Medicine (ISSM), unconsummated marriage (UCM) is the inability of a heterosexual couple to engage in penovaginal sexual intercourse. It can result from factors affecting one or both partners and has implications for the couple’s well-being.

Physical and psychological factors, as well as sociocultural and religious contexts, contribute to UCM. The phenomenon is often observed in regions where premarital sex is considered taboo. Common causes of UCM are erectile dysfunction (ED) and vaginismus (a condition in which a person has overly tight muscles around their vagina, preventing penetration).

Due to the sensitive nature of UCM, many couples delay seeking treatment, which can lead to challenges in therapy and infertility being a possible consequence. Given the complex interplay of the contributing factors, psychological impacts, and unintended consequences of UCM, a new study aimed to systematically review the elements that contribute to the occurrence of UCM as well as its clinical management.

Researchers conducted a comprehensive search of multiple databases in June 2023 to find studies on UCM. They excluded any studies that took place before 1980. In the end, the investigators included 27 publications on UCM involving 1,638 males and 1,587 females in their review.

Most of the studies were case series from various countries, with no randomized controlled trials found. The average study quality was low-intermediate. Patients’ ages ranged from 17 to 75 years for males and 14 to 49 years for females.

Across these studies, the reported causes of UCM included vaginismus, ED, performance anxiety, premature ejaculation, and several other factors. Other elements that were identified were a lack of sex education and LGBTQ+ issues.

The management of UCM in these studies involved multiple approaches. Basic sex education, including understanding anatomy and copulation, was universally advised. A multidisciplinary approach with urologists, gynecologists, psychiatrists, and pelvic floor physiotherapists over the course of one month achieved a 97% consummation rate in 135 patients.

Medications for ED like sildenafil and tadalafil resulted in consummation rates of 84.6%-100%. On the other hand, vaginismus treatments included desensitization and vaginal dilators, achieving a 66.6%-100% success. Other interventions, such as penile plication and deinfibulation surgery, were successful in specific cases. The adverse effects of these treatments were generally minimal.

From their research, the authors discovered that ED and vaginismus are the most common causes of UCM. Consummation ceremonies have far-reaching historical and cultural significance, and UCM can lead to numerous consequences if untreated, including depression, anxiety, infertility, marital issues, and divorce.

Fortunately, the researchers highlighted successful treatments for UCM in their review, including oral medications and intracavernosal injections for ED, as well as vaginal dilation and behavioral therapies for vaginismus. Further research on UCM may help determine the most effective ways to address the issue early and avoid any negative consequences of the situation.

References:

• Krishnappa, P., Manfredi, C., Jayaramaiah, S., Ditonno, F., Matippa, P., Shah, R., & Moncada, I. (2024). Unconsummated marriage: A systematic review of etiological factors and clinical management. The Journal of Sexual Medicine, 21(1), 20–28. https://doi.org/10.1093/jsxmed/qdad146.